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Stookey et al • Medical education At a time when Appalachia and West Virginia in particular suffered from extremely limited healthcare in their mostly rural areas, a group of determined West Virginia osteopathic physicians took a bold step in organizing the Greenbrier College of Osteopathic Medicine in 1974. Originally a private medical school, its founders established the school for the purpose of providing physicians to serve the rural and underserved areas of West Virginia and Appalachia. In January 1976, the move from a private to a public institution brought the college into the state system of higher education. By virtue of its state funding, the college became the West Virginia School of Osteopathic Medicine (WVSOM) and focused its efforts on preparing West Virginia residents to practice primary care medicine in rural communities of the state. Since its inception, the school has carried out its stated mission of educating primary care osteopathic physicians for rural communities. The school is dedicated, first and foremost, to service for West Virginia and prepares graduates to care for the special healthcare needs of West Virginia’s elderly population. The institutional mission is supported by education service and research. Education is primary and receives top priority for institutional resources. In a region with a real need for rural primary care physicians, WVSOM is distinguished by its success in training and placing osteopathic physicians in rural West Virginia and Appalachia. The mission not only drives the admissions process, but all aspects of the institution, including curriculum, faculty, and postgraduate training. According to the American Osteopathic Association’s 1999 Yearbook and Directory, 621 (54%) of WVSOM’s 1146 graduates specialized in family practice.1 A retrospective study of recent graduates practicing in Appalachia in 1978 to 1990 found that WVSOM led the nation in providing physicians for rural practices in the Appalachian region.2 Similarly, the 1999 report of the State College and University Systems of West Virginia showed that 17% of WVSOM graduates from 1989 through 1994, who did not have contractual obligations to leave for other southern states, practiced in rural areas of West Virginia, compared to an average of only 7% for the two allopathic medical schools in the state.3(p138) The school’s success in meeting its mission of training primary care physicians for practice in rural communities of West Virginia and Appalachia and in serving the needs of rural healthcare has led to increased recognition for the college. The Graduate and Professional Degree Program Review Committee of the University System of West Virginia has twice designated WVSOM as a “Program of Excellence.” The college faculty and administration have often been asked to identify reasons for WVSOM’s success and to list the programmatic components that have contributed to these accomplishments.4 Several of the reasons for the college’s success relate to WVSOM’s unique mission and how the program has developed specifically to address this mission. While some of the special aspects of the program have contributed to WVSOM’s success, a few factors threaten the college’s ability to accomplish its mission.

How West Virginia School of Osteopathic Medicine achieves its mission of providing rural primary care physicians