Barriers and Facilitators to Providing Rural Clinical Training for Health Professions Students and Residents

Research center:
Lead researcher:
Project funded:
September 2023
Anticipated completion date:
August 2024

Competition for scarce rural clinical training sites is the top barrier preventing nurse practitioner (NP) and physician assistant (PA) education programs from providing rural training to their students. Medical schools and residencies also struggle to find and develop preceptors and teaching sites. Meanwhile, the demand for rural training is increasing as the number of health professions schools and students expands, including those with a rural orientation.

Other barriers to rural clinical training include funding for internships, student difficulties traveling to rural sites and affording living expenses, lack of rural housing for students, and lack of available and willing rural preceptors. Anecdotally, educators also report that health system consolidation increasingly means that the decision to precept is made at a distant corporate site rather than locally, as rural facilities merge into larger health systems. Community-based sites for clinical training hold potential, but smaller and more rural sites may lack the resources and capacity to accept students and provide effective training.

Factors that are important for enabling health professions education in rural communities include adequate patient volumes and demographic characteristics to support learning about a variety of patients and conditions, funding to attract and develop faculty clinical preceptors, broadband internet access, and availability of student housing. The COVID-19 pandemic resulted in the adoption of distance learning modalities for clinical education that have the potential to support more rural training, but virtual learning strategies cannot substitute for all in-person learning.

This combination of challenges and necessary ingredients for successful rural clinical training calls for new models to encourage collaboration between and across disciplines, particularly models that support interprofessional training. This study seeks to understand trends in teaching among family physicians as well as barriers and facilitators to rural training collaborations by answering these questions:

  1. To what extent do rural vs. urban family physicians participate in teaching students, which types of students, and how has participation in teaching changed over time?
  2. What family physician background, practice, and community factors are associated with teaching?
  3. What are the barriers to establishing and maintaining rural training sites for a variety of health professions students (physicians, NPs, PAs, psychologists, pharmacists, and others)?
  4. What are potential solutions that can facilitate establishing and sustaining rural clinical training collaborations that benefit all health professions students?