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Medical School Campus Choice: Factors Influencing a Student’s Decision to
Attend a Rural Regional Medical Campus
Brooke Fowler, BS, Chase Brown, BS, and William Cathcart-Rake, MD
DOI: https://doi.org/10.24926/jrmc.v4i2.3695
Journal of Regional Medical Campuses, Vol. 4, Issue 2 (2021)
z.umn.edu/JRMC
All work in JRMC is licensed under CC BY-NC
Brooke Fowler, BS; University of Kansas School of Medicine-Salina
Salina, Kansas
Chase Brown, BS; University of Kansas School of Medicine-Salina
Salina, Kansas
William Cathcart-Rake, MD; University of Kansas School of Medicine-Salina
Salina, Kansas
Corresponding author: William Cathcart-Rake, M.D., Clinical Professor of Medicine, University of Kansas School of Medicine-Salina,
138 North Santa Fe, Salina, Kansas 67401; email: wcathcart-rake@kumc.edu
All work in JRMC is licensed under CC BY-NC
Volume 4, Issue 2 (2021) Journal of Regional Medical Campuses Original Report
Medical School Campus Choice: Factors
Influencing a Student’s Decision to Attend
a Rural Regional Medical Campus
Brooke Fowler, BS, Chase Brown, BS, and William Cathcart-Rake, MD
Abstract
The factors that influence medical school choice have been the subject of previous reports, but there is a paucity of data
regarding the factors influencing a student’s choice between the main campus and a regional medical campus (RMC) in
the United States. The authors surveyed current students and graduates of the University of Kansas School of Medicine
(KUSM) rural RMC in Salina regarding those factors that influenced their decision to attend that campus and their
satisfaction with delivery of their medical education and student support services. The authors identified 3 major factors
influencing rural campus selection (important or very important in >75% of current students and graduates): small class
size, quality of core clinical experiences, and working one-on-one with clinical faculty and residents. Salina met student
expectations regarding the main reasons for selecting the campus but were disappointed with several other campus
aspects, including: research opportunities, interest groups, academic counseling, mental health services, and residency
counseling. The survey results provided impetus for optimizing recruitment strategies and improving campus support
services.
Introduction
Medical school campus selection can be a daunting
process for any prospective medical student. While it
may be a straightforward decision for the premedical
student who is accepted at only one medical school,
there may be disappointment and hesitation if it was not
their preferred choice. The decision can be challenging
for the pre-medical student accepted to more than one
school. Undoubtedly, multiple factors are considered
when deciding on which medical school to attend or on
which campus to attend when a school offers more than
one campus location. Hours of research, self-reflection,
and advice seeking may be required, resulting in what
one hopes is the best decision regarding school choice.
The factors that influence a student’s decision to choose
a particular medical school have been addressed
previously.1-8 The most common threads in a student’s
decision regarding a choice of medical schools in nearly
all of these reports were the importance of school
reputation and campus location.
The decision regarding medical school choice
may be just as difficult for those students admitted to a
medical school with a main campus (usually in a
metropolitan area) and one or more regional (often
rural) campuses. Which campus should they attend? In a
study by Graeme Jones,9 students attending the
University of Melbourne in Australia were sent a survey
to evaluate their concerns about choosing to study at
the rural clinical school (RCS) for 18 months of their
training. The most commonly cited concerns were quality
of teaching and education, transportation and location
issues, and student access to patients. Family and
partner commitments, financial issues, and housing
commitments were the most common deterrents cited
by those students who did not choose the RCS. In their
study of campus choice (main campus versus 2 regional
campuses), Mihalynuk et al10 from the University of
British Columbia and the University of Northern British
Columbia in Canada also investigated the factors
influencing the decision to attend the main metropolitan
campus versus a smaller regional campus. The authors
noted that the smaller regional campuses emphasized
close relationships and educational experiences, while
greater access to medical and educational specialists, a
Journal of Regional Medical Campuses, Vol. 4, Issue 2
Original Report
greater patient case mix, and the community were
features of the larger campus. While education,
relationships, and lifestyle were important influences on
study-site choice, partner and family exerted even
greater influence on campus choice. Krahe et al11
surveyed 6 Australian universities with RCSs and found
that the primary driver to attend a RCS was students’
access to patients, although friends and academic
reputation were also important considerations.
Because there is a paucity of data from the United States
regarding the factors that influence the decision to
attend a main urban campus versus a rural regional
medical campus (RMC), the Salina RMC of the University
of Kansas School of Medicine (KUSM-Salina) conducted
a survey of current students and graduates regarding the
factors that influenced their decision to attend its
campus. The primary goal of this study was to identify
those factors influencing a student’s decision to select
the rural RMC in Salina. Determining what factors were
most important and least important can assist the KUSM
Admissions Committee in presenting campus choices to
prospective students, as well as in campus assignment
decisions. This information may also provide guidance to
other medical schools with urban and rural campuses in
their recruitment of students and their campus
assignment decisions. The secondary goal of this study
was to determine the satisfaction of KUSM-Salina
students with the educational program and support
services provided once they were on campus.
KUSM-Salina was established as a small rural 4-year
RMC in 2011; eight students matriculated on the campus
each year from 2011 to 2019. This campus
complemented KUSM’s urban RMC in Wichita and the
main campus in Kansas City. Salina is a community of
approximately 50 000 people located in a predominately
agricultural region in north-central Kansas. The founding
mission of KUSM-Salina is to educate medical students
in a rural environment, hoping that many graduates will
choose to practice in rural Kansas.12
Although there are differences in presentation, the
curriculum on the KUSM-Salina campus is identical to
that on the Kansas City and Wichita campuses. The
majority of the foundational science lectures during
years 1 and 2 are delivered to Salina students via live
televideo conferencing generated from the main
campus, while small group case-based discussions,
anatomy labs, and clinical skills labs are facilitated by
local faculty. Required and elective clinical clerkships
during years 3 and 4 are offered in Salina, although
students have the opportunity to complete clinical work
on other campuses.
The rural KUSM-Salina campus is particularly attractive
to students from rural communities, and studies have
shown that medical students originally from rural areas
are more likely to return to such areas and practice
medicine.13-18 Cathcart-Rake recently published a report
regarding the dramatic impact the KUSM-Salina campus
has had on the production of primary care physicians
who stay in or return to Kansas, especially rural Kansas.19
Students applying to KUSM do not list campus choice on
their AMCAS application. Prospective students rank their
choice of campuses (main campus in Kansas City,
metropolitan RMC in Wichita, first 2 years in Kansas City
and final 2 years in Wichita, or rural RMC in Salina) on
their supplemental application. The KUSM Admissions
Committee initially decides which students are accepted
for admission to the medical school and then decides on
campus assignment. Campus assignment is
predominantly based on student preference.
Methods
An invitation to voluntarily and anonymously participate
in a 51-question REDCap20,21 survey was sent to all 24
current students (Classes of 2021, 2022, and 2023, each
comprised of eight students) and all 47 graduates of
KUSM-Salina (Classes of 2015-2020). The study was
conducted during the first weeks that the incoming first-
year medical students (Class of 2024) were on campus.
Although this group could identify factors that
influenced their campus choice, they could not
accurately reflect on their KUSM-Salina campus
experiences; therefore, they were not invited to
participate.
The first 8 questions of the survey identified the
participants’ current status as either a student or
graduate of KUSM-Salina, interview site for medical
school admission, rural background, future medical
practice plans, and overall satisfaction with the KUSM-
Salina campus. The next 22 questions used a 5-point
Likert scale (1 = not important, 2 = slightly important, 3
= moderately important, 4 = important, and 5 = very
important) to query factors that may have influenced
their decision to attend KUSM-Salina. Then 17 questions
(also using the same 5-point Likert scale; 1 = very
dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied,
and 5 = very satisfied) inquired about satisfaction with
the campus. Finally, there were 4 open-ended questions:
1) why they did or did not rank Salina first among the 3
KUSM campuses; 2) what was most gratifying about
Journal of Regional Medical Campuses, Vol. 4, Issue 2
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matriculating to KUSM-Salina; 3) what was most
disappointing about attending KUSM-Salina; and 4)
satisfaction with the KUSM curriculum in general.
The survey remained open for 3 weeks. Reminders to
complete the survey were sent to both current students
and graduates at approximately weekly intervals. All
respondents who replied within the 3 weeks of opening
the survey were included in the analysis. Univariate
statistics were calculated to describe participant
responses and achieve our study objective.
The University of Kansas Medical Center IRB reviewed
and approved the study protocol (STUDY00146084).
Results
Summary statistics regarding respondents are noted in
Table 1. Fifty-three (20 students and 33 graduates) of the
71 individuals invited to participate in the REDCap survey
completed the survey, representing an overall response
rate of 74.6% (an 83.3% response rate for current
students and a 70.2% response rate for graduates).
Overall, 18 (90%) of the current student respondents and
29 (87.9%) of the graduate respondents indicated that
they ranked Salina number one on their supplemental
application. Seventeen (85%) of the current students and
29 (87.9%) of the graduates indicated that they were
originally from a rural community the size of Salina or
smaller. Twelve (60%) of the current students and 25
(75.8%) of the graduates were either planning to practice
or were practicing primary care. Twenty (100%) of the
current students and 26 (78.8%) of the graduates were
planning on or engaged in rural practice. All respondents
in both groups (100%) stated that they were ultimately
happy with the KUSM-Salina campus assignment,
regardless of whether they ranked Salina as their first
choice.
Table 1. Summary of respondent statistics
Factors that influenced a student’s decision to select the
KUSM-Salina campus (Table 2) were segregated into 3
ranges: 1) important to very important (≥75% of current
students and > 75% of graduate respondents selected a
Likert score of 4 or 5 score = important or very
important), 2) moderately important (50-74.9% of each
group of respondents selected a 4 or 5 score), and 3) less
important (≤50% of each group of respondents selected
a 4 or 5 score). The factors that were ranked most
important in influencing the decision to choose the
Salina campus were: the desire to work one-on-one with
attendings and residents, small class size, and high-
quality core clinical experiences. The factors ranked
moderately important were the desire to practice in a
community the size of Salina or smaller, the desire to
receive individualized attention from the faculty/faculty
mentors, a good “gut feeling” about the campus, the
location of the campus in a rural community, and a short
commute to school. The factors that were least
influential in choosing the Salina campus included:
proximity to the student’s hometown, school/campus
reputation, easy parking, opportunities for leadership
roles, family medicine specialty emphasis, positive
experience during the medical school interview, the
history of Salina graduates matching in top residency,
family influences, campus differences in presentation of
curriculum, few distractions outside of school, campus
facilities, Salina community assets, Salina campus-
specific scholarships , and research opportunities. We did
not attempt to determine statistically significant
differences in responses between current students and
graduates; however, it was noted that there was
relatively close agreement in ranking of responses to
nearly all questions.
Journal of Regional Medical Campuses, Vol. 4, Issue 2
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Table 2. Factors Influencing the Decision to Attend
KUSM-Salina
Students and graduates were asked to provide text
comments regarding their choice of the Salina campus
(Table 3). Among the respondents who ranked KUSM-
Salina as their first choice, open-ended responses
echoed similar themes: a desire to live in a small town, a
desire for a small class size, studying on a campus close
to home, KUSM-Salina’s history of providing frequent
hands-on experiences, one-on-one experiences with
attendings, and an interest in rural medicine. For those
who did not rank Salina as their first choice of KUSM
campuses, open-ended responses included: location far
from home, foundational science lectures presented by
interactive televideo (ITV) conferencing rather than in
person, less access to a wide range of specialties, and
lack of knowledge about the KUSM-Salina campus.
Table 3: Selected open-ended responses regarding
factors influential in choosing KUSM-Salina
One section of the survey was designed to determine
how well the Salina RMC delivered on the students’
expectations (Table 4). Elements of the educational
experience were segregated into three ranges: 1) high
satisfaction (≥75% of current students and graduates
selected a Likert score of 4 or 5 score = satisfied or very
satisfied), 2) moderate satisfaction (50-74.9% of each
group of respondents selected a 4 or 5 score), and 3) low
satisfaction (≤50% of each group of respondents
selected a 4 or 5 score). Students were highly satisfied
with the cost of living in Salina, the exposure to
attendings and residents in clinical years, the Salina
campus building and equipment, the exposure to
specialties and sub-specialties in clinical years, and
virtual lectures via ITV.
Students were moderately satisfied with the Salina
clinical simulation lab, student health services provided
locally, accessibility to student resources (i.e. library,
financial aid, educational support), social
environment/opportunities in Salina during free time, the
living space/housing options in Salina, campus diversity,
and assistance with financial aid/debt management
questions.
Issues associated with lower levels of satisfaction were
research opportunities, academic counseling services
provided in Salina and/or virtually by Kansas City staff,
number of student interest groups on campus, mental
health services provided in Salina, and residency
program information provided on the Salina campus
(process, lifestyle, choices, etc.).
Journal of Regional Medical Campuses, Vol. 4, Issue 2
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Table 4. Current Student and Graduate Satisfaction with
KUSM-Salina
Discussion
The Salina rural RMC was particularly appealing to
students from rural communities who eventually wanted
to return to rural communities to practice. Interestingly,
interview site and the interview itself had a minor
influence on campus choice, leading the authors to
conclude that neither visualizing the campus nor the
interviewer or interview process were major factors
influencing campus selection. Reputation and location
were identified as important factors influencing school
choice in multiple previous studies.1-4, 5-9 Although the
general topic of school or campus reputation was not a
major factor influencing campus choice in this study, the
reputation of the KUSM-Salina campus for specific
attributes (small classes, high-quality core clinical
experiences, and working one-on-one with attendings
and residents) was important in campus choice.
Interestingly, in contrast to the findings of Mihalynuk et
al,10 family pressures had little influence on Salina
campus choice. Also, the fact that KUSM-Salina offered a
minimum of $5 000/year in scholarship support was not
an important factor in campus choice.
The cost of a medical school education is not trivial;
however, participation by many KUSM-Salina students in
the Kansas Medical Student (KMS) loan program may
negate the need for scholarship awards. The KMS loan
program, offered to all KUSM students, funded by the
State of Kansas and administered by KUSM, pays tuition
expenses and provides a modest living allowance during
medical school. Loans are totally forgiven if the recipient
elects to practice primary care in one of 100 rural
counties or the single underserved urban county in
Kansas. The majority of KUSM-Salina students are
interested in rural primary care; therefore, a KMS loan
provides an excellent means to fund an expensive
medical education. Historically, 57% of KUSM-Salina
graduates elected to receive KMS loans to fund all or
part of their medical education.19
In 2018 the KUSM-Salina moved from old and crowded
quarters to a larger, completely remodeled, state-of-the-
art medical school building. It was anticipated that this
new health education center would be a major draw for
the current medical student group (Classes of 2021-
2023). Surprisingly, the new facilities had minimal impact
on campus choice for those students who would use it.
A significant number of respondents were disappointed
with the delivery of a number of support services:
campus mental health services, academic counseling
services, residency program information provided,
research opportunities, and campus student interest
groups. KUSM-Salina provided mental health services
through a local behavioral health center, as well as via
secure, confidential telehealth services provided by the
main campus. Whether respondents were fully informed
regarding these services and/or dissatisfied with them is
unknown. Respondents also voiced dissatisfaction with
academic counseling services. Access to a learning
specialist is available on campus and through the main
campus in Kansas City. It is unknown whether
respondents were not fully cognizant of what the
learning specialists could provide or were just
dissatisfied with the services received. Respondents were
not satisfied with the information provided about
residency programs and the residency application
process. Although there was not a designated KUSM-
Salina campus office or faculty member to handle
residency questions and concerns, the local KUSM-Salina
faculty was available to provide information regarding
residency programs and the residency application
Journal of Regional Medical Campuses, Vol. 4, Issue 2
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process. Once again, respondents may not have realized
what was available or wanted more than provided.
Despite the fact that no respondents identified research
opportunities as an important factor in choosing the
Salina campus, after matriculation the majority of
respondents were dissatisfied with the research
opportunities offered. It is possible that once students
realized that research experiences/scholarly engagement
could be an important factor in competing for residency
positions, their opinions regarding research
opportunities changed dramatically. Therefore, once on
campus, they found the KUSM-Salina campus lacking in
this respect.
Opportunities for leadership roles was another area
deemed less important for prospective KUSM-Salina
students; however, once on campus, opinions changed.
Although the Salina campus offered students the
opportunity to serve in tri-campus student government
organizations, the opportunities to participate in a wide
variety of campus student interest groups was limited
and this was disappointing. Student interest groups and
student government organizations provide opportunities
for students to meet other students with similar interests
and assume leadership positions. Engagement in such
organizations may also strengthen their resume for
residency positions.
Conclusion
The small rural KUSM RMC in Salina has a 10-year history
of providing a full 4-year allopathic medical education to
a select group of students. Although the small group of
current students and graduates surveyed might be
criticized, the response rate was nearly 75% and the
results provided insight into what factors influenced the
decision to choose a particular campus, what factors
were less important, and how well that campus met
student expectations. Over 75% of respondents found
KUSM-Salina’s small class size, strong clinical program,
and one-on-one relationships with faculty attractive, and
this campus met their expectations regarding these
issues. Our findings amplify previous reports that, when
faced with the decision to choose a medical school or
choose between medical school campuses, students are
influenced by the school’s academic reputation and
location. In addition, as noted by Cecelia Brown et al,2
students may be attracted by “intangible factors”—
perhaps the “good gut feeling” noted by 70% of
respondents in this study.
The Salina campus is not perfect. There is room for
improvement in providing student research
opportunities, expansion of student interest groups,
delivery of mental health services, providing academic
counseling, and providing information regarding
residency programs and the process of residency
application. The importance and methods of providing
student support services at KUSM-Salina were previously
reported by Kollhoff et al.22 Despite mechanisms
established to address the support services required by
the Liaison Committee on Medical Education and, more
importantly, demanded by students, KUSM-Salina needs
to review and redress several elements. Identifying these
deficiencies provides impetus to the KUSM-Salina
administration to seek solutions, whether it be improved
communication regarding what is available, or
improvement/expansion of services provided.
The lessons learned by KUSM-Salina are important in
improving strategies for recruiting students to a rural
RMC and providing them with an exceptional
educational experience. KUSM-Salina was most attractive
to students from rural communities who were interested
in eventually returning to rural communities to practice.
Recruitment efforts should be focused on, although not
entirely limited to, this cohort. In addition, promotional
materials should emphasize what current and previous
students have found most attractive about the rural RMC
and what the RMC has historically delivered—small class
size, quality clinical experiences, and working one-on-
one with clinical faculty. It may be difficult for RMCs to
provide a robust array of research opportunities and
interest groups, as well as other student support services,
but they cannot ignore these important elements in the
education, health and happiness of students. Our
findings may benefit other medical schools with rural
RMCs in improving their programs and attracting the
best students.
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