Rural Career Research Articles

Influences on medical students' decisions to study at a rural clinical school

To identify factors that influenced medical students at Monash University to undertake their first year of clinical training (third year of the medical course) at a rural clinical school (RCS). Third-year Monash University medical students undertaking clinical placements at a RCS were surveyed in 2005. A semistructured questionnaire was used to ask students to rate the influence of a list of factors on their decision to undertake their year-long placement at a RCS. Under half (48%) of students studying at an RCS reported that they were of rural background. All surveyed items were identified as having had a positive influence. Greater clinical experience, learning opportunities and patient access were identified as having the greatest positive influence followed closely by free accommodation and other financial and supportive incentives. Future rural career intention was eight times more likely to be a positive influence in rural compared with urban background students. The most important positive influence on Monash third-year medical students' decision to study at an RCS is the perception of high-quality clinical experiences and education. This perception arises from rural exposure during pre-clinical years.

Will Australian rural clinical schools be an effective workforce strategy? Early indications of their positive effect on intern choice and rural career interest

Will Australian rural clinical schools be an effective workforce strategy? Early indications of their positive effect on intern choice and rural career interest

Rural placements in Tasmania: do experiential placements and background influence undergraduate health science student's attitudes toward rural practice?

Each year growing numbers of undergraduate health science students, from a variety of disciplines, participate in a University of Tasmania Department of Rural Health supported rural placement program in Tasmania. This study aimed to investigate the influence rural placement and rural background had on students' intentions to live and work in a rural or remote location after graduation. Between January 2005 and December 2006, 336 students participated in the placement program. Students were requested to complete a survey at the completion of their placement. A response rate of 239 was achieved (71%). The survey measured students' stated rural career intentions and rural background status according to location of primary and secondary school attendance. A demographic analysis of respondents was undertaken and results cross tabulated according to the rural, remote and metropolitan area (RRMA) classification system. Statistical analyses, including paired t-tests and a Wilcoxon signed rank test, were conducted to compare reported mean intention to practise rurally both prior to and after placement. The results from this survey show that rural placements in the undergraduate health science programs have a predominantly positive influence on students' intention to work in a rural community post-graduation. While these findings were significant for the disciplines of nursing, medicine and allied health, the results were not significant for pharmacy students. Students' average intention to practise rurally significantly increased after the placement for students from RRMA classifications 1 and 3-5. The value of rural placements as a method for increasing health science students' intentionality to take up rural practice as a positive and viable career option is considerable.

National Centre of Rural Medicine in Norway: a bridge from rural practice to the academy

Rural medical practice in Norway has an honourable 400 year history, but this has diminished since the end of World War II. Despite official intention to support a decentralised population, rural and remote populations have continuously reduced in Norway over the last 10 years. A consequence of the accompanying reduction in rural and remote GP services has been a distinct reduction in opportunities for medical student and intern placements. In 1999 the University of Tromso implemented some projects to stimulate rural medical practice, funded by the government. This culminated in the 2007 foundation of the Norwegian National Centre of Rural Medicine (NCRM) in Tromso. A key challenge of the NCRM is to identify factors that influence young doctors to choose rural careers. This is reflected in the three concurrent aims or perspectives of the NCRM: (1) to bridge the gap between the academy and rural medical practice (the principal perspective); (2) to promote research, education and networking among rural health professionals (the operational perspective); and (3) to contribute to the recruitment, stability and quality of rural health care (the political perspective). The NCRM has had a number of achievements that include a publication that provides a narrative perspective on rural practice, the role of the rural doctor, and how rural culture and context influence proper clinical decision-making. Another achievement is a professional development and research program that has been successful in fostering a number of major studies, and led to the formation of a supportive PhD research group. The NCRM has also facilitated networking between rural practitioners and academics, at conferences and via its rural doctor website, and promoted cooperative international activities. In these ways the NCRM has fostered the transformation of rural doctors' experience into theory to enhance medical knowledge, begun to redress the balance between community- and hospital-based services, and so made a favourable start to building a bridge between rural practice and the medical academy in Norway.

Attitudes of advanced Australian medical oncology trainees to rural practice

AbstractAim: To identify the views of medical oncology trainees regarding rural training posts and rural practice overall, and to identify factors that may improve recruitment.Methods: A questionnaire was posted to all advanced oncology trainees in Australia in June 2006. The trainees were questioned on the perceived advantages and disadvantages of rural practice, their experience during previous rural rotations and potential incentives and barriers in recruiting trainees and specialist oncologists to regional and rural centers.Results: There was a 60% response rate. Of all participants 58% had considered rural practice. Those with a rural family background were more likely to have considered rural practice. Attitudes based on responses to listed disadvantages and advantages of rural practice were heterogenous. Lifestyle factors seemed to be of particular importance. Although there were perceived deficiencies in opportunities for professional education in rural oncology rotations, 94% felt their rotation had been a positive experience overall and 62% were more likely to consider a rural career following their rural rotation. Improving locum cover for leave was seen as a potential incentive by 97% trainees.Conclusion: Despite positive attitudes towards rural practice, many barriers exist preventing recruitment of medical oncology trainees to rural areas, in particular lifestyle factors that are difficult to modify. Factors that can be improved include improving access to clinical trials, enabling access to locum cover. Educational opportunities for current rural trainees need to be improved. Further study into potential incentives to enhance rural recruitment is required.

Students' perceptions of clinical attachments across rural and metropolitan settings

For many years, medical students at the University of Sydney undertook their clinical clerkships in traditional metropolitan teaching hospitals, which were regarded as the ‘gold standard’ for clinical training. In 2001 the university established a rural clinical school at which increasing numbers of students now complete a significant proportion of their medical education. The aim of the study reported here is to examine students’ perceptions of what facilitates their learning in clinical settings and to compare their perceptions across rural and metropolitan settings. Focus groups were conducted to collect students’ views on their experiences of learning in clinical settings. The findings were used to generate a questionnaire with items designed directly from focus‐group data ensuring content validity. The questionnaire was sent to all students in the 2004 cohort. Exploratory factor analysis was used to provide evidence of construct validity. The internal consistency reliability of the questionnaire was assessed using Cronbach’s alpha. Factor scores were computed to compare students’ perceptions across the two settings. Four factors were extracted: (1) clinical teachers’ orientation to teaching; (2) opportunities to develop clinical skills; (3) supportiveness of the clinical setting; and (4) student confidence and sense of self‐efficacy. Students rated the rural experience more highly and positively than the metropolitan hospital experience with regard to all four factors. This study highlights the positive role that rural attachments can play in providing an educationally sound learning experience. The findings are important in the context of both the drive, among medical programs worldwide, to seek out additional and alternative settings for clinical education and the national agenda to foster student interest in rural careers through positive rural training experiences.

Vocational career paths of graduate entry medical students at Flinders University: a comparison of rural, remote and tertiary tracks

To provide data on the career trajectories of medical students from rural and remote workforce programs at Flinders University (the Parallel Rural Community Curriculum [PRCC] and the Northern Territory Clinical School [NTCS]), comparing them with students at the urban Flinders Medical Centre (FMC). Retrospective postal survey of all 150 graduates who undertook their Year 3 study in the period 1998-2000. Associations with career preference, assessed using univariate analyses and multivariate regression. PRCC and NTCS graduates were more likely to choose rural career paths than graduates from FMC. The odds ratios were 19.1 (95% CI, 3.4-106.3; P < 0.001) and 4.3 (95% CI, 1.2-14.8; P = 0.026), respectively, after adjusting for age and rural background. There was no difference in the specialty choices of graduates of the three programs. This study provides evidence that clinical attachments designed to increase the rural and remote medical workforce do fulfil this objective.

Will Australian rural clinical schools be an effective workforce strategy? Early indications of their positive effect on intern choice and rural career interest

Will Australian rural clinical schools be an effective workforce strategy? Early indications of their positive effect on intern choice and rural career interest

Rural temperament and character: A new perspective on retention of rural doctors

This exploratory study serves as a starting point to establish a psychobiological profile for rural GPs. The overall aim is to describe how individual levels and combinations of temperament (mildly heritable) and character (influenced by sociocultural learning) traits allow GPs to flourish or fail in rural medicine. In a mixed-method study, 13 rural GPs (rural and remote metropolitan areas 5-7, minimum 7 years of experience) from Central/Southern Queensland, Australia completed the Temperament and Character Inventory-R140 to identify the intensity of the seven basic dimensions of temperament and character. These are novelty seeking, harm avoidance, reward dependence, persistence, self-directedness, cooperativenes and self-transcendence. Semistructured interviews provided in-depth information on what brought them to and kept them in rural practice. Preliminary results show that our sample of rural GPs are highly self directed, caring, cooperative, objective and persistent. Individual variations occur in the temperament dimensions of harm avoidance, novelty seeking and reward dependence. In particular, GPs who intended to leave rural practice due to dissatisfaction had significantly higher harm avoidance (F = 23.74; P < 0.01) than those GPs intent on staying. Although preliminary, triangulation of the data sources provides insight into individual GP profiles regarding which particular combination of traits is most conducive to maintaining a rural career, and might provide a greater understanding of rural doctors. This information could provide a basis for counselling of students with an interest in rural medicine and for informing policy on appropriate initiatives for rural GPs and the communities they serve.

The Effects of Disability Awareness Trainings with Career and Technical Educators Teaching in High Need Rural Schools

The purpose of this study was to investigate the effectiveness of a series of disability awareness workshops and their effects on rural career and technical education teachers who have students with disabilities in their classrooms. Two research questions were posed: (a) Will career and technical education teachers who receive a disability awareness workshop demonstrate a greater knowledge base in disability issues and legislation? and (b) Will employees who receive a disability awareness workshop alter their attitudes toward students with disabilities? Sixteen career and technical education teachers from the Genesee Valley Board of Cooperative Educational Services (BOCES) participated in this study. The teachers attended four disability awareness workshops over the span of one school year. The Facts on Disabilities Scale (FAD) and the Interaction with Disabled Persons Scale (IDP) were used as pretest/posttest measurements of knowledge about disabilities and attitudes towards students with disabilities. Results indicated an increase in degree of knowledge of issues pertinent to people with disabilities and an increase in positive attitudes toward a person with a disability.

Will Australian rural clinical schools be an effective workforce strategy? Early indications of their positive effect on intern choice and rural career interest

To use short-term indicators (hospital internship choice, and interest in a future rural career) to assess how the University of Queensland rural clinical school is meeting its program objectives. Cross-sectional quantitative data collected through self-report questionnaires. University of Queensland rural clinical school (UQRCS). Year 4 students who attended the UQRCS for their entire clinical year in 2006. Most students were from an urban background. Over the year, interest in a future rural medical career increased measurably across the cohort. The most important factors in choosing to study at the UQRCS were the quality of teaching, level of student contact with clinical teachers, increased patient access, and accommodation facilities. Comparison of graduates' choice of internship location for 2006 compared with 2005 showed a trend away from urban or metropolitan toward regional or rural hospitals. Our results suggest that the primary attraction of UQRCS is the quality of education, and rural undergraduate training is a popular choice for urban students. Although the long-term effect on rural medical workforce remains to be determined, the trend at UQRCS of new graduates choosing non-urban internships is encouraging.

University rural health clubs: nurturing the future Australian rural workforce

Australian university rural health clubs (RHC) are part of a national strategy to address the rural health workforce shortage. The student members of these clubs throughout Australia comprise the National Rural Health Network (NRHN). The NRHN is a multidisciplinary body representing medical, nursing and allied health students, aiming to increase the health workforce and health outcomes for rural and remote Australians. The NRHN and its constituent clubs run a variety of activities to promote rural careers to both school-aged and university students. These have included events at local, state and national levels. The purpose of the present article is to describe the roles and activities of RHC and the NRHN as they aim to contribute towards developing a sustainable rural workforce. Key features of RHC and the NRHN are: (1) providing positive rural experiences; (2) peer promotion of rural health; (3) personal and professional development; (4) providing a volunteer workforce for rural health initiatives; and (5) cross-disciplinary interaction. The NRHN is currently investigating methods to quantify the impact of the RHC on the career choices of potential rural health professionals. The NRHN and its constituent clubs are student-driven initiatives occupying a unique place in addressing the rural workforce shortage. Although little formal evidence exists for their success, the issues raised in this article illustrate their importance and broader benefits in this field.

What does it take? The influence of rural upbringing and sense of rural background on medical students' intention to work in a rural environment

There is abundant evidence that rural origin is an influence on rural career choice. Rural origin is widely used to select students to be supported into programs designed to address the rural medical workforce shortage. What is not as clear is how many years of rural upbringing are required to have a maximal effect on rural career choice. Neither is the place of having a sense of rural background well understood. A cross-sectional self-completed paper-based survey of all students in years one through four of the Monash University medical course was undertaken in 2003. The survey included a scale to measure stated rural career intention as well as questions about the number of years of rural upbringing and whether students had a sense of rural background. The Rural Intention score was divided into three categories: strong urban intent, strong rural intent, and an intermediate, less certain intent. There was an 88% (n = 399) response rate from students holding Commonwealth Supported Places. Approximately 30% of these claimed a sense of rural background, and 28% had more than 8 years of rural upbringing. Twenty-five percent stated a strong intention to choose a rural career and 34.5% had strong urban intent. The remaining 40.5% were in the intermediate group. Almost all students (97.5%) with over 5 years of rural upbringing had developed a sense of rural background, and almost all (97.5%) with less than 5 years' rural upbringing denied a sense of rural background. Rural intent was high for those with a sense of rural background and those with more than 8 years of rural upbringing, but the students who had had from 4 to 8 years of rural upbringing mainly fell into the 'uncertain' category. In this cohort of almost 400 Australian medical students, a sense of rural background developed at a clear point, around 5 years of rural upbringing. Students with a sense of rural background were likely to develop a strong rural intent several years before similar students who had failed to make this connection with a rural community. This latter group displayed uncertainty toward a rural career choice, possibly due to unfamiliarity. Unlike those with strong urban intent, these students have not excluded a rural career and should be supported. The inclusion of a measure of the intention of students to work in a rural environment is likely to increase the reliability and validity of selection procedures.

Medical students and rural general practitioners: Congruent views on the reality of recruitment into rural medicine

In-depth exploration of the perceptions, experiences and expectations of current long-term rural GPs and medical students intent on a rural career, regarding the current and future state of rural medicine. Qualitative study using semistructured interviews. Rural and remote towns in Central and Southern Queensland and the School of Medicine, University of Queensland. Thirteen rural GPs with 10-40 years experience. Medical students (five second- and seven third-year), all of whom are members of a rural students' club and have an intention to pursue rural practice. Interviews were conducted between August and December 2004. Emergent themes relating to participant perceptions of the current and future state of rural medicine. Despite large differences in generation and experience, medical students and rural GPs hold similar perceptions and expectations regarding the current and future state of rural practice. In particular, they cite a lack of professional support at the systems level. This includes specific support for: continuing medical education to obtain and retain the skills necessary for rural practice; dealing with the higher risks associated with procedural work; and consequences of medico-legal issues and workforce shortage issues such as long hours and availability of locums. Issues relating to recruitment and retention of the rural health workforce are identified by both cohorts as relating to professional support. Medical schools and institutional support systems need to join forces and work together to make rural practice a viable career in medicine.

Rural clinician opinion on being a preceptor

This article reports the evaluation of the motivation and experiences of preceptors of health professional students in the Spencer Gulf Rural Health School (SGRHS) in South Australia. The aims for this evaluation were to establish: (1) What factors influenced the professional's decision to precept students? (2) Did preceptors report having adequate skills and preparation for preceptoring? (3) What were the variations in professional streams with regards to the factors and skills of the staff involved? (4) What were preceptors' overall perceptions of their role? Heeding the opinions of preceptors involved in such initiatives is an important part of ensuring the sustainability of the rural workforce initiatives such as SGRHS. A preceptor questionnaire was developed from the literature in 2002 and pilot tested twice. At the end of 2004, all 255 preceptors who had been involved with SGRHS placement programs were sent a paper questionnaire. 145 valid responses were received (58%). The data were analysed using SPSS, Excel and Xpro. Respondent preceptors were drawn from medicine (n = 70), nursing (37), allied health (24), and other (14) backgrounds and had generally preceptored previously (133). Respondents had preceptored a total of 1007 students from medicine, nursing, allied health and other fields of study. Respondents had worked for either a very long time (> 15 years) or a short time (< 5 years) in rural areas. Respondents reported the factors which influenced their decision to precept were (in order): (1) I value my contribution to the growth in student's knowledge and skills; (2) Teaching allows me to promote rural health as a career option; (3) I enjoy the teaching/preceptor role; (4) Being a preceptor enhances my desire to keep up with recent health developments/literature; (5) I increase my time reviewing the basics of my clinical knowledge. There was significant interdisciplinary difference with nurses valuing their professional contribution more highly than doctors or allied health professionals. Preceptors' reports of their rural placement experiences reveal high agreement (99%) with the statement about the purposefulness of rural placements for providing students with the opportunity to see careers in rural practice in action, and most (93%) believed that they had adequate skills to precept and (91%) that the placement was an overall positive experience for the practice. Open-ended answers were coded and analysed to further understand these findings. Medical preceptors delighted in sharing youthful students' enthusiasm for learning while nurses most enjoyed encouraging students' understanding of rural health care. The principal preceptor problems related to time and associated issues, while doctors more than nurses and allied health professionals reported these issues. The SGRHS findings are consistent with world preceptor literature. To ensure sustainability of preceptors a number of areas need to be improved--notably recognition of loss of productivity; improvements to communication between sending institution and placement site; maintaining a multi-disciplinary approach to selecting preceptors based on the different 'world view' of the respondents; and, last, persisting with rural placements in acknowledgement that preceptors themselves agree that short observational placements allow students to see rural careers in action, which is the fundamental goal for rural placements.

SARRAH: Rural career status

Australian Journal of Rural HealthVolume 13, Issue 6 p. 371-371 SARRAH: Rural career status Owen Allen, Owen Allen SARRAH PresidentSearch for more papers by this author Owen Allen, Owen Allen SARRAH PresidentSearch for more papers by this author First published: 29 November 2005 https://doi.org/10.1111/j.1440-1584.2005.00743.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume13, Issue6December 2005Pages 371-371 RelatedInformation

Tradition and technology: teaching rural medicine using an internet discussion board

The aim of the Rural Medicine Rotation (RMR) at the University of Queensland is to give all third year medical students exposure to, and an understanding of, clinical practice in Australian rural or remote locations. Because the primary role of the Rural Clinical School is to improve medical recruitment and retention in rural areas, the provision of positive student learning experiences and subsequent ability to make adequately informed rural career choices is of fundamental importance. A difficulty in achieving this is the relatively short period of student clinical placements, in only one or two rural or remote locations. A web-based Clinical Discussion Board (CDB) has been introduced to address this problem by allowing students at all clinical sites to discuss their rural experiences and clinical issues with each other. The rationale behind the CDB is to encourage an enhanced understanding of the breadth and depth of rural medicine through peer-based learning. All third year students undertaking the RMR are required to submit a minimum of two original contributions, on any clinically related topic, and two replies to other submissions on the CDB. At the end of their 8 week rotation, the students evaluate the CDB by answering a short survey that focuses on the ease of use and access and the educational value of the CDB. A question regarding the influence of the RMR on their interest in pursuing a rural medicine career is also asked. The CDB transcripts are further analysed for type of article posted, category of medicine that was discussed and the specific topic under discussion. This article reports on the results from the first two RMR of 2005. A total of 83 third year medical students undergoing an 8 week rural rotation posted a total of 819 responses on the CDB. This resulted in 217 individual articles or topics discussed within 12 broad medical categories. The student ratings of the ease of use and access of the CDB were high, as were their ratings of its educational value and its potential to increase knowledge of rural medicine. Likewise, the majority of students felt the RMR increased their interest in rural medicine. The CDB offers a unique way to understand the concerns and interests of third year medical students immersed in their RMR. It highlights the issues they need to discuss with their peers, and offers the potential to guide future curriculum changes in response to identified needs. A major advantage of the CDB is its ability to enable all students to access a wide variety of rural practice experiences by sharing ideas and strategies they encounter. Likewise, the CBD encourages the development of deep reflective patterns of learning through a peer-based process. Equally important is the potential for building professional networks, interpersonal relationships, teamwork, collaboration and collegial support systems. These networks and relationships are essential for rural medicine to help alleviate the possible isolation recognised in rural life.

Recruiting undergraduates to rural practice: what the students can tell us

There are still large gaps in the evidence base for the effectiveness of Australian undergraduate rural coursework and placements programs designed to increase the numbers of health graduates choosing rural practice. This article reports on an online survey conducted in 2004 of health science students at the University of Tasmania, Australia, designed as a part of a long-term study to test coursework interventions by tracking students' attitudes to, and experience of, rural practice from course entry to eventual practice. All first and final year students in medicine, nursing and pharmacy in the Faculty of Health Science were invited to complete an online survey exploring the undergraduate experience of rural health. The survey was completed by 148 first year and 87 final year students, a response rate of 32.4% and 23.1% respectively. Over one-third (38.5%) of first years and 56.3% of final years indicated a general preference for rural life and practice and almost 90% expected to spend at least some of their career in rural practice. There was a statistically significant relationship between rural practice orientation and rural origin among first years, although this relationship was weaker among final years. Of first years, 82.4%, and 82.7% of final years appear to have made at least some commitment to a particular career path, and two-thirds to a particular practice environment. Rurally oriented first year students were significantly more committed to a career path than those without that orientation, although this did not hold for final years. When asked how much of their careers they expected to spend in capital city, rural, remote and/or overseas practice, both first and final year students' responses were notable for their spread. Few ruled rural or urban practice in or out entirely with most opting for middle range responses of 'most', 'about half' or 'part' of their career. Over half of both years expected to spend some time in remote practice and 75.1% of first years and 66.6% of final years some time in overseas practice. The factors rated most important in relation to career choice were those related directly to the realities of day-to-day professional practice--professional and peer support, work conditions and variety of work. Approximately three-quarters of those entering undergraduate education felt themselves to be at least 'somewhat informed' about rural practice but, apart from medical students, were little better informed by final year. The only perception of rural practice very widely shared (by more than 80% of respondents) was the possibility of developing better patient relations. Many of the other factors frequently identified as major issues in the rural practice literature--locality, flexibility, opportunities for further study, and spouse/partner and children's needs - while recognised by some, do not appear to loom large with undergraduates either in terms of career choice or perceptions of rural practice. Most final year students recalled receiving specific rural health training through rural placements and/or rural curriculum content. Overall recall of coursework was patchy, although placements were well-remembered and there was good support for increases in both. None of those who recalled undertaking rural coursework felt that it had influenced them towards a rural career and over two-thirds (n = 37, 69.8%) felt that this exposure had actually influenced them away from such a career. Three students reported that undertaking a rural placement influenced them towards, and 35 away from, a rural/remote career. The ultimate measure of the success of undergraduate interventions will be workforce changes over time. In the meantime more research is needed into undergraduate experience of rural health to provide the data needed for the careful design of coursework, detailed planning of the placement experience and long-term strategies to address those aspects of rural practice that are of most concern to these emerging health professionals.

Factors associated with rural doctors’ intention to continue a rural career: A survey of 3072 doctors in Japan

To show the relationship between the personal and educational backgrounds of rural doctors and their intention to continue a rural career. Nationwide postal survey. Public clinics or hospitals in municipalities that are classified as 'rural' by the national government. A total of 4896 doctors working for 828 public clinics and hospitals. A questionnaire was mailed. The questionnaire inquired about the subject's age, sex, hometown, exposure to rural practice in undergraduate education, postgraduate training, continuing medical education, current position and affiliation status with a medical school, as well as his or her intention to continue a rural career. Response rate was 64%; 26% answered that they intended to continue a rural career. Postgraduate training in general internal medicine, general surgery, anaesthesiology, paediatrics and gastroenterology were positively related with the intention to continue a rural career (odds ratio = 2.045, 1.59, 1.30, 1.48, 1.38). Rural background, undergraduate exposure to rural practice, multispecialty-rotation in postgraduate training and current administrative position had positive correlations with the intention to continue in logistic regression analysis (odds ratio = 1.80, 2.47, 1.54, 2.17). Affiliation with a medical school department was negatively related with the intention to continue (odds ratio = 0.45). In addition to the rural background of physicians, some undergraduate and postgraduate factors were independently associated with the intention to continue a rural career.

Do career criminals exist in rural America?

The criminal career paradigm had essentially ignored investigating offenders in rural areas. To fill this void, a retrospective, cross-sectional design sampled 331 former adult correctional clients from the case archives in a rural midwestern state. Self-report and official records indicated that rural criminal careers were characterized by relatively few arrests, short-lived criminal justice system involvements, and a paucity of violent crime. Although the sample demonstrated relatively benign criminality overall, the most chronic offenders, top 10 percent of the sample, were plagued by overlapping, contemporaneous problems such as alcoholism, substance abuse, mental health difficulties, early onset of antisocial behavior, low educational attainment, and revolving involvement in the criminal justice system. Like rural communities, which were characterized by exceedingly low crime rates, rural career offenders tended to be relatively harmless criminals especially compared to habitual offenders commonly found in the criminological literature.