Hi, everyone. My name is Nazia Huck. I am a fourth year medical student at the Alabama College of Osteopathic Medicine, and today I am presenting Limitations of Life, a mixed method survey exploring osteopathic medical students' perspectives on reasons preventing them from practicing in rural communities. Although there is a significant physician shortage in rural communities, with equally substantial efforts to recruit physicians to fill the gaps, the disparity continues to exist. The lack of physicians thus limits health care access, further contributing to health disparities and unequal health care outcomes, as we can see on the graph on the left created by the Rural Health Information Hub. As in July 2024, the vast majority of the United States has a shortage of qualified health professionals. The darker the area on the map, the more there is a shortage. So thus, the purpose of our study was to examine and identify potential factors that either contribute to or prevent students from practicing medicine in rural communities. So our mixed method study utilized an online cross-sectional survey administered to over 700 osteopathic medical students, faculty, and staff at an osteopathic medical school in the southeastern United States. Participants were recruited both online through school-wide emails and social media, as well as in-person via posters and in-person school events on campus. Informed consent was obtained prior to taking the survey. All responses were anonymized. The research instrument was developed to post a broad literature review on diversity, equity, and inclusion, and contained multiple choice and open-ended response questions. Our open-ended response questions were analyzed for themes with the use of a qualitative codebook, as seen in Figure 1, while multiple choice questions were analyzed using chi-square tests. The osteopathic significance of the study is that it specifically asks osteopathic medical students about their perspectives and beliefs regarding clinical practice in rural communities. So, to illustrate our qualitative codebook, we first name the code, which in this case is cultural isolation. We define the code, which is the physical separation from others who share respondents' cultural or ethnic backgrounds. We have our inclusion and exclusion criteria, so we included this when discussing feelings of separation or isolation from those of a similar background, and we excluded it when discussing social barriers. An example quote that illustrates the code is the lack of accessibility and closed-mindedness, which leads to isolation. So, what did we find out? That there is a statistically significant relationship between osteopathic medical students' geographic backgrounds and their future geographic preference for their career, with a p-value less than 0.05. Thematic analysis generated six themes and two sub-themes, so geographic relocation, family and support systems, social barriers, lack of resources, cultural isolation, which we showed in the methods section, and professional opportunity, with its sub-themes of compensation and military obligations. The graph on the left was part of our quantitative analysis. So, we discovered that depending on where you grew up, so whether you grew up in an urban community, suburban community, or rural community, this was self-identified. So, you would, and the students would say that they grew up in an urban community, a suburban community, or rural community, and then say upon graduation they wanted to practice in an urban environment, a suburban environment, or a rural environment. As you can see, our x-axis describes where they grew up, and the y-axis talks about the percentage of students that want to practice in one of these three communities upon graduation. So, of the urban students surveyed, over 60 percent said they wanted to return to an urban community after graduation, while a little bit more than 20 percent wanted to go to suburban environment and rural environments. Similarly, about 70 percent of suburban students wanted to go back to suburban environments after graduation, with only 30 percent wanting urban, and about 40 percent wanting rural. Conversely, for rural students, about 40 percent wanted to go back to an urban environment, a little less than 10 percent for suburban, and even less than that for urban. Going back to our thematic analysis, we also discovered that students namely describe these six themes. To illustrate them, I highlighted a few salient quotes. So, limitations of life in a rural community is where we derive the name of our presentation. So, the student goes on to describe access of care, Amazon delivery times, distance to an airport, food access limitations, and sanitation and water quality as reasons preventing them from practicing in a rural community. Another OMS1 student describes lack of access to potential life partners, that once they've started a family, they might consider it, but I would be isolating myself too much from others like me. And then another student says she does want to serve, or he or she wants to work with medically underserved communities. The biggest reason they do not want to stay in a rural area is because they would prefer to be closer to their family, and none of their family members live in rural environments. So, our conclusion is that, as other studies have noted, osteopathic medical students' geographic backgrounds may play a significant role in where they choose to practice medicine. Our study has several limitations, such as not reaching full saturation with the themes. It's inability to follow up questions and or gauge if students' perception on rural communities changed after starting their clinical rotations in their third and fourth years. Our findings suggest potential future avenues for research and recruitment, ranging from more in-depth qualitative approaches to a more longitudinal study analyzing how students' perspectives might change in their clinical years. These are our references below, and we would like to thank Angelina and Dr. Mafuete for their contributions to survey and data analysis. We appreciate your time and hope you have a wonderful rest of your day. Thank you so much!

osteopathic medical students

rural practice barriers

geographic relocation

physician shortage

family support systems