Comparing learning environments across rural and non-rural clinical teaching sites

Background Medical schools utilizing community-based medical education (CBME) models are responsible for providing students with learning environments that are respectful, intellectually stimulating, and professionally supportive across dozens, and sometimes hundreds, of clinical teaching sites in rural and urban communities. The University of Washington School of Medicine’s (UWSOM) CBME model is one of the oldest and largest, spanning across Washington, Wyoming, Alaska, Montana and Idaho. This descriptive study compared the treatment of students between rural and non-rural clerkship preceptors. Methods This study utilized Medical Student of Educator Evaluation (MSEE) data from 1,101 students who completed required clinical rotations in family medicine, pediatrics, internal medicine, surgery, psychiatry, and obstetrics/gynecology from 2019 to 2023. The analysis focused on two key evaluation questions regarding the clinical learning environment: Likert scale respect scores of preceptors and reports of negative behaviors by preceptors toward students. The results were compared between preceptors at rural and non-rural teaching sites. All evaluations were anonymized and aggregated to protect student identities. Results Across all clerkships, at both rural and non-rural sites, mean Likert respect scores were above 4.9 on a Likert Scale of 5. Similarly, less than 1% of students in both rural and non-rural sites reported negative behavior directed toward them. “Public embarrassment” was the most frequently reported negative behavior in both settings. Conclusion This study suggests that CBME-based medical schools can provide supportive learning environments across rural and non-rural teaching sites. However, the infrequent occurrence of negative preceptor behavior underscores the importance of continued monitoring and timely intervention to safeguard students.