Need: An increased interest among young people to pursue a medical career in rural North Carolina
Intervention: Two medical students started a program that gives high school seniors medical academic training, mentor relationships, and hands-on experience in rural North Carolina facilities.
Results: Project PROMISE has graduated 36 high school students, 16 of whom are pursuing an undergraduate degree with an interest in studying medicine. Two students were recently accepted into medical school.
Rural counties in North Carolina are suffering from a
persistent shortage of healthcare providers. Studies
have shown that medical students with rural backgrounds
are more likely than their peers to return to rural
areas, and yet schools of health professions continue to
have low enrollments of students from these regions.
As a result, two UNC
School of Medicine students started Project PROMISE
(Providing Rural Opportunities in Medicine through
Inspiring Service and Education). Based in Spruce Pine,
North Carolina, the educational and experiential pipeline
program was intended to pique the interest of high school
students not only in pursuing a career in medicine, but
also in returning to practice in rural North Carolina.
Through an application and interview process, Project
PROMISE selects up to 6 high school seniors who have an
authentic interest in healthcare. Participating students
are from Mitchell
High School, McDowell High
Heritage High School, and Madison High
School. Each student completes a semester-long course
that includes weekly sessions taught by medical students,
rotations in healthcare facilities throughout Mitchell,
Yancey, and McDowell Counties, and several health-related
service projects. Through these elements, Project PROMISE
provides their students with more than 135 credit hours
and exposure to the following healthcare professions:
dentistry, anesthesiology, obstetrics and gynecology,
pediatrics, palliative care, family medicine, public
health, geriatrics, pharmacotherapy, internal medicine,
Project PROMISE was initially pitched to the Albert
Schweitzer Foundation who accepted the program
founders into their year-long healthcare leadership and
community-engagement fellowship. The Foundation helped
with strategic planning and initial costs for the launch
of Project PROMISE. Funding is now solely supported by
MAHEC and state-appropriated money for the Rural Health
Project PROMISE launched in the Fall of 2014 with their
first group of students. Since then, several aspects have
changed to further embed the program into the local
communities and give the students hands-on training. The
program now includes the following main components:
Rotations – Rural medical facilities host students 4
days a week for several hours each day. The regular
rotations give students an opportunity to learn
first-hand from medical preceptors within a rural
Health-Related Service Projects – Students coordinate
efforts such as pet therapy, peer-to-peer presentations,
and Meals on Wheels in order to "give back" to their
towns. Such initiatives are meant to foster professional
connections and a sense of pride in their rural
Mentorship – UNC School of Medicine students serve as
mentors, regularly checking in with Project PROMISE's
students to discuss their rotations and answer questions.
MAHEC Electives – Students have
the option to attend Mountain Area Health Education
Center programs that are focused on academic enrichment,
college planning, service learning opportunities, and
oral and written communication skills.
Health Careers Academy – This program, added in 2023, is for rural students located in one of the 16 counties (excluding Buncombe) in MAHEC's catchment area. This experience is filled with virtual learning opportunities throughout the Spring semester, several hands-on experiences, and admission into MAHEC's health careers summer camp to tie everything together. The academy was designed to be competitive, and a prestigious accomplishment that students are proud to be a part of.
The Spring semester of 2023 marks the 10th semester of
Project PROMISE. Since the program's beginning, they have
seen the following results:
21 clinicians have participated as preceptors and
36 high school students have graduated from Project
Summer 2023 will be the third year that MAHEC has hosted a health careers summer camp opportunity for students in Western North Carolina. This camp is a three-day overnight camp that is packed with healthcare-related events and built to give students new knowledge and skills to add to their resume.
At the end of the first year, a survey was
distributed and exit interviews conducted with the
program's graduates. The outcomes were not as prominent
as the founders had initially hoped. More defined
measurables are being created to better track students'
progress and understanding of rural healthcare.
Although a benefit of the participating high schools
was their rural location, poor internet connection posed
a large problem.
The amount of work required and the necessity to
change several aspects of Project PROMISE led the
founders to put a hold on the program for the 2015 Fall
semester. They reopened the program for the 2016 Spring
Activities like sports, additional classes, and jobs
competed with the program for students' commitments. As
such, a focus group was conducted with rural providers
The following are words from the founders to those
interested in launching a similar program:
Capitalize on popular healthcare topics. Because
healthcare education and physician retention are
currently common discussion points, Project PROMISE has
caught the attention and assistance of funders, partners,
and medical professionals.
When you come from outside of a rural community, no
matter how good your intentions, there will always be
some skepticism. The degree of their welcoming your
program stands upon your understanding of their culture
and town politics, as well as the ability to execute your
Start small. During your first year, it may be all
you can do to "shield your flame" so that the fire
doesn't burn out. Continue on until you can find the
right funding and partnerships that can make your program
Be open to change and willing to alter your initial
plans to allow your program to become more sustainable.
Continue to invest in your program and retain those
who were once involved, including your medical school
mentors, rural preceptors, and creating opportunities for
your program's students to return as interns.
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.