Why clinical skills assessment matters.
Artificial intelligence (AI) and other emerging technologies are changing the way healthcare is taught, assessed, and practiced. But in many rural healthcare centers, AI is still a world away. In rural medicine–where many DOs practice–physicians must think on their feet, often with limited staff and scarce resources. Here, Rick Pescatore, DO, an emergency medicine physician, reflects on how rural practice shaped him, how it differed from urban medicine, and why AI will never replace an excellently trained DO with strong clinical skills.
The ER was lit by tired fluorescent bulbs, the kind that hum louder the longer you stand beneath them. No CT scanner. No specialist on call. Just me, a nurse, and a farmer in his sixties doubled over with abdominal pain. His vitals slipped; his skin turned damp and pale: the look you recognize before labs ever confirm it. There was no AI-generated differential, no dashboard of predictive analytics. What decided whether he lived was the simple act of being there: my hands, my judgment, my willingness to commit to him fully in that moment.
I carry the lessons of rural ER nights everywhere. Over my career, I’ve moved between big-city trauma bays and stripped-down critical access hospitals. In that contrast, the noise around AI often feels detached from reality. AI dominates headlines, grant cycles, and tech conferences. Yet in the places where medicine has to work without fanfare–in fluorescent hallways, empty radiology suites, and among limited nurses pulling double shifts–the presence of a physician truly matters. Boots on the ground, not algorithms in the cloud.
Rural practice demands improvisation: tubing a crashing patient with limited airway equipment, running sepsis resuscitation before labs or lactates are processed, stabilizing a patient for transfer hours away. DO training was built for this reality. A body–mind–spirit framework isn’t a slogan; it teaches you to see patients as whole people and marshal every ounce of physiology, psychology, and presence toward survival. In small-town ERs, that mindset is less philosophy than survival mechanism.
It’s not an accident that osteopathic physicians are more likely to serve rural America. These hospitals aren’t relics, but lifelines. They’re where families bring their children at midnight with fevers that won’t break, where farmers appear after falls, and where the elderly arrive confused and septic. Standing in those hallways makes clear that osteopathic medicine’s insistence on the whole patient isn’t ornamental. It is the core resource when resources are otherwise absent. Communities depend on it, even when policy debates and AI panels never mention them.
Rural hospitals may wait decades for advanced technologies to reach their doors, if they arrive at all. What saves lives isn’t software; it’s the physicians trained to adapt in any setting. That’s why osteopathic medicine’s educational foundation and assessment of clinical skills matters: it both produces clinicians ready for conditions that are far from ideal, in places where medicine remains elemental, and ensures that doctors continue to have these skills.
If you’re a student reading this, understand the work ahead. It is hard, isolating, humbling, and often thankless. It is also the work that matters most. Resist prestige metrics. Resist the seduction of AI hype. Patients in underserved areas don’t need avatars or prediction dashboards. They need you.
Bring resilience. Bring humility. Bring service. When you do, you’ll learn medicine stripped of illusion, and you’ll give care no machine can approximate.
I still remember the farmer. The absence of technology wasn’t the story; the presence of people was. The fluorescent bulbs buzzed. We stabilized him with what we had. And in that moment, the truth was clear: AI isn’t staffing the hallways; people are.