title: Student perception about working in rural United States/Canada after graduation: a study in an offshore Caribbean medical school.
abstract: BACKGROUND
  Rural residents of the United States (US) and Canada face problems in accessing healthcare. International medical graduates (IMGs) play an important role in delivering rural healthcare. IMGs from Caribbean medical schools have the highest proportion of physicians in primary care.  Xavier University School of Medicines admits students from the US, Canada and other countries to the undergraduate medical (MD) course and also offers a premedical program. The present study was conducted to obtain student perception about working in rural US/Canada after graduation.
  
  
  METHODS
  The study was conducted among premedical and preclinical undergraduate medical (MD) students during October 2014. The questionnaire used was modified from a previous study. Semester of study, gender, nationality, place of residence and occupation of parents were noted. Information about whether students plan to work in rural US/Canada after graduation, possible reasons why doctors are reluctant to work in rural areas, how the government can encourage rural practice, possible problems respondents anticipate while working in rural areas were among the topics studied.
  
  
  RESULTS
  Ninety nine of the 108 students (91.7%) participated. Forty respondents were in favor of working in rural US/Canada after graduation. Respondents mentioned good housing, regular electricity, water supply, telecommunication facilities, and schools for education of children as important conditions to be fulfilled. The government should provide higher salaries to rural doctors, help with loan repayment, and provide opportunities for professional growth.  Potential problems mentioned were difficulty in being accepted by the rural community, problems in convincing patients to follow medical advice, lack of exposure to rural life among the respondents, and cultural issues.
  
  
  CONCLUSIONS
  About 40% of respondents would consider working in rural US/Canada. Conditions required to be fulfilled have been mentioned above. Graduates from Caribbean medical schools have a role in addressing rural physician shortage. Similar studies in other offshore Caribbean medical schools are required as Caribbean IMGs make an important contribution to the rural US and Canadian health workforce.
authors.affiliation: Xavier University School of Medicine, Oranjestad, Aruba.
authors.forename: P Ravi
authors.initials: PR
authors.lastname: Shankar
authors.affiliation: Xavier University School of Medicine, Oranjestad, Aruba.
authors.forename: Arun K
authors.initials: AK
authors.lastname: Dubey
authors.affiliation: Xavier University School of Medicine, Oranjestad, Aruba.
authors.forename: Atanu
authors.initials: A
authors.lastname: Nandy
authors.affiliation: Xavier University School of Medicine, Oranjestad, Aruba.
authors.forename: Burton L
authors.initials: BL
authors.lastname: Herz
authors.affiliation: Xavier University School of Medicine, Oranjestad, Aruba.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Little
keywords: Canada, Caribbean, doctors, healthcare, physicians, rural, shortage