The effect of preceptorship rurality on students' self-perceived clinical competency

Objective: This study's objective was to determine whether students' learning experiences, as measured by the improvement in students' perceived competence in several clinical areas, varied by the preceptorship county's rurality. Methods: Rural preceptorship experiences from 1990 to 2003 were assessed using pre- and post-preceptorship questionnaires regarding students' perceived levels of competence. Questionnaires addressed basic clinical skills, common diagnoses, and advanced clinical skills. Rurality was measured both as population density and using the Rural-Urban Continuum (RUC) codes. Results: Primary analysis was completed using 1,037 sets of questionnaires; 231 questionnaires were unsuitable for analysis due to missing information. Mean perceived competency improved for all items. Students in rural locations, regardless of operationalization, had no statistically significant differences from students in urban locations in perceptions of their clinical skill or comfort with basic diagnoses. Individual item analyses revealed a gendered pattern. Women improved more than men on the technical skills; men improved more on women's health and psychosocial items. Conclusions: There were no differences in medical students' perceived competence based on the rurality of their family medicine preceptorship site. The preceptorship experience provides both women and men with a variety of experiences that lead to increased confidence in areas where they were least confident prior to the preceptorship.