From prejudice to pride: how to prevent medical student relocation

Attracting and retaining physicians in rural and medically underserved areas is a global challenge. In France, undergraduate medical students must do their professional training in the region where they attend school. Many students from rural underserved areas register at distant schools, thereby precluding training in their region of origin. We hypothesised that the relocation of potential future physicians to regions outside the rural and underserved Centre-Val de Loire (CVDL) region exacerbates the lack of physicians in that region. This mixed-methods study with simultaneous quantitative and qualitative analyses focused on medical students from the rural county of Indre (in CVDL). The quantitative analysis assessed the number of Indre students at three medical faculties (one in CVDL, and two in a nearby region) during the academic years 2014-2017, and compared their passing rates with those of their peers. The qualitative analysis investigated factors that may hinder or facilitate choice of faculty, using in-person and telephone student interviews from academic year 2017-2018. From academic years 2014-2017, 296 students from Indre registered for the first-year examination, with significantly fewer enrolled at the medical faculty of Tours (in CVDL) than at the other two faculties combined (2.0% v 6.8%; p<0.01). First-year pass rates for all faculties combined were similar for Indre students compared to all students (15.5% v 16.1%; p=0.84). Most of the 22 students interviewed knew that they would have to relocate for school. Key determining factors in their choice of faculty included a nearby support network of family and friends, prior impressions of the city, and school reputation as shared with them by others. Students from the rural county of Indre were as successful as their peers in their first year of medical school, yet were convinced of the opposite. For the confidence to apply and the community assistance to succeed, students need both reliable information, preferably from undergraduates to whom they feel close, and logistical and moral support. Medical schools can work to build community, in order to attract students and help them succeed in their studies.