Document Type
Article
Abstract
Optimizing the geographic allocation of health care providers has the potential to improve health care access and health outcomes for rural populations. To inform the design of a discrete choice experiment (DCE) survey to elicit health professions trainees’ preferences for rural practice, this formative research aimed to: (1) elicit factors that influence job selection among health profession trainees, including medical residents physician assistant (PA) and nurse practitioner (NP) students, (2) identify how these trainees evaluate trade-offs for rural job placement and (3) inform attribute selection for inclusion into a future DCE to identify health professions trainees’ preferences for rural practice. Third- and fourth-year medical residents, PA students, and NP students completed an in-depth semi-structured interview, an adaptive choice-based conjoint exercise, and a ranking exercise. Inductive and deductive coding and reflexive thematic analysis were used to analyze the data. We reached thematic saturation after 22 interviews (n = 14 PA, n = 6 residents, n = 2 NP). We identified multiple domains across two major themes: (1) job-related attributes and (2) community-related attributes. Job-related attribute domains included: (1) team dynamics, management/leadership, and clinical decision support, (2) onboarding and professional development, and (3) compensation package/remuneration. Community-related covered two attribute domains included: (1) amenities and social environment and (2) rurality and commute time. Participants were willing to trade non-pecuniary factors against salary and loan repayment. We identified 10 attributes for potential inclusion in the DCE. This study identified several viable factors for potential inclusion as attributes in a DCE. Several of these factors have yet to be explored in a policy environment and may aid the design of rural healthcare recruitment strategies.
Digital Object Identifier (DOI)
Publication Info
Published in Medical Education Online, Volume 31, Issue 1, 2026.
Rights
© 2026 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
APA Citation
Gillette, C., Ostermann, J., Aguilar, A. A., O’Neal, S., Everett, C., Caviness, D., Patel, E., Steele, L., Goel, D., & Tabassum, Q. M. (2026). What factors influence health professions trainees’ preferences for employment in rural Appalachia? a qualitative study to inform the design of a discrete choice experiment. Medical Education Online, 31(1).https://doi.org/10.1080/10872981.2026.2649666