Global Rotations, Local Impact: Preparing Physicians for Rural Primary Care
By: Liz Reid
Lights flickered and rain pounded on the tin roof while University of Pittsburgh fourth-year medical student Tom Rubino focused intently on stitching up the man’s hand. The patient had come to the clinic in San Jose, Honduras – the only medical facility for miles – late at night after cutting himself with a dirty knife.
“That was a wow moment,” Rubino recalls. “You’re working with what you have, and you realize how much you can do with so little. It reminded me why I wanted to go into medicine.”
Experiences like Rubino’s are increasingly rare in modern medical training, yet they are urgently needed. Across the United States, there is a growing shortage of primary care physicians, particularly in rural and underserved areas. This gap translates into delayed diagnoses, unmanaged chronic conditions, preventable complications and premature deaths. Medical educators at Pitt and UPMC are increasingly focused on how — and where — future physicians are trained to meet that need.
For more than two decades, medical students, residents and attending physicians from Pitt and UPMC have traveled to the remote mountain village of San Jose for rotations at the Clinica Medica.
The idea for the program was conceived over coffee at a Pittsburgh diner in 2000, as UPMC family medicine physicians Mark Meyer, M.D., N. Randall Kolb, M.D. and the late William Markle, M.D. discussed how to combine medical education with sustainable global health work. They envisioned a program that would strengthen local health systems rather than provide short-term fixes, and they looked at the model developed by a non-profit group called Shoulder to Shoulder, based in Cincinnati. Founded in 1990 by a University of Cincinnati family physician, Shoulder to Shoulder was working alongside local leaders and health officials in another part of Honduras to help address health care and education challenges.
“Shoulder to Shoulder said they had this other village that needed help and asked if we would take it on,” said Dr. Meyer, interim co-chair of the Department of Family Medicine at Pitt and chief of Family and Community Medicine at UPMC Shadyside Hospital. “We’ve been partnering with the village of San Jose ever since.”
Physicians and medical students visit many patients at their homes in and around the village.
At the center of this work is Dr. Tania Castillo, the clinic’s sole full-time physician for more than 14 years. She provides prenatal care, pediatric asthma management, chronic disease treatment and even late-night emergency care, often making home visits to patients who can’t reach the clinic.
“When I first came here, I was right out of medical school,” said Castillo, who grew up on the island of Roatán in Honduras. “I was like a baby learning to walk. There is so much to do here, and I wouldn’t be the doctor I am today without this experience.”
Dr. Meyer said Dr. Castillo is a role model for many of the students. Accustomed to the high-resource environment of UPMC hospitals, the clinic in rural Honduras offers a stark contrast.
“In Honduras, you have vital signs and glucose, and that’s it,” says fourth-year medical student Peyton Groves. “You learn to rely on your diagnostic skills, patient history, what you can see and hear.”
Amrita Mani, a third-year student on Pitt’s primary care academic track, said the experience solidified her desire to work in a rural setting. She said the daily home visits were especially impactful.
Medical students say treating patients in their homes is a particularly impactful experience.
“Every afternoon, we’d split up and walk to different parts of the village, sometimes quite far, to see patients who couldn’t make it to the clinic,” said Mani. “It was the most authentic way to understand their lives and challenges.”
For example, one elderly patient had high blood pressure, but had previously passed out when on blood pressure medication.
“At 80 years old, it was more important to make sure he could get around safely than to focus on his numbers,” said Mani.On another home visit, Groves recalls treating a patient whose joints were locked from rheumatoid arthritis because she couldn’t access the effective and inexpensive medication that is the standard of care in the U.S.
“It becomes really clear how things like the environment, infrastructure and income affect someone’s health,” she said.
The lessons learned in Honduras resonate far beyond its borders. In the U.S., projections show a shortage of up to 48,000 primary care physicians by 2034, with rural communities expected to be hit especially hard.
“Students learn that medicine isn’t just about technology. It’s about listening, adapting and meeting people where they are,” said Dr. Meyer. “That mindset is what makes great family doctors, whether in Pittsburgh or a remote mountain village in Honduras.”
Children receive eye exams at Clinica Medica in San Jose, Honduras.
Experiences like these are not meant to stand alone. At Pitt and UPMC, global rotations are one piece of a broader effort to intentionally build the primary care workforce of the future, especially for rural and underserved communities where the need is greatest. Lessons learned in places like San Jose inform how students and residents are trained for rural healthcare where patients face many of the same challenges: limited resources, complex social needs and communities that depend on a small number of physicians for comprehensive care.
For example, UPMC launched its Rural Family Medicine Residency in 2023 to train physicians for rural practice in north central Pennsylvania. Residents learn to care for patients across the lifespan and manage a wide range of complex conditions, from chronic disease and cardiovascular issues to addiction and mental health. Like the students in Honduras, they learn to rely on strong clinical judgment, adaptability and deep community relationships.
In rural settings, a family physician is often not just a doctor, but a trusted presence woven into the fabric of everyday life. Rubino, who grew up in Beaver County, says the trip solidified his decision to pursue family medicine.
“This specialty is for people who are willing to work in the gray,” said Rubino. “Yes, patients have health challenges, but what else are they facing? Transportation issues, food insecurity, unstable income, separation from loved ones. As a family doctor, you address all of those things.”
Photos provided by Shoulder to Shoulder Pittsburgh
