How early clinical experiences in rural communities influence student learning about rural generalism considered through the lens of educational theory


  • Brian M Ross Northern Ontario School of Medicine University
  • Kirstie Taylor Northern Ontario School of Medicine University
  • Brenton Button University of Winnipeg
  • Frances Kilbertus Northern Ontario School of Medicine University
  • Erin Cameron Northern Ontario School of Medicine University



Introduction: Rural communities have poorer health compared to urban populations due partly to having lesser healthcare access. Rural placements during medical education can equip students with the knowledge and skills to work in rural communities, and, it is hoped, increase the supply of rural physicians. It is unclear how students gain knowledge of rural generalism during placements, and how this can be understood in terms of place-based and/or sociocultural educational theories. To gain insight into these questions we considered the experiences of pre-clerkship medical students who completed two mandatory four-week rural placements during their second year of medical school.

Methods: Data was collected using semi-structured interviews or focus groups, followed by thematic analysis of the interview transcripts.

Results: Rural placements allowed students to learn about rural generalism such as breadth of practice, and boundary issues. This occurred mainly by students interacting with rural physician faculty, with the effectiveness of precepting being key to students acquiring knowledge and skills and reporting a positive regard for the placement experience.

Discussion: Our data show the central role of generalist physician preceptors in how and what students learn while participating in rural placements. Sociocultural learning theory best explains student learning, while place-based education theory helps inform the curriculum. Effective training and preparation of preceptors is likely key to positive student placement experiences.


Metrics Loading ...


Braveman PA, Kumanyika S, Fielding J, et al. Health disparities and health equity: the issue is justice. Am J Public Health. 2011; 101(S1): S149-S155.

Silver JK, Bean AC, Slocum C et al. Physician workforce disparities and patient care: a narrative review. Health Equity. 2019; 3(1): 360-377.

Hartley, D. Rural health disparities, population health, and rural culture. Am J Public Health. 2004; 94(10): 1675-1678.

Weeks WB, Wallace AE., Wang S, Lee A, Kazis LE. Rural‐urban disparities in health‐related quality of life within disease categories of veterans. J Rural Health. 2006; 22(3): 204-211.

Marrone S. Understanding barriers to health care: a review of disparities in health care services among indigenous populations. Int J Circumpolar Health. 2007; 66(3): 188-198.

Singh GK, Siahpush M. Widening rural–urban disparities in life expectancy, US, 1969–2009. Am J Prev Med. 2014; 46(2): e19-e29.

Artiga S, Orgera K, Pham O. Disparities in health and health care: Five key questions and answers. Kaiser Family Foundation; 2020. [Accessed Apr 28, 2023].

Garasia S, Dobbs G. Socioeconomic determinants of health and access to health care in rural Canada. Univ Tor Med J. 2019; 96(2):44-46.

Ross BM, Daynard K, Greenwood D. Medicine for somewhere: the emergence of place in medical education. Educ Res Rev. 2014; 9(22): 1250-1265.

Boelen C. Coordinating medical education and health care systems: the power of the social accountability approach. Med Educ. 2018; 52(1): 96-102.

Boelen C, Woollard B. Social accountability and accreditation: a new frontier for educational institutions. Med Educ. 2009; 43(9): 887-894.

De Villiers M, Van Schalkwyk S, Blitz J, Couper I, Moodley K, Talib Z, Young T. Decentralised training for medical students: a scoping review. BMC Med Educ. 2017; 17(1): 1-13.

Jones MP, Bushnell JA, Humphreys JS. Are rural placements positively associated with rural intentions in medical graduates? Med Educ. 2014; 48(4): 405-416.

Fatima Y, Kazmi S, King S, Solomon S, Knight S. Positive placement experience and future rural practice intentions: findings from a repeated cross-sectional study. Journal Multidiscip Healthc. 2018; 11:645.

Ross BM, Cameron E, Greenwood D. A qualitative investigation of the experiences of students and preceptors taking part in remote and rural community experiential placements during early medical training. J Med Educ Curric Dev. 2019; 6: 2382120519859311.

Bingham A, O’Sullivan B, Couch D, Cresser S, McGrail M, Major L. How rural immersion training influences rural work orientation of medical students: theory building through realist evaluation. Med Teach. 2021; 43(12): 1-8.

Worley PS, Prideaux DJ, Strasser RP, Silagy CA, Magarey JA. Why we should teach undergraduate medical students in rural communities. Medical J Aust. 2000; 172(12), 615-617.

Barrett FA, Lipsky MS, Lutfiyya MN. The impact of rural training experiences on medical students: a critical review. Acad Med. 2011; 86(2): 259-263.

Birden HH, Wilson I. Rural placements are effective for teaching medicine in Australia: evaluation of a cohort of students studying in rural placements. Rural Remote Health. 2012; 12: 2167.

Sobel D. Place-based education: Connecting classroom and community. Nature Listening. 2004; 4(1): 1-7.

Gruenewald DA. The best of both worlds: a critical pedagogy of place. Educ Res. 2003; 32:3-12.

Shannon D, Galle J. Where we are: place, pedagogy, and the outer limits. In: Shannon D, Galle J, editors. Interdisciplinary approaches to pedagogy and place-based education. Cham: Palgrave MacMillan; 2017. p. 1-8.

Ross BM, Cervin C. Northern Ontario School of Medicine. Acad Med. 2020; 95(9S), S588-S591.

Mercer N, Howe C. Explaining the dialogic processes of teaching and learning: the value and potential of sociocultural theory. Learning Cult Soc Interact. 2012; 1(1), 12-21.

Vågan A. Towards a sociocultural perspective on identity formation in education. Mind Cult Act. 2011; 18(1), 43-57.

Hudson G, Hunt D. The Northern Ontario School of Medicine and social accountability. In: Tesson G, Hudson G, Strasser S, Hunt D, editors. The making of the Northern Ontario School of Medicine. A case study in the history of medical education. Montreal and Kingston, Canada: McGill-Queens University Press; 2009. p. 157-182.

Strasser R, Lanphear J, McCready W, Topps M, Hunt D, Matte M. Canada's new medical school: the Northern Ontario School of Medicine - social accountability through distributed community engaged learning. Acad Med. 2009; 84(10):1459-1456.

Ross BM, Cameron E, Greenwood D. Remote and rural placements occurring during early medical training as a multidimensional place-based medical education experience. Educ Res Rev. 2020; 15(3): 150-158.

Lichtman M. Qualitative research in education. A user’s guide. California, USA: Sage Publications Inc; 2006.

Braun V, Clarke V. Thematic analysis. In: Cooper H, editor. APA Handbook of Research Methods in Psychology: Vol. 2. Research designs. Washington, DC: American Psychological Association; 2012. p. 57-91.

Finlay L. ‘Rigour’, ‘ethical integrity’ or ‘artistry’? Reflexively reviewing criteria for evaluating qualitative research. Br J Occup Ther. 2016; 69(7):319-326.

Smith, B., & Sparkes, A. C. (2006). Narrative inquiry in psychology: Exploring the tensions within. Qual res psychol. 3(3), 169-192.

Stagg P, Prideaux D, Greenhill J, Sweet L. Are medical students influenced by preceptors in making career choices, and if so how? A systematic review. Rural Remote Health. 2012; 12: 1832.

MacDonald PJ, Bass MJ. Characteristics of highly rated family practice preceptors. J Medical Educ. 1983; 58(11), 882-893.

Huggett KN, Warrier R, Maio A. Early learner perceptions of the attributes of effective preceptors. Adv Health Sci Educ. 2008; 13(5), 649-658.

Shinners J, Franquiero T. Preceptor skills and characteristics: Considerations for preceptor education. J Contin Educ Nurs. 2015; 46(5): 233-236.

Mazerolle SM, Barrett JL, Eason CM, Nottingham S. Comparing preceptor and student perceptions on mentoring characteristics: an exploratory study. Int J Athl Ther Train. 2017; 22(2): 70-77.

Walters L, Couper I, Stewart RA, Campbell DG, Konkin J. The impact of interpersonal relationships on rural doctors' clinical courage. Rural Remote Health, 2021;21(4), 1-8.

Saito M, Schubert NS, Tsuzaki T, Gupta TS. Development of the Rural Generalist Program Japan: meeting the needs of Japanese rural communities. Rural Remote Health, 2020;20(3), 1-8.

Atmore C. The role of medical generalism in the New Zealand health system into the future. N Z Med J, 2015;128(1419), 50-55.

Larkins S, Evans R. Greater support for generalism in rural and regional Australia. Aust Fam Physician, 2014;43(7), 487-490.

Doyle C, Isles C, Wilson P. Time to revisit the skills and competencies required to work in rural general hospitals. PLOS one. 2020;15(10), e0240211.

Daly M, Roberts C, Kumar K, Perkins D. Longitudinal integrated rural placements: a social learning systems perspective. Med Educ. 2013; 47(4), 352-361.

John-Steiner V, Mahn H. Sociocultural approaches to learning and development: a Vygotskian framework. Educ Psychol. 1996; 31(3-4): 191-206.

Thistlethwaite JE, Bartle E, Chong AAL, et al. A review of longitudinal community and hospital placements in medical education: BEME Guide No. 26. Med Teach. 2013; 35(8), e1340-e1364.




How to Cite

Ross BM, Taylor K, Button B, Kilbertus F, Cameron E. How early clinical experiences in rural communities influence student learning about rural generalism considered through the lens of educational theory. Can. Med. Ed. J [Internet]. 2024 Apr. 15 [cited 2024 Jun. 15];15(2):6-13. Available from:



Original Research

Most read articles by the same author(s)