The Rural Integrated Community Clerkship: a vital stretch in the Alberta rural physician workforce pipeline.

Background: Longitudinal integrated clerkships are thought to operate synergistically with factors such as rural background and practice intent to determine medical graduates' practice types and locations-sometimes known as the pipeline effect. We examined the influence of the rural integrated community clerkship (ICC) at the University of Alberta on students choosing family medicine and rural practice. Methods: We completed a retrospective cohort analysis of graduates from 2009-2016. The cohort was cross-referenced by background, type of clerkship, practice type and practice location. We used χ2 analyses and risk ratios to measure the relative likelihood that ICC students would settle on rural practice and/or family medicine. Results: ICC participation had more influence than rural background on students' choice of rural and/or family practice, and both factors were synergistic. Rotation-based clerkship students were least likely to enter family medicine or rural practice. Conclusions: The ICC is a clerkship model that influences students to become rural and/or family physicians, regardless of their rural/urban origins. The ICC diverts rural-interested students into rural practice and protects rural-origin students from ending up in urban practice. Expanding ICC infrastructure, including sustaining the rural physician workforce, will benefit rural Alberta communities by increasing the numbers of UA graduates in rural practice.

Contexte: L'externat longitudinal intégré déterminerait, en synergie avec d'autres facteurs, notamment l'origine rurale et l'intention, le type de pratique et le lieu d'exercice des diplômés en médecine, un rapport appelé parfois « effet de pipeline ¼. Nous avons examiné dans quelle mesure l'externat communautaire intégré (ECI) en milieu rural à l'Université de l'Alberta incite les étudiants à choisir la médecine familiale ou l'exercice en milieu rural. Méthodes: Nous avons effectué une analyse de cohorte rétrospective des diplômés de 2009 à 2016. Les données sur la diplomation et celles sur l'origine, le type d'externat, la discipline et le lieu d'exercice ont été croisées. Nous avons utilisé le test du Chi-2 et le rapport de risques pour mesurer la probabilité relative que les étudiants qui ont fait l'ECI choisissent l'exercice en milieu rural et/ou la discipline de la médecine familiale. Résultats: Le fait d'avoir fait l'ECI a été un facteur plus déterminant que l'origine rurale quant au choix des étudiants d'exercer la médecine familiale ou de travailler en milieu rural, mais les deux facteurs étaient synergiques. Les étudiants ayant fait des stages rotatifs étaient les moins susceptibles d'opter pour la médecine familiale ou le milieu rural. Conclusions: L'ECC est un modèle d'externat qui incite les étudiants à se diriger vers la médecine familiale ou l'exercice en milieu rural, et ce, quelle que soit leur origine, rurale ou urbaine. Il amène ceux d'entre eux qui éprouvent déjà un intérêt pour l'exercice en milieu rural à concrétiser ce choix et ceux qui sont d'origine rurale à demeurer dans ce milieu pour y exercer leur profession. Le développement de l'infrastructure de l'ECC et le soutien que l'externat apporte à la main-d'œuvre médicale rurale profiteront aux collectivités rurales en dirigeant un plus grand nombre de diplômés de l'Université de l'Alberta vers l'exercice en milieu rural.

Crisis and continuity: Rural health care students respond to the COVID-19 outbreak.

The COVID-19 outbreak in Winter (2020) has caused widespread disruption for health sciences students undergoing clinical placements-vital periods of experiential learning that cannot be substituted with distance alternatives. For students placed in rural areas, already coping with isolation, precarious supply chains and shortages of essential personnel, the effects of the COVID-19 outbreak may have far-reaching implications for psychosocial wellness, self-efficacy and clinical judgment. Four nursing and eight medical students (n = 12) supplied photographs and commentary documenting the experience of withdrawing suddenly from clinical sites in rural Alberta. Collaborative, thematic analysis revealed continuities between pre- and post-outbreak life, both for the students and their rural hosts. Social determinants of health such as seclusion, environmental hazards, and health-seeking behaviors carried over and compounded the effects of the outbreak on the placement communities and clinical sites. Other continuities included the reliance on technology for clinical and social connectivity, and capitalizing on natural settings to cope with isolation and confinement. Prolonged liminality, lack of closure, and the loss of team identity were the greatest stressors brought on by the suspension of clinical activities. However, the participants felt well equipped to deal with these circumstances through the resilience, adaptability, and community ethos acquired during their placements.