Medical education for African American communities in the rural South: A focus group approach to identify fundamental considerations.

PURPOSE: We sought to understand concerns fundamental to planning medical education specific to rural southern African Americans who are virtually nonexistent in American medical schools. METHODS: A diverse multidisciplinary research team conducted this qualitative study with 3 focus groups, including 17 rural medical educators recruited nationwide, 10 African American alumni of a rural medical education pipeline in Alabama, and 5 community and institutional associates of this pipeline. Analysis of recorded transcripts generated themes fitting an ecological model suggesting concerns and intervention foci at individual, community, and institutional levels. FINDINGS: Three major themes operating at all ecological levels were: (1) How "rural minority student" is defined, with "rural" often supplanting race to indicate minority status; (2) Multiple factors relate to rural racial minority student recruitment and success, including personal relationships with peers, mentors, and role models and supportive institutional policies and culturally competent faculty; and (3) Challenges to recruitment and retention of rural minority students, especially financial concerns and preparation for medical education. CONCLUSIONS: Our findings suggest that individuals, communities, and institutions provide intervention points for planning medical education specific to southern rural African Americans. These spheres of influence project a need for partnership among communities and rural medical educators to affect broad programmatic and policy changes that address the dire shortage of rural African American health professionals to help ameliorate health inequities experienced in their home communities. It is likely that linear thinking and programming will be replaced by integrated, intertwined conceptualizations to reach this goal.

Participatory research and service-learning among farmers, health professional students, and experts: an agromedicine approach to farm safety and health.

Agromedicine developments in Alabama rest heavily on the interest and support of the farm community. Participatory approaches have been advocated in order to impact the safety and health of farms. The University of Alabama Agromedicine Research Team, working closely with and guided by farmers, places emphasis on identifying areas of farmer concern related to agricultural health and safety and on developing jointly with the farmers plans to address their concerns. Agricultural extension agents were key to developing the trust relationships among farmers, health professionals, and extension personnel required for these successful agricultural safety and health developments. In this article the authors describe how the research team engaged farmers in participatory research to develop service learning activities for graduate students studying Agricultural Safety and Health at The University of Alabama. Accepting farmers' active role in research processes creates an environment that is favorable to change, while providing farmers reassurance that their health and safety is of utmost importance to the researchers.

The rural medical scholars program study: data to inform rural health policy.

INTRODUCTION: medical education to produce rural physicians hinges on the characteristics of students, educational programs, and rural experiences. Family physicians are key components of rural medicine. This study tested the effectiveness of multiple, combined strategies of the Rural Medical Scholars Program to produce family medicine residents. METHODS: we compared the relative effectiveness of the Rural Medical Scholars Program, family medicine-oriented branch campuses, and a traditional urban campus to produce family medicine residents using a prospective quasi-experimental design. Logistic regression was used to account for covariates. RESULTS: the relative effectiveness of 3 educational modalities to produce family medicine residents was examined: Rural Medical Scholars Program (44.0%; odds ratio [OR], 15.6), family medicine-oriented branch campuses (18.9%; OR, 5.8), and a traditional urban campus (3.9%; OR, 1). These differences were significant (P < .05) after controlling for sex, race, Medical College Admission Test scores, and graduation rate. CONCLUSIONS: the findings are consistent with the literature, which recommends multiple strategy interventions to produce rural physicians (e.g., admit rural students who have an interest in family medicine, use family medicine faculty, and provide rural experiences). Further study will determine whether rural practice follows training in family medicine among Rural Medical Scholars.