title: Clinical training in the rural setting: using photovoice to understand student experiences.
abstract: BACKGROUND
  Attracting and retaining healthcare providers in rural locations in the USA has been an issue for more than two decades. In response to this need, many health sciences education institutions in the USA have developed special programs to encourage students to become healthcare providers in rural locations. One approach is the use of community-based education experiences through rural track programs. Rural track programs seek to address the shortage of healthcare providers working in rural areas by nurturing and educating students interested in rural practice and primary care. Such programs serve both medical students and students of other health professions. Yet, little is known about student experiences in rural track programs. As such, this study aimed to generate discourse on student experiences in the rural training environment and gain insight into the impact of rural environments on student learning.
  
  
  METHODS
  An exploratory qualitative analysis of medical and physician assistant student experiences in two rural medical education training programs was conducted using the photovoice methodology. Photovoice is a participatory research method combining photography with participant commentary and focus groups.
  
  
  RESULTS
  Twenty-two third-year medical and six second-year physician assistant students participated in the study. Students noted that in their rural sites the learning environment extended beyond direct clinical teaching in four primary ways: (1) relationships with clinical faculty translated to a sense of meaningful participation in healthcare teams; (2) connections with community members outside of clinical settings led to increased awareness of healthcare concerns; (3) rural settings provided important space to reflect on their experiences; and (4) the importance of infrastructure was highlighted. Students also believed that diversity of occupation, education, attitude, and perception of medical care impact learning in rural environments.
  
  
  CONCLUSIONS
  The photovoice participatory research methodology allowed for a deeper understanding of the aspects of the rural training experience that resonated most among students in real time, using visual representations of students' lived experiences as defined by the students.
authors.affiliation: State University of New York Upstate Medical University - Department of Family Medicine, Syracuse, New York, USA. madere@upstate.edu.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Mader
authors.affiliation: State University of New York Upstate Medical University - Department of Family Medicine, Syracuse, New York, USA. roseamec@upstate.edu.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Roseamelia
authors.affiliation: State University of New York Upstate Medical University - Department of Family Medicine, Syracuse, New York, USA. lewissa@upstate.edu.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Lewis
authors.affiliation: State University of New York Upstate Medical University and St. Joseph's Hospital Health Center - Departments of Family Medicine, Syracuse, New York, USA. arthurm@upstate.edu.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Arthur
authors.affiliation: State University of New York Upstate Medical University, Syracuse, New York, USA. reederi@upstate.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: Reed
authors.affiliation: State University of New York - Upstate Medical University, Syracuse, New York, USA. germainl@upstate.edu.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Germain
mesh_terms: D002983:Clinical Competence; D003625:Data Collection; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D004777:Environment; D006801:Humans; D007858:Learning; D010823:Physician Assistants / Q000193:education* / Q000523:psychology*; D015397:Program Evaluation; D012111:Residence Characteristics; D012423:Rural Health / Q000193:education; D012424:Rural Population; D012959:Socioeconomic Factors; D013337:Students, Medical / Q000523:psychology*
keywords: Education; Medical; North America; Postgraduate; Undergraduate