Appalachian Preceptorship Program
- Need: To prepare future physicians for practicing in rural southern Appalachia.
- Intervention: The Appalachian Preceptorship Program offers medical students clinical preceptorships to give them experience practicing in rural, underserved communities of southern Appalachia.
- Results: Students who participate in this preceptorship are more than 3 times as likely to practice medicine in a rural location.
Evidence-levelEffective (About evidence-level criteria)
Approximately 20% of Americans live in rural settings, but merely 11% of American physicians reside in those rural communities. In an effort to combat this shortage, the Appalachian Preceptorship Program was created in 1984 by the Department of Family Medicine at East Tennessee State University James H. Quillen College of Medicine (ETSU). The 4-week, summer program gives medical students cross-cultural experience in rural primary care by observing a physician practicing in a rural southern Appalachian community.
The experience counts for ambulatory or family medicine credit, or as a senior elective.
Students' living expenses have been covered by the HRSA Title VII, Predoctoral Educational Grant. During the years when this was not available, the program has received support from numerous primary care associations and preceptors.
Prior to the 3 weeks with their assigned rural physician, students will spend 1 week at educational sessions at ETSU. Lectures focus on:
- Appalachian history and economics
- Rural health issues
- Alternative health systems
- Patient-centered interviewing
Preceptors serve as role models for the students, taking part in panel discussions and lead field trips to introduce students to various healthcare practices and cultural experiences in the area. Recreational activities such as hiking, boating, biking, and white water rafting are planned for the students to take part in as well.
Follow-up efforts with the 157 students who participated in the Appalachian Preceptorship over an 18-year period before 2004 showed the following:
- 82% chose residencies in primary care
- 60% entered into family medicine
- 56% of their practice settings held numerous underserved or rural designations
- In comparison to the national average, medical students involved in the program were 3 times more likely to end up practicing in a rural location
- The program has helped transform a legislative mandate to build up rural-serving physicians, leading to more extensive programs and increased recognition of ETSU's rural focus
For more detailed program results:
- Journal article: Lang, F., Ferguson, K., Bennard, B., Zahorik, P., & Sliger, C. (2005). The Appalachian Preceptorship: Over Two Decades of an Integrated Clinical–Classroom Experience of Rural Medicine and Appalachian Culture. Academic Medicine, 80(8), 717-723. Article Abstract.
- Online article: Keeping It Real: Preceptorship Exposes Students to Importance of Rural Family Medicine, the Appalachian Preceptorship Program's impact from the perspective of Reid Blackwelder, M.D. and President of the American Academy of Family Physicians.
Challenges faced by this program include:
- Housing arrangements — In these small, often poverty-stricken rural communities, lining up housing for students can be very difficult.
- Scheduling conflicts between students and practitioners — For instance, many practitioners take vacation days in July, which is when many students have the greatest availability to partake in the program.
- Transportation — If a student does not have a personal mode of transportation, traveling to remote areas is extremely difficult.
This preceptorship counts as credit for a required ambulatory rotation, family medicine rotation, or a senior elective. Students who have completed at least 1 year of medical school are eligible to apply.
The annual budget for this program is approximately $17,500.
- $3,500 covers the cost for brochures, postage, speakers, field trips, food, and entertainment
- $1,120 stipend per student covers housing and living expenses and is usually supported through extramural grants
Health workforce education and training
September 26, 2014
Date updated or reviewed
October 9, 2018
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.