The WRITE Stuff: A Rural Longitudinal Integrated Clerkship Addresses Workforce Needs

  • Misbah Keen, MD, MBI, MPH
  • Danielle Bienz, M.Ed. University of Washington
  • Toby Keys, MA, MPH
  • Douglas Schaad, PhD
  • David Evans, MD
Keywords: Rural Medicine, Primary Care, Family Medicine, Longitudinal Integrated Clerkship, Physician Workforce



The University of Washington School of Medicine has six campuses in the five state WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region. The WRITE (WWAMI Rural Integrated Training Experience) program is a 22 to 24 week long rural longitudinal integrated clerkship experience offered to medical students in their clinical phase (third year) of training. This program seeks to meet the rural workforce needs of the WWAMI region by increasing the number of medical students going into primary care. Critics of LIC’s have expressed concern about overall quality control of the more remote educational experience and the lack of specialty specific teaching.  The aim of this study was to compare medical school and PGY-1 performance of WRITE and Non-WRITE students while determining how well each cohort is meeting the regional workforce needs.


The study group was all UWSOM students who matriculated from 2009 to 2013, advanced to graduation, and subsequently matched to a residency through the National Residency Match Program. WRITE and non-WRITE cohorts were compared for USMLE step 1 and 2 scores, MSPE (Medical Student Performance Evaluation) key word, and self and program director assessments in the first year of residency. The match results of the two cohorts were also compared to determine the proportions entering primary care residencies. Finally, for both cohorts the specialty choice at matriculation was compared with the match results. Descriptive statistics were used to test the comparisons.


The medical school performance of the WRITE and Non-WRITE cohorts was equivalent in all metrics (USMLE Step 1 and 2, MSPE key word, self and program director assessment of performance in the first year of residency). WRITE students were significantly more likely to match into primary care (67.6% vs 48.3%, p<0.001) overall and, in particular, Family Medicine as their specialty (40% vs 14.3%, p<0.001).  WRITE students were also more likely to match into the same specialty that they indicated on the UWSOM matriculation survey. For Family Medicine the loss of fidelity between matriculation and match among WRITE students was 3% (43.4 - 40.4) and among Non-WRITE students, it was 6.3% (20.6 - 14.3).


Performance outcomes of the WRITE program are equivalent to a traditional block curriculum.  However, the WRITE cohort is significantly more likely to go into primary care fields, especially family medicine and is more likely to stay with the declared specialty at matriculation. Medical schools that seek to increase the number of students going into primary care may benefit from adopting a similar model.


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Author Biographies

Misbah Keen, MD, MBI, MPH

Professor and Executive Vice Chair, Department of Family Medicine, University of Washington, 1959 NE Pacific St, Box 356390, Seattle, Washington 98195 USA

Danielle Bienz, M.Ed., University of Washington

LIC Education Specialist, Office of Rural Programs, University of Washington School of Medicine, 1959 NE Pacific St, Box 356340, Seattle, Washington 98195 USA

Toby Keys, MA, MPH

Lecturer, Department of Family Medicine, University of Washington, 1959 NE Pacific St, Box 356390, Seattle, Washington 98195 USA

Douglas Schaad, PhD

Division Head of Medical Education and Evaluation, Biomedical Informatics and Medical Education, University of Washington, Box 358047, Seattle, Washington 98195 USA

David Evans, MD

Rosenblatt Family Endowed Professor in Rural Health, Program Director University of Washington Family Medicine Residency, 331 NE Thorton Place, Box 358732 Seattle, Washington 98125 USA

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