title: The impact of public hospital closure on medical and residency education: implications and recommendations.
abstract: BACKGROUND
  Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices.
  
  
  OBJECTIVE
  To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents.
  
  
  METHODS
  Retrospective cohort study of medical students' and residents' and clinical placement into safety-net experiences after the closure of the primary teaching hospital.
  
  
  RESULTS
  The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County.
  
  
  CONCLUSIONS
  While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location.
authors.affiliation: Robert Wood Johnson Clinical Scholars program, University of California Los Angeles, Los Angeles, CA 90024, USA. kodom@mednet.ucla.edu
authors.forename: Kara Odom
authors.initials: KO
authors.lastname: Walker
authors.forename: Daphne
authors.initials: D
authors.lastname: Calmes
authors.forename: Nancy
authors.initials: N
authors.lastname: Hanna
authors.forename: Richard
authors.initials: R
authors.lastname: Baker
mesh_terms: D000328:Adult; D002140:California; D015331:Cohort Studies; D004504:Education, Medical, Undergraduate / Q000706:statistics & numerical data*; D006271:Health Facility Closure / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D015141:Los Angeles; D008507:Medically Underserved Area; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D012189:Retrospective Studies