Published
2026-01-15
Issue
Section
Original Reports
License
Copyright (c) 2026 Kaitlyn Weinheimer, Brad Burns, Heidi Wellenstein, Melinda Frank, John F. McCarthy, Toby Keys
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All work in JRMC is licensed under a Creative Commons Attribution-Noncommercial 4.0 License
Comparing learning environments across rural and non-rural clinical teaching sites
Kaitlyn Weinheimer
University of Washington School of Medicine
https://orcid.org/0009-0007-0128-6556
Brad Burns
University of Washington School of Medicine
Heidi Wellenstein
University of Washington School of Medicine
Melinda Frank
University of Washington School of Medicine
John F. McCarthy
University of Washington School of Medicine
https://orcid.org/0000-0002-3997-9223
Toby Keys
University of Washington School of Medicine
DOI: https://doi.org/10.24926/jrmc.v8i3.6179
Keywords: Community-Based Medical Education (CBME), Learning Environment, Rural Medical Education, Respect and Mistreatment
Abstract
Background
Medical schools utilizing community-based medical education (CBME) models are responsible for providing students with learning environments that are respectful, intellectually stimulating, and professionally supportive across dozens, and sometimes hundreds, of clinical teaching sites in rural and urban communities. The University of Washington School of Medicine’s (UWSOM) CBME model is one of the oldest and largest, spanning across Washington, Wyoming, Alaska, Montana and Idaho. This descriptive study compared the treatment of students between rural and non-rural clerkship preceptors.
Methods
This study utilized Medical Student of Educator Evaluation (MSEE) data from 1,101 students who completed required clinical rotations in family medicine, pediatrics, internal medicine, surgery, psychiatry, and obstetrics/gynecology from 2019 to 2023. The analysis focused on two key evaluation questions regarding the clinical learning environment: Likert scale respect scores of preceptors and reports of negative behaviors by preceptors toward students. The results were compared between preceptors at rural and non-rural teaching sites. All evaluations were anonymized and aggregated to protect student identities.
Results
Across all clerkships, at both rural and non-rural sites, mean Likert respect scores were above 4.9 on a Likert Scale of 5. Similarly, less than 1% of students in both rural and non-rural sites reported negative behavior directed toward them. “Public embarrassment” was the most frequently reported negative behavior in both settings.
Conclusion
This study suggests that CBME-based medical schools can provide supportive learning environments across rural and non-rural teaching sites. However, the infrequent occurrence of negative preceptor behavior underscores the importance of continued monitoring and timely intervention to safeguard students.
