# Medical Education Beyond Beirut: A Qualitative Study of Rural Training in Lebanon

## TL;DR

This study explores the challenges and opportunities of rural medical training in Lebanon to improve healthcare access in underserved areas.

## Contribution

The study proposes a practical model for rural medical training and highlights barriers to its implementation in Lebanon.

## Key findings

- Legal requirements for rural service exist but are inconsistently enforced.
- Barriers include supervisor shortages and financial constraints.
- Collaboration between governments and institutions is recommended to improve rural healthcare.

## Abstract

Introduction: In Lebanon, a lack of systematic incorporation of rural medical training into medical curricula exacerbates healthcare disparities. This study describes the current state of medical training in rural areas and explores the needs, requirements, and limitations associated with establishing training programs in those areas.

Methods: This qualitative study used semi-structured interviews with relevant stakeholders. Purposive sampling was employed to identify key persons potentially involved in planning medical education programs and the implementation of rural primary healthcare facilities, and to query about their opinions and vision. Of 26 stakeholders invited, eight participated in the study. Inductive analysis was performed to define thematic domains from the transcribed text.

Results: Analysis identified four major themes: (i) disconnect between legal requirements and practicality, (ii) mutual benefits, (iii) reality of rural medical training: existing efforts and challenges, and (iv) a practical model for implementation. Responses covered the status of rural medical training in Lebanon, rural communities’ needs, challenges, and a proposed implementation model. Despite legal requirements mandating rural service for practicing physicians in Lebanon after graduation, enforcement is inconsistent, with medical training and practice concentrated in urban centers. Barriers such as supervisor shortages and financial constraints hinder any rural implementation. Collaborative efforts between local and national governments and academic institutions are recommended to address these challenges through new legislative frameworks, quality improvement of primary healthcare centers, and targeted funding.

Conclusions: Future initiatives should address existing obstacles to establish a sustainable and equitable healthcare system nationwide. While limited by a small sample size and the qualitative scope, this research can serve as a foundation to create a model for improving medical education and healthcare delivery in rural areas, in Lebanon, the Arab region, and other low- and middle-income countries facing similar challenges.