Fully Integrated Readiness for Service Training (FIRST): An Accelerated Medical Training Program for Rural and Underserved North Carolina

Acad Med. 2021 Oct 1;96(10):1436-1440. doi: 10.1097/ACM.0000000000003946.


Problem: The U.S. primary care workforce remains inadequate to meet the health needs of the U.S. population. Effective programs are needed to provide workforce development for rural and other underserved areas.

Approach: At the University of North Carolina (UNC) School of Medicine (SOM), between November 2014 and July 2015, the authors developed and implemented the Fully Integrated Readiness for Service Training (FIRST) Program, an accelerated curriculum focused on rural and underserved care that links 3 years of medical school with a conditional acceptance into UNC's 3-year family medicine residency, followed by 3 years of practice support post-graduation. Students are recruited to the FIRST Program during the fall of their first year of medical school. The FIRST Program promotes close faculty mentorship and familiarity with the health care system, includes a longitudinal quality improvement project with an assigned patient panel, includes early integration into the clinic, and fosters a close cohort of fellow students.

Outcomes: As of March 2020, the FIRST Program had successfully recruited 5 classes of medical students, and 3 of those classes had matched into residency. In total, as of March 2020, 18 students had participated in the FIRST Program.

Next steps: The FIRST Program will be expanded to additional clinical sites across North Carolina and to specialties beyond family medicine, including pediatrics, general surgery, and psychiatry.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Curriculum
  • Education, Medical, Graduate / organization & administration
  • Education, Medical, Graduate / standards
  • Education, Medical, Undergraduate / organization & administration*
  • Education, Medical, Undergraduate / standards
  • Health Workforce
  • Humans
  • Internship and Residency / organization & administration
  • Internship and Residency / standards
  • Medically Underserved Area*
  • Mentoring
  • North Carolina
  • Physicians, Primary Care / education*
  • Physicians, Primary Care / supply & distribution*
  • Program Development*
  • Quality Improvement
  • Rural Population*