Hawai'i Rural Health Program: Shaping the Next Generation of Rural Doctors

Introduction: The State of Hawai‘i has an estimated 29% physician shortage.1 This deficit is particularly glaring in Hawai‘i’s rural communities which have shortages of 33-53%.1 Multiple studies have validated that health care providers from rural areas are more likely to practice in rural communities.2 3 Literature also suggests that rural medical training programs may improve physician recruitment. John A Burns School of Medicine (JABSOM) students can gain exposure in rural health care via the Hawaiʻi Rural Health Program (HRHP) which has been providing first-year medical students with opportunities to experience medical practice in rural Hawaiʻi communities since 2011. The main goal of the program is to encourage students to return to these rural communities in the future as practicing physicians.

Objectives: The goal of this abstract is to describe JABSOM’s HRHP and share the insights from students who completed the program.

Methods: HRHP sends two groups of six students to rural towns on Hawaiʻi Island for a 12-week block during their first year of medical school. The program covers the costs of living and transportation. Students participate in the same educational activities as their counterparts on Oʻahu, including problem-based learning (PBL), clinical shadowing, and community engagement, all in a unique rural setting. Each group on Hawaiʻi Island is paired with a local physician to serve as a tutor during their bi-weekly PBL sessions. Students also shadow local physicians and engage with the community by participating in local health events, mentoring elementary and high school students, and exploring the natural beauty of the island. Final exam grades from 2015 to 2019 were compared between HRHP and non-HRHP JABSOM students to ensure that the new model did not affect their academic performance. In 2019, surveys were sent to the 12 students once they completed their time on Hawaiʻi Island.

Results: To date 97 students have participated in HRHP, 29 of whom have completed residency training. Six of the 29 (21%) are working in rural communities. Five of the six are working Hawaiʻi and one is working in rural California. From 2015 to 2019, there were no statistical differences between the end-course exam scores for HRHP students vs. non-HRHP students, showing it does not compromise their academic education. Reflections were collected from 10 students of the 2019 cohort, all highlighting themes of community involvement, mentorship, empathy, and advocacy.

Discussion: Programs like HRHP are vital to educating physicians who will practice in rural communities. It is promising that 21% of former HRHP students currently practice in rural communities. The literature shows that 11% of JABSOM graduates3 and 11% of the medical students nationally1 go on to practice in rural communities. Our data also supports that HRHP students performed as well as non-HRHP students on medical school examinations. The addition of student reflections helped to illustrate the value this program offers beyond the promising d