The Rural Integrated Community Clerkship: a vital stretch in the Alberta rural physician workforce pipeline




Background: Longitudinal integrated clerkships are thought to operate synergistically with factors such as rural background and practice intent to determine medical graduates’ practice types and locations—sometimes known as the pipeline effect. We examined the influence of the rural integrated community clerkship (ICC) at the University of Alberta on students choosing family medicine and rural practice.

Methods: We completed a retrospective cohort analysis of graduates from 2009 - 2016. The cohort was cross-referenced by background, type of clerkship, practice type and practice location. We used χ2 analyses and risk ratios to measure the relative likelihood that ICC students would ultimately settle on rural practice and/or family medicine.

Results: ICC participation had more influence than rural background on students’ choice of rural and/or family practice, and both factors were synergistic. Rotation-based clerkship students were least likely to enter family medicine or rural practice.

Conclusions: The ICC is a clerkship model that influences students to become rural and/or family physicians, regardless of their rural/urban origins. The ICC diverts rural-interested students into rural practice and protects rural-origin students from ending up in urban practice. Expanding ICC infrastructure, including sustaining the rural physician workforce, will benefit rural Alberta communities by increasing the numbers of UA graduates in rural practice.


Metrics Loading ...

Author Biographies

Darren Nichols, University of Alberta

Associate Professor, Department of Family Medicine

James Cockell, University of Alberta

Research Assistant, Office of Rural & Regional Health

Daniel Lemoine, University of Alberta

Research Assistant, Office of Rural & Regional Health

Jill Konkin, University of Alberta

Acting Coordinator, Rural Integrated Community Clerkship

Professor, Family Medicine

Faculty of Medicine & Dentistry, University of Alberta


Worley P, Couper I, Strasser R, Graves L, Cummings B-A, Woodman R, et al. A typology of longitudinal integrated clerkships. Med Educ. 2016;50(9):922–32. DOI:

World Health Organization. Increasing access to health workers in remote and rural areas through improved retention: global policy recommendations. Geneva: Author; 2010.

Brooks KD, Eley DS, Zink T. Profiles of rural longitudinal integrated clerkship students: a descriptive study of six consecutive student cohorts. Med Teach. 2014;36(2):148–54. DOI:

Henry JA, Edwards BJ, Crotty B. Why do medical graduates choose rural careers? Rural Remote Health. 2009;9(1):1083. DOI:

Mitra G, Gowans M, Wright B, Brenneis F, Scott I. Predictors of rural family medicine practice in Canada. Can Fam Physician. 2018;64(8):588–96.

Rabinowitz HK, Diamond JJ, Markham FW, Santana AJ. The relationship between entering medical students’ backgrounds and career plans and their rural practice outcomes three decades later. Acad Med. 2012;87(4):493–7. DOI:

Greenhill JA, Walker J, Playford D. Outcomes of Australian rural clinical schools: a decade of success building the rural medical workforce through the education and training continuum. Rural Remote Health. 2015;15(3):2991. DOI:

Kwong JC, Dhalla IA, Streiner DL, Baddour RE, Waddell AE, Johnson IL. A comparison of Canadian medical students from rural and non-rural backgrounds. Can J Rural Med. 2005 Winter;10(1):36–42

Rourke J, Dewar D, Harris K, Hutten-Czapski P, Johnston M, Klassen D, et al. Strategies to increase the enrollment of students of rural origin in medical school: recommendations from the Society of Rural Physicians of Canada. Can Med Assoc J. 2005;172(1):62–5. DOI:

Campbell DG, McGrail MR, O’Sullivan B, Russell DJ. Outcomes of a 1-year longitudinal integrated medical clerkship in small rural Victorian communities. Rural Remote Health. 2019;19(2):4987. DOI:

Fuller L, Beattie J, Versace V. Graduate rural work outcomes of the first 8 years of a medical school: What can we learn about student selection and clinical school training pathways? Aust J Rural Health. 2021;29(2):181–90. DOI:

Rourke J, Asghari S, Hurley O, Ravalia M, Jong M, Graham W, et al. Does rural generalist focused medical school and family medicine training make a difference? Memorial University of Newfoundland outcomes. Rural Remote Health. 2018;18(1):4426. DOI:

Eley DS, Cloninger CR, Power DV, Brooks KD. The personalities of most medical students are suited to rural practice: Implications for rural education program recruitment. Med Teach. 2019;41(10):1160–7. DOI:

Kwan MMS, Kondalsamy-Chennakesavan S, Ranmuthugala G, Toombs MR, Nicholson GC. The rural pipeline to longer-term rural practice: General practitioners and specialists. PLoS One. 2017;12(7):e0180394. DOI:

Eley DS, Brooks KD, Zink T, Cloninger CR. Personality profiles of rural longitudinal integrated clerkship students who choose family medicine. Fam Med. 2015;47(3):194–203.




How to Cite

Nichols D, Cockell J, Lemoine D, Konkin J. The Rural Integrated Community Clerkship: a vital stretch in the Alberta rural physician workforce pipeline . Can. Med. Ed. J [Internet]. 2023 Jul. 27 [cited 2024 May 28];14(5):59-63. Available from:



Brief Reports