Kenan Primary Care Medical Scholars Program

Adequate staffing of primary care physicians in rural communities is a national dilemma—one that we are also confronting in North Carolina—and this shortage is a serious barrier to health care. While North Carolina has slowly increased its overall supply of physicians, these increases are not seen in underserved rural counties. North Carolina retains about 40% of medical students educated in the state, but only 2% go into primary care in North Carolina's underserved rural counties [1].

Rural track models in medical education programs have shown an increase in the supply of primary care physicians in rural practice [2, 3]. National and state data support the use of a similar type of rural medical education program in North Carolina. In 2013, the William R. Kenan, Jr. Charitable Trust—along with the University of North Carolina at Chapel Hill School of Medicine (UNC SOM) and the Mountain Area Health Education Center (MAHEC) in Asheville—collaborated to create the Kenan Primary Care Medical Scholars Program.

The Kenan program seeks to increase the number of UNC SOM students seeking rural health careers in North Carolina, while providing enrichment experiences and financial support to sustain their decision to choose a rural primary care specialty. Students are identified during their 1st year of medical school and are encouraged to apply to the program, which includes the opportunity to participate in a 6-week summer internship in rural Western North Carolina. Selected rural scholars are located at various clinical sites and matched with a rural physician who specializes in a primary care discipline (family medicine, obstetrics/gynecology, pediatrics, internal medicine, or general surgery). Scholars spend time participating in hands-on patient care activities as well as local community health events.

During the summer internship program, scholars participate in weekly group enrichment sessions at MAHEC that allow them to gain additional knowledge about rural health care. Topics for these weekly enrichment sessions include Appalachian culture, integrative/alternative medicine, and wilderness medicine. Scholars are also required to work on a community project that will directly help their host clinic. Previous projects have included creating patient educational materials, assisting with a community's first health fair, and improving practice systems that encourage patient well-being.

Once scholars complete their summer internships, they continue to participate in monthly educational talks and group sessions in Chapel Hill for the remainder of their 2nd year of medical school. Speakers for the 2nd-year meetings are UNC SOM faculty members and community members from organizations related to rural health. Topics of discussion include community health centers, rural workforce issues, medical ethics, and research. Upon completion of their 2nd year, students in this program are automatically accepted into the program at UNC SOM's Asheville campus, which collaborates with MAHEC and Mission Health System. The Asheville campus program is based on the longitudinal integrated clerkship (LIC) model and is currently in its 7th year of operation. This regional campus of UNC SOM boasts high exam scores, an amazing breadth of clinical experiences, and high student satisfaction.

In addition to offering enrichment activities and financial support, the Kenan program offers students the opportunity to interact with fellow learners, including residents, medical students, and high school students. This interaction assists the region in recruiting and retaining individuals interested in practicing rural medicine by creating a pipeline of learners who can offer continued support and mentoring throughout a learner's educational journey. Students selected for the Kenan program are from all over the country, although a large majority come from North Carolina. They also represent various interests, including migrant health, population health, telehealth, leadership development, global health, and community outreach. Students have been featured in several publications highlighting the program's importance to Western North Carolina.

The success of the 1st year of the Kenan program prompted its expansion to include scholars interested in serving underserved urban populations. The urban experience provides students with an opportunity to participate in a 6-week summer internship program in Charlotte, with leadership provided by faculty at the UNC SOM Charlotte campus (another regional campus that operates with blended LIC and traditional block curriculum models). Through this unique program, the Kenan urban-focused cohort of students has had the chance to create lasting relationships with their peers, their urban preceptors, and the Charlotte community.

Addressing North Carolina's physician shortage will take the continuation of programming focused on medical student recruitment to underserved areas. The cohort relationship these students encounter through this program will be a key factor in its success. As the 1st group of Kenan rural scholars prepares to graduate in 2016 and enter residency, we are confident they will match in North Carolina–based residencies in family medicine, obstetrics/gynecology, and psychiatry, and that they will ultimately practice in underserved areas in North Carolina.

• ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.