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Rural Health Information Hub

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.


Effective (About evidence-level criteria)


In an effort to combat a rural physician 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. When this grant has not been available, the program has received support from numerous primary care associations and preceptors.

Students with farm animals - Appalachian Preceptorship Program

Services offered

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.


In 2019, 10 medical students and 3 pharmacy students were accepted into the program. Since its start, the Appalachian Preceptorship Program has graduated around 250 students and seen success in the following areas:

Appalachian Preceptorship Program
  • 75% of graduates have chosen residencies in primary care
  • 60% have entered into family medicine
  • 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:

  • 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.


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

Contact Information

Carolyn Sliger, Rural Programs Coordinator
Appalachian Preceptorship Program

Health workforce education and training

States served

Date added
September 26, 2014

Date updated or reviewed
December 17, 2019

Suggested citation: Rural Health Information Hub, 2019. Appalachian Preceptorship Program [online]. Rural Health Information Hub. Available at: [Accessed 13 August 2022]

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.