Evidence-based Reform of Rural Medical Education

Literature Review and Political Application

Abstract

Concentration of physicians in urban areas and the shortage of them in rural places has long been a social problem. Political interventions to medical education system play an important role in redressing the disparate distribution. Educationrelated factors that influence physician's choice of rural practice have been evaluated by many studies. In this paper we review past literature and propose a policy-led reform of medical education as a solution to the maldistribution of physicians. Rural background, primary care related generalist specialties, educational experience in rural physician production programs, and early career exposure to rural practice are known to increase the probability of physicians to work in rural areas. In addition, undergraduate exposure to rural practice, scholarship in exchange for postgraduate rural service, and setting medical school campuses in rural areas are suggested to facilitate physician's choice of rural practice. In Japan the foundation of Jichi Medical University in 1972 and expansion of rural quota in medical schools accelerated since 2008 are two major policies that aim to increase rural physicians. Recently further political interventions, i. e. undergraduate rural clinical clerkship and postgraduate rural clinical training, were implemented. However, there is a substantial variation in size and content among rural quotas of medical schools, and much room for improvement in admission system and undergraduate rural education in medical schools and postgraduate rural training. A further reform of medical education based on the scientific evidence is needed for an effective and efficient solution to this problem.