3 rd Year MD and PA Students from Rural Training Programs Describe their Interactions between Rural Setting and Clinical Training Experiences using PhotoVoice Carrie A. Roseamelia, MA; Emily M. Mader, MPH MPP; Sheila Singleton-Best, BS RPA-C; Melissa E. Arthur, PhD MA MSW; Sarah L. Lewis, MS; Lauren J. Germain, PhD   How does the alternative training setting impact student learning?   How does rural training change students’ perspectives of medicine and future practice?   How does the alternative training setting impact student learning?   How does rural training change students’ perspectives of medicine and future practice? SUNY Upstate hosts two training programs that place students in rural locations:   College of Medicine Rural Medical Education Program (RMED)   College of Health Professions Physician Assistant Studies Program (PA) SUNY Upstate hosts two training programs that place students in rural locations:   College of Medicine Rural Medical Education Program (RMED)   College of Health Professions Physician Assistant Studies Program (PA) Participants Students from the 2014 RMED and PA program cohorts Design Qualitative exploratory study using PhotoVoice PhotoVoice Data Collection and Analysis   PhotoVoice is a form of participatory action research Participants represent their lived experiences through their own lenses   Participants asked to take photos that answer the question, “How does participating in a rural training program change your perspective of medicine or future practice?” All photos accompanied by vignettes   Research team reviewed and coded photos and vignettes for themes   Students attended focus groups Discussed photos and vignettes Provided feedback for research team thematic analysis Participants Students from the 2014 RMED and PA program cohorts Design Qualitative exploratory study using PhotoVoice PhotoVoice Data Collection and Analysis   PhotoVoice is a form of participatory action research Participants represent their lived experiences through their own lenses   Participants asked to take photos that answer the question, “How does participating in a rural training program change your perspective of medicine or future practice?” All photos accompanied by vignettes   Research team reviewed and coded photos and vignettes for themes   Students attended focus groups Discussed photos and vignettes Provided feedback for research team thematic analysis BACKGROUNDBACKGROUND PROBLEMPROBLEM METHODSMETHODS Two Overarching Themes 1. 1.The rural learning environment extended beyond clinical training a) a)Community connections both within and outside clinical setting afforded more hands-on training opportunities and continuity of care b) b)The rural lifestyle allowed students more time for reflection on their training experiences c) c)Exposed students to sociopolitical realities of access to and management of care 2. 2.Rural culture influenced patient care and communication a) a)Illnesses and injuries often directly related to rural work and lifestyle b) b)Patient demographics influenced how they were trained to practice medicine c) c)Students felt they were acknowledged and respected to a higher degree among rural patients and physicians Two Overarching Themes 1. 1.The rural learning environment extended beyond clinical training a) a)Community connections both within and outside clinical setting afforded more hands-on training opportunities and continuity of care b) b)The rural lifestyle allowed students more time for reflection on their training experiences c) c)Exposed students to sociopolitical realities of access to and management of care 2. 2.Rural culture influenced patient care and communication a) a)Illnesses and injuries often directly related to rural work and lifestyle b) b)Patient demographics influenced how they were trained to practice medicine c) c)Students felt they were acknowledged and respected to a higher degree among rural patients and physicians RESULTSRESULTS “Full view of the portable telemedicine system. It is hard to recruit specialists to move to a smaller town to begin with, but then to have them help patients in the surrounding smaller towns is very difficult. This allowed specialists to see patients in these surrounding communities without taking two hours each day just to drive there and back.” – PA student “The town plows could not keep up with the brutal winter. It became a daily occurrence for farmers…to plow my road. I, and many of my colleagues, would not have made it to the hospital some mornings if it weren’t for the people in our community. Medicine is largely a team effort, and in a small community, everyone plays a part.” – PA student “Farm life involves a close relationship between farmers and animals. An understanding of potential infections, illnesses, and injuries that can result from this close interaction is important in rural medicine.” – RMED student “I am part of a team at my rural site. Being treated as an equal has profoundly affected my perspective of medicine…because of my experience in a rural site with such welcoming physicians and staff, I have learned it is very humanistic and includes a great deal of social work, cultural awareness, off-label treatments, and pearls only learned with experience.” – PA student   Rural medical training programs provide space for reflection on what students are learning and doing   Students’ connections with community providers prepare them for challenges inherent to providing health care today, including the extraordinary need for teamwork   Rural medical training programs provide space for reflection on what students are learning and doing   Students’ connections with community providers prepare them for challenges inherent to providing health care today, including the extraordinary need for teamwork IMPLICATIONSIMPLICATIONS