Is there equivalency between students in a longitudinal, rural clerkship and a traditional urban-based program?

BACKGROUND Demonstrating the equivalency between the traditional metro-based clerkships within close proximity to the academic health center and the nontraditional rural preceptorships is important. The University of Minnesota has had a 9-month longitudinal rural elective for third-year medical students for 40 years, the Rural Physician Associate Program (RPAP). In the metro area, traditional students rotate through clerkships of 4 to 8 weeks in length. Both cohorts of students are evaluated in similar ways. METHODS We analyzed the test scores and demographic data for two cohorts of students: RPAP (n=201) and traditional (n=1,129) who graduated between 2004 and 2009. Tests included pre-medical school data (Medical College Admission Tests, college grade point averages) as well as National Board of Medical Examiners subject examinations (shelf), US Medical Licensing Examination Step One and Two (Clinical Knowledge and Clinical Skills), and an Objective Structured Clinical Examination (OSCE). Scores were analyzed using descriptive/comparative statistics for the two groups of students. RESULTS For the most part, RPAP students performed similarly to students in the traditional metro-based curriculum on the standard educational outcome metrics. On the obstetrics shelf, while a similar proportion of the RPAP students passed, they scored statistically significantly lower (traditional: median 72 (range 50-98) versus RPAP: 71 (51-89). DISCUSSION This study is the largest cohort demonstrating equivalency between students taking a rural longitudinal clerkship and their metro-trained colleagues.