essay on the number 3

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The Number 3 Explained – Why Is It Universally Powerful

• By Sandra Ngo-Trong
• May 19, 2020

Why is the “THIRD time a charm”? Or, the “THIRD time lucky”?  … and it’s all over the world!

French : “Jamais deux sans trois” – Never two without three

Vietnamese : “Qua tam ba ban” – try three times before quitting

Japanese: “ 三度目の正直 ” – the truth of the third try

Farsi – “Ta 3 nashe baazi nashe”  –  till the 3 rd happens, there will be no game

Spanish – “la tercera es la vencida” – in the third one is the defeated

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Most of the time 3 is perceived as a good thing, but not always, like in baseball “3 strikes you’re out”, or in some cultures, one should not take a picture in a group of three. Three is used in so many things like expressions, games, tales and superstitions. Could these all have been influenced by today’s religions, such as the Christian’s Trinity, or other even more ancient religions?

• Trimurti of Hinduism
• Three Pure Ones of Taoism
• The many Triads of Ancient Egypt
• Three Jewels of Buddhism
• 3 Fates of Ancient Greece

Maybe it’s the other way around, where the religions take from the expression or superstition… And why the expression to begin with? Maybe they are all independent from one another?! The bottom line, is there something special about the number 3?

Well, let’s take a look at this mysterious number by looking at the source of it. We’re going to look at it from a mathematical and logical point of view, but first, let’s see how world religions incorporated this number in their doctrines.

Number 3 in Religions

The Ancient Egyptians had thousands of gods and goddesses and they were often grouped in triads – in other words, groups of three. These triads would usually represent a family unit; father, mother, and child.

The Sumerians of Ancient Mesopotamia – today’s Middle East – believed in a universe divided into three; the heavens, the earth, and the waters. They also had many deities, but it was their supreme triad ( Anu, Enlil and Ea) that would rule over these regions.

In Hinduism , a religion considered to be the most ancient living one, the Trimurti which means “three forms”, consists of the powerful deities Bhrama, Vishnu and Shiva who undertake the primary cosmic functions of Creation, Preservation and Destruction, respectively.

In Taoism , the Three Pure Ones are the highest gods in the pantheon. They were usually depicted in the three basic colours – blue, red and yellow – to represent creation. The first Pure One represents the celestial or universal qi, or energy (find out more about what qi is in this Yin Yang article ). The second one represents the human plane qi, and the third one represents the Earth qi (inside the earth that is.)

Buddhism , a religion that focuses on wisdom instead of God, also groups its philosophical elements in threes, like the Three Gems (Buddha, Dharma, Sangha), the Three Roots called Trikaya, the Three Vajras…

And of course, there is the Trinity from Christianity , which states that God is a single being who exists simultaneously and eternally as three persons; the father, the son and the holy spirit. Moreover, there is the story of Jesus, the son of God, which is full of mentions of the number 3, like:

• The three wise men who gave the newborn Jesus three gifts.
• Jesus’ ministry lasted approximately three years.
• The devil attempts Jesus three times.
• St-Paul denied Jesus three times.
• St-Paul went blind for three days.
• Jesus died at the age of 33 .
• He resurrected after three days.

Now, this makes me ask myself … Is this all real? Could we just have become superstitious in the way we group elements and tell stories? Ok, I’ll admit, I myself am guilty of that; I prefer to place my candles in threes, and when I express my super excitement, I have to write my exclamation marks in three’s !!! Not 4, not 2.

Remember that rule of not taking pictures in groups of three?  Well, it’s actually an Asian superstitious belief that if you do take such a picture, the person in the middle will be leaving. I’m not too sure about the specifics of “leaving” though…

Heh he heh… (gulp) Well, I always assumed “leaving the country”.

Hey, I’m not the only superstitious one here. The famous Italian poet from the 1300s, Dante Alighieri, also liked to group things in threes;

• He did a trilogy about the different regions after death
• The three regions were: Heaven, Purgatory, and Hell
• The verses are in three lines

Superstitious or not, three does seem like a perfect number, not just esthetically but practically as well. Most of us say “on the count of 3”; 2 would be too short and 4 too long. The same goes for the number of tries one should do, like in baseball,  “3 strikes and you’re out”.

3 is practical and pleasant to the eye, and perhaps it is why we use it a lot. Maybe there’s more to it, so let’s look at it from a scientific point of view.

Number 3 from a Scientific Point of View

Mathematics.

The number 3 is the only number equal to the sum of the previous numbers.

1 2 3 4 5 6 7 8 9 10 11 …

The number 3 is also the only number whose sum with those below is equal to the product of itself and those below.

1 2 3 4 5 6 7 8 9 …

3 + 2 +1 = 3 x 2 x 1

Three is like a number that encompasses everything in its world!!

Fundamental elements are broken down into 3

• Life has three parts; birth, life and death.
• A story has three parts; beginning middle and end.
• And something as basic as a line has three parts (beginning, middle and end)

The most basic polygon (shapes made of lines) is the triangle. And all other polygons are made of triangles. The triangle is like the source of all polygons!

The triangle is said to be the most stable shape. It’s also the only polygon that can have all of its points at equal distance to one another. In other words, 3 points can be arranged graphically so that they are all in equal distance to one another. That can’t happen with any other number.

Until relatively recently, we knew the world as having 3 dimensions.

Three was recognized for its perfection but also for its usefulness. All colours are derived from the 3 base colours; blue, red, and yellow.

Family unit

Three composes the basic family unit; father, mother and child

Break a Tie

The number three is the smallest number to break a tie or consensus. It’s as if it takes three to go forward!

So we looked at some of the facts on the number three, but it’s hard to tell if Trinities and Triads of the past were consciously formed from these facts. Maybe they just came about naturally, because, in many ways, number three just seems right. Number three is regarded as perfection – mathematically, visually and practically. That could easily be the reason why the number 3 is prominent in world religions, tales, expressions and games. Still, all we can do is speculate. But one thing’s for sure; from the most ancient religions to the most modern practices, humanity has continued to find power in the number 3.

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What Does The Number 3 Mean? Symbolism and Significance of the Number 3

Numbers have long held a mystique, transcending mere mathematical values to become symbols embedded in our cultural, spiritual, and scientific narratives. Among these symbolic digits, the number 3 emerges as an enchanting entity, rich with profound meanings across various cultures, spiritual traditions, and scientific disciplines. Join us on a journey as we unravel the captivating symbolism of the number 3, delving into its multifaceted significance and exploring the roles it plays in shaping our understanding of the world.

The Symbolic Power of Three in Numerology:

At the heart of numerology, the study of mystical number symbolism, the number 3 is revered for its triadic harmony, balance, and dynamic energy. Often associated with creativity, expression, and communication, the number 3 embodies the synergy that arises when opposites come together to create a unified whole. In Western numerology, it is seen as a symbol of completeness and unity, a concept reflected in the Tarot card 'The Empress,' which is associated with fertility, creativity, and abundance.

Cultural Perspectives on the Number 3:

Cultures around the world ascribe profound meanings to the number 3. In Christianity, the Holy Trinity—Father, Son, and Holy Spirit—epitomizes the divine unity represented by the number 3. The concept of trilogy is prevalent in literature, with stories often unfolding in three parts, emphasizing a balance between beginning, middle, and end.

In Hinduism, the Trimurti consists of three principal deities—Brahma, Vishnu, and Shiva—symbolizing the cosmic processes of creation, preservation, and destruction. The power of three is also evident in Celtic symbolism, where the triquetra represents interconnectedness and unity.

Mathematics and the Triad:

Mathematically, the number 3 holds significance as the first odd prime number. Its role in geometry is pivotal, forming the basis of the triangle—a shape known for its stability and balance. Triangles abound in nature, art, and architecture, reflecting the mathematical beauty inherent in the number 3.

Spiritual Significance:

In spiritual traditions, the number 3 often signifies a transcendent, divine presence. The triad is considered a symbol of spiritual enlightenment, with many spiritual practices emphasizing the harmony between mind, body, and soul. Additionally, the power of three resonates in many rituals and ceremonies, underscoring the holistic nature of spiritual experiences.

Astrological Influences:

Astrologically, the third sign of the zodiac, Gemini, embodies the communicative, adaptable, and dualistic qualities associated with the number 3. Governed by Mercury, Gemini's influence emphasizes versatility and the ability to navigate dual perspectives. The astrological aspects of the number 3 extend to Jupiter, the planet associated with expansion and abundance.

Time and Cycles:

Philosophically, the number 3 is intertwined with the concept of time and cycles. The triadic nature of past, present, and future encapsulates the temporal journey of existence. This cyclic symbolism is echoed in the seasons—spring, summer, and fall—and the phases of the moon.

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Traits of this number

What’s the meaning and symbolism of the number 3.

Numerologists recognize that 3 is the number of the child – it symbolizes the growth and magic that results from the combination of two other things; it’s the metaphorical child brought forth from two parents, full of energy and possibility. This number is the fruit of your labors, it carries spiritual meaning , power and an abundance of energy that is SO much more than the sum of its parts.

BUT WHAT DOES THIS REALLY MEAN?

Your life and the number 3, lucky angel number 3, the number 3, rhythm and movement, the meaning of angel number 3 (three) and history, mythology, astrology, and religion, the angel number 3 (three) in numerology: step up to the stage, shadow traits of the number 3 (three).

Well, using the ancient art of Numerology, you can see that numbers are SO much more than just digits;  they hold unique vibrational patterns (or archetypes) and are containers of the currents of divine, universal life, in which we all flow.

Numbers can be used to describe everything from the DNA sequences that connect you to your ancestors, to your most ordinary and everyday encounters.

Everything in life has a sacred purpose, and numbers can help you figure out what that is. For this reason, we like to think of Numerology as  "decoding the voice of the Universe" .

As well as describing the world around you, numbers and their archetypal, spiritual energy will often serve as signposts, indicating the best decisions to make and the next steps to take. This means that getting to know their unique qualities can bring a huge amount of insight , reassurance, and guidance for you, whilst you navigate the path of your life.

Read on to discover more about this number or download your  free repeating numbers handbook here.

Our view of the world is separated so smoothly, so naturally, and in so many ways,  into three parts  that this number is an innate part of our experience. And what's more, is that it's our relationship to these three parts that is how we find our place and position in the world, at any time.

• Almost everything in life can (and is) separated into a beginning, a middle and an end.
• We live our lives through birth, life, and death.
• Time is measured through past, present, and future.
• The dimensions of the space we inhabit are measured through width, length and height.
• The Sun’s stages move through dawn, noon and dusk.
• The planting cycle of our food is also threefold: plant, harvest, dormant.
• The ancient matriarchal societies recognized the Moon’s three phases: waxing, full and waning
• The Goddess herself has three expressions: Virgin, mother and crone.

Three is often considered to be a lucky number.

• “Third time lucky”
• “One, two, three, GO!”
• “Hip Hip Hooray!”.
• “Going once, going twice…SOLD!”

Good things happen on three!

Stop and feel into the numbers for a moment. Two is not quite enough, whilst four seems too many. The perfection of three isn’t something which is learned necessarily, it’s an innate spiritual quality contained within the archetypes of the number. The old superstition of not walking underneath a ladder, lest you invite in bad luck actually stems from the ancient Egyptian belief that one should not “break a triangle’. The form of the triangle (appearing under the ladder) – the geometry of the angel number 3 (three) – was considered by the Egyptians as complete and perfect, and therefore not to be touched.

In religious ceremonies, incantations are repeated three times to be effective.

In natural magic, it’s well known that any spell that's cast, intending to cause harm will come back to get you threefold. (Any positive energy you put out also returns threefold - something worth remembering!)

In fact, this magic, almost supernatural power of the three is the essential, almost intangible spark that this number brings, like the invisible thread that links cause and effect; it’s what makes a joke funny or a lecture interesting, it is what’s conveyed in a knowing look or a painted masterpiece. The angel number 3 gives depth, it gives an extra dimension, to experiences.

Watch this short video on Why You Keep Seeing the Number 3 !

The 3 has rhythm, which gives it a flowing momentum, and the sense of being always aligned with the best possible outcomes!  It’s also a busy energy; from the “on your mark, get set, go!” that begins a race, to the gold, silver and bronze medals at the end. From the unceasing activity of a growing child to the “three times’ a charm” reminder of luck, it almost always represents motion , social activity, and creative ways of enhancing life and experience.

• Christianity is fundamentally based on the Trinity - the father, the son and the holy spirit.
• In the Bible, Jesus rose after three days in the tomb.
• The Sumerian Goddess Inanna rose from the dead after three days and three nights in the underworld.
• The ancient Sumatran chicken God Manuk Manuk laid three eggs, from which hatched the three worlds: the upper world (heaven), the lower world (earth) and the underworld.
• The Borromean rings is a centuries-old symbol of unity and is made up of three interlocking rings. But if one is removed, the other two will fall apart.
• In astrology, the planet Jupiter vibrates to the frequency of the three.
• The third sign of the Zodiac signs is Gemini ( where the Sun sails from May 21 – June 21 ).
• In Tarot, card number three is the Empress .
• Only the three primary colors are needed to mix all others.

In Numerology, it’s recognized that the angel number 3 – more than any other number – pertains to performance and expression!

People with this number in their Numerology charts – as the Life Path Number , Destiny (Expression) Number or Soul Urge Number are always on the lookout for fun, and bursting with self-confidence,  enthusiasm, and charm. In fact, the number three has a zeal for life that’s infectious. But it’s not all for show. Number three has highly creative energy, is very forward-focused and has many great interpersonal skills. As well as being willing to take the limelight, a person with this number in their chart will tend to be good at putting others at ease by reading the room, cracking just the right number of jokes and keeping the atmosphere light.

With such a happy-go-lucky personality, the three can sometimes suffer from not being taken seriously enough. They may miss out on opportunities, promotions or invitations because they’re perceived as not being serious enough. Not true. They just prefer to look on the bright side!

Such hugely positive enthusiasm for life and all its variety can make it tricky for number threes to settle down into developing the few interests, gifts, and talents that it would really serve them to master. A little like when you see the number fives, it’s super-important for the person who has an abundance of this energy in their life, to learn discipline (especially from a young age).

Another pitfall of the number 3, can be inauthenticity. This seems counterintuitive, being such expressive folks, but it’s common for threes to become so adept at playing the role they think others expect of them, that they lose touch with who they really are. So it’s not fakery, it’s simply “playing to the crowd”. Digging deep, and working through the self-criticism and judgment that rise is where number threes will find their greatest strength.

• Read about the Life Path Number 3 HERE.
• Read about the Soul Urge Number 3 HERE.
• Read about Angel Number 333 HERE.

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What’s the Real Meaning Behind Angel Number 3333?

Are you wondering why you keep seeing the number 3? Maybe you keep walking past door number 33, or waking up every morning to see 3:33 on the clock? Or have you been seeing the…

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Sir Gawain and the Green Knight

The perfect number: three’s significance in sir gawain and the green knight miranda pederson college.

Our lives are seemingly centered around numbers. We count the years we have been alive, recall events based on the numerical dates they occurred on, and organize our finances with the help of simple numbers. Life itself appears to be a quantifiable thing – easily arranged and manipulated by mere numbers. But what does this mean? Is there a reason why numbers take such a significant place in life? The poem Sir Gawain and the Green Knight written by an anonymous author possibly offers insight into what numbers, specifically a single number, could mean on the larger scale of human life. In Sir Gawain and the Green Knight, the prevalence of the number three exists as a juxtaposition to Sir Gawain’s imperfection to emphasize the contrast between perfection and imperfection.

First, a close examination of what the number three meant when this poem was written offers a new insight into the meaning of the number. To the modern reader, the prevalence of the number three in the poem would perhaps seem to be a mere elemental addition to the piece, an ornament, but in medieval times, the number three was more than a mere number. In early medieval times, numbers were recognized as being gateways for abstract and symbolic thinking and...

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Home — Essay Samples — Literature — The Divine Comedy — The Leitmotif of the Number Three in Dante’s Inferno

The Leitmotif of The Number Three in Dante's Inferno

• Categories: The Divine Comedy

About this sample

Words: 2099 |

11 min read

Published: Jul 2, 2018

Words: 2099 | Pages: 5 | 11 min read

"'It seems, if I hear right, that you can see/ beforehand that which time is carrying,/ but you're denied the sight of present things.'/ We see, even as men who are farsighted,/ those things,' he said, that are remote from us;/ the Highest Lord allots us that much light./ But when events draw near or are, our minds/ are useless; were we not informed by others,/ we should know nothing of your human state./ So you can understand how our awareness/ will die completely at the moment when/ the portal of the future has been shut'" (X, 97-108).

"Yet his Divine Comedy was written in the local Tuscan dialect; not in Latin. And although this work contains the universal concepts of the classical and Christian traditions, it is also a Florentine poem, replete with the particular values, emotions, and concerns of that tradition. The poet did not succeed in reconciling all of the contradictions between the two traditions, but his genius enabled him to surmount these discordant elements, and to create a magnificent synthesis combining ideal and reality, the universal and the particular" (215).

"One day, to pass the time away, we read/ of Lancelot.../ And time and time again that reading led/ our eyes to meet, and made our faces pale,/ and yet one point alone defeated us./ When we had read how the desired smile/ was kissed by one who was so true a lover,/ this one, who never shall be parted from me,/ while all his body trembled, kissed my mouth./ A Gallehault indeed, that book and he/ who wrote it, too; that day we read no more'" (V, 130-8).

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The number three.

• Word Count: 799
• Approx Pages: 3
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             In William Shakespeare's, Macbeth, the number three emerges most frequently, not necessarily in plain number form, but different renditions of it are present throughout the entire play. Shakespeare most likely inserted the threes to reveal more about Macbeth and himself to people who took the time to look. The threes can be interpreted through many processes, some of which deal with the numerology of the number three, spiritual terms dealing with the number three, or just the fact that they are repetitive. .              According to the numerology of the number three, the number three person should be cheerful, creative, artistic, religious, and love a challenge. Macbeth does not fit these descriptions very well, but William Shakespeare does. William Shakespeare was born a number three; he even shows the characteristics that a true number three should have. But, there are also other characteristics of the number three that Macbeth shares as well, such as number threes dislike restraints, they prefer being the authority to others, and they desire to raise to the top wherever they go. As said by the Indian numerological point of view on the number three, you are seen as Jupiter, the ruling planet. This goes along with the theory that a "positive three" can see himself as a King ruling over everyone. Even know we don't know the full name of Macbeth (which is how you determine what numerological number you are); it is assumed that he would also be a three, and if that were true, Shakespeare and Macbeth would share qualities of each other, which could have been what Shakespeare was aiming for, a distorted version of himself. In contrast, the number threes could have also been in the play for the sake of balancing the storyline out. In spiritual terms the number three is keen on harmony and the balance of life. Everything has balance in itself, and the threes were used to balance Macbeth.              In addition to the numerology and the spiritual point of view of the number three, it was apparent that events were frequently occurring three times as well.

• Page 1 of 3

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As of 2020, 20% of people residing in the United States of America (U.S.) lived in rural communities. Despite rural residents tending to be older, poorer, and having greater disease burden than their urban counterparts, the number of rural primary care providers continues to decline. Nearly 66% of U.S. Primary Care Health Professional Shortage Areas are designated as rural. Pharmacists can help address this shortage of rural primary care providers, often serving as providers of first-contact care; however, only 12% of U.S. pharmacists practice in rural communities. To help address this gap, in 2022 an elective Rural Pharmacy course was created at the University of Minnesota College of Pharmacy by a faculty member who has rural practice experience.

The course combines formal lectures, guest presentations by rural pharmacists and student interviews with additional rural pharmacists. For the 42 students enrolled in the course in 2022 and 2023, non-parametric statistics were used to compare the percentage of students who were raised in rural communities or who otherwise had extensive exposure to rural, and compare student interest ratings (1 to 7) about practicing/living rural at the beginning and end of the course. Students also wrote end-of-course reflection papers, commenting on the course and their interviews with rural pharmacists.

Across both years, 45% of the enrolled students had previous experience in rural communities. The net change in Rural Interest scores among students completing both questionnaires was + 5 in 2022 and + 2 in 2023, both non-significant differences. The largest shifts in student interest were from “Not Sure” at the start of the course to “Interested” or “Not Interested” at the end of the course, and from “Interested” to “Very Interested.” In their reflection papers nearly 60% of students reported being most impressed by their interviews with rural pharmacists.

Conclusions

A course addressing the benefits and challenges of practicing pharmacy in rural communities was well-received by pharmacy students. Even students who have little interest in living in a rural community can benefit from being introduced to rural culture, enabling them to provide more culturally-responsive care for patients from rural communities.

Peer Review reports

Introduction

The Unites States (U.S.) Census Bureau redefined “rural” for the 2020 census as communities with populations of fewer than 5,000 people (fewer than 2,000 housing units) and located more than 1.5 miles (2.4 km) from a high-density urban area. Based on this revised definition, 20% of the U.S. population in 2020 lived in rural communities [ 1 ]. The percentage of rural residents varied greatly by region, with only 11% of people in the West Region residing in rural areas, followed by 16% in the Northeast Region, 24% in the South Region and 26% in the Midwest Region [ 2 ]. At the extremes, fewer than 6% of people in California lived in rural areas, while nearly 65% of Vermont residents lived in rural areas [ 1 ]. In contrast, as of 2021 the U.S. Bureau of Labor Statistics reported that only 12% of the nation’s pharmacists practiced in nonmetro (rural) communities [ 3 ].

On average, rural residents tend to be older [ 4 ], poorer [ 5 ], experience greater disease burden [ 6 ] and lack health insurance or be underinsured [ 7 ] than residents of urban communities. The average age and disease burden among rural residents is increasing due to outmigration of young adults from rural to urban communities and the in-migration of older adults to rural communities following retirement [ 4 ]. Yet as the proportion of older residents in rural communities continues to increase, the availability of primary care providers in rural communities continues to decrease. Nearly 66% of Primary Care Health Professional Shortage Areas in 2023 are designated as rural [ 8 ]. Pharmacists can be part of the solution to address the existing and anticipated shortage of primary care providers in rural communities [ 9 ]. Rural pharmacists often serve as “providers of first-contact care” for patients who are seeking to self-treat a health condition [ 10 ]. Where self-treatment is inappropriate, the pharmacist is in a position to refer the patient to appropriate professional care.

This paper describes a new course taught in the Doctor of Pharmacy (PharmD) program in the University of Minnesota College of Pharmacy that introduces students to the unique benefits and challenges of practicing pharmacy in rural communities.

One college, two campuses

The University of Minnesota (UMN) is a public, research-intensive (Carnegie R1) institution. The UMN College of Pharmacy opened on the Minneapolis campus in 1892 [ 11 ]. Prior to 2003, the College of Pharmacy included four departments: Experimental & Clinical Pharmacology, Medicinal Chemistry, Pharmaceutics, and Pharmacy Care & Health Systems. However, to address a shortage of pharmacists in Greater Minnesota – counties outside of the seven-county Minneapolis-St. Paul Twin Cities Metro Area [ 12 ] – in 2003 the College of Pharmacy expanded its program 150 miles (241 km) north to Duluth on the University of Minnesota Duluth campus, adding a fifth department to the College, Pharmacy Practice and Pharmaceutical Sciences (PPPS).

The specific multi-campus model used by the UMN College of Pharmacy is somewhat unique among multi-campus pharmacy programs in the U.S. The PPPS department includes faculty representing Biochemistry and each of the major Pharmacy disciplines (Clinical Pharmacy, Medicinal Chemistry, Pharmaceutics, Pharmacology, Pharmacy Practice, and Social & Administrative Pharmacy). Didactic courses within the College are taught using videoconferencing technology, with classroom presentations/lectures originating from either Minneapolis or Duluth and being broadcast to the other campus.

The mission of the PPPS department includes preparing pharmacists to provide patient care in rural and Indigenous communities [ 13 ]. PPPS faculty embody this mission in all four areas of an academic health professions program, highlighting the unique health needs of rural residents in their teaching, addressing these needs through community-based participatory research [ 14 ], conducting service activities in rural communities, and providing clinical services. Until 2022, however, no single course in the College of Pharmacy’s curriculum was devoted specifically to rural health.

Rural pharmacy elective-course description and structure

To help address this gap in the College of Pharmacy curriculum, the author – a pharmacist who has practiced hospital, community and long-term care pharmacy in frontier/Indigenous communities in Alaska [ 10 ], Eastern Montana and Minnesota – created a two-credit elective course (two hours per week for 15 weeks) in Rural Pharmacy to introduce students to the benefits and challenges of living and practicing in rural communities. Development of the course was guided by the author’s teaching philosophy; to paraphrase Confucian philosopher Xun Kuang [ 15 ]: “Tell me and I will forget. Show me and I will remember. Involve me and I will understand.”

The Rural Pharmacy course was designed as a HyFlex course [ 16 ] that allows the learner to choose by which content delivery method they would like to learn. Learners in a Hyflex course may elect to attend a live class session in person in a classroom, may attend a live class session remotely via videoconference, or may learn online anytime. Each live class session is recorded to accommodate students who prefer to learn online during a given week, or throughout the entire course.

The Rural Pharmacy elective is a “modified” HyFlex design in that no in-person option is available. University of Minnesota College of Pharmacy faculty and students are accustomed to videoconferencing as a course delivery method, the college having used videoconference technology since 2003 to conduct live, in-person sessions for learners on campuses located 2.5 h apart from one other. Required and elective didactic courses delivered by videoconference are always recorded, enabling learners to view the recording at a more convenient time if they are unable to attend the live class session. Another reason that an in-person option for the Rural Pharmacy elective is not offered is that live course sessions are conducted in the evening to accommodate students from different years in the pharmacy program (P2 and P3) whose other courses are all on different schedules, and Minnesota’s frequent snowy and icy winter conditions are not always conducive to safe travel to and from campus, especially at night.

At the time of this writing, during the first three pre-clinical years University of Minnesota College of Pharmacy students are required to complete 15 credits of elective courses above and beyond their required courses. The Rural Pharmacy elective is open to students in the final two pre-clinical years of the PharmD program (P2 and P3), but enrollment is capped by the instructor at 25 students per offering. Live class sessions are conducted once weekly for two hours in the early evening by videoconference for all students, whether based in Duluth or in the Minneapolis-St. Paul Twin Cities area. The early evening hours avoid conflicts with students’ other courses, which are on different schedules between 8:00 am and 5:30 pm for both of the two years. Students are encouraged to attend as many live videoconference sessions as possible, especially when a guest presenter is scheduled; however, as noted above all class sessions are recorded for viewing or reviewing at a more convenient time. The recordings accommodate students who may be working in a pharmacy as a Pharmacy Intern or Pharmacy Technician at the time class is scheduled, or students who desire to review one or more recorded class sessions prior to the written midterm examination.

A University of Minnesota Post-Graduate Year 1 (PGY1) Rural Pharmacy Resident [ 17 ] serves as the Teaching Assistant for the course each year, participating in the live class sessions via videoconference. The Pharmacy Resident is based out of a rural community in central Minnesota, traveling to two other rural communities and providing comprehensive medication management services [ 18 ] to residents of all three communities. While maintaining patient confidentiality, the Resident shares with students their experiences caring for patients in rural communities, some stories being only a few hours old. In addition to regularly participating in live class sessions, the TA prepares and leads a class session on their own, and conducts the live session interviews with guest rural pharmacists as described below.

About half of the class sessions feature guest pharmacists who currently practice in rural communities, guests joining the live class sessions via videoconference. When a guest pharmacist is invited to participate in the course, the instructor provides the pharmacist with a list of potential interview questions that they would be asked to address during the class session. On rare occasions the visits with pharmacist(s) are pre-recorded either to better accommodate the pharmacist’s work schedule or because of time zone differences between Minnesota and the states where the pharmacists live/work. Pre-recorded interviews are played during the live class session, and students submit questions they would have asked the pharmacist had the pharmacist been able to join the class session in real time. Those questions are then summarized by the instructor and forwarded to the guest pharmacist to respond to as the pharmacist’s time allows. Pharmacists living and practicing in rural and Indigenous communities from throughout Minnesota and from as far away as Alaska have participated in the live sessions, either pre-recorded or in real time. In addition to rural pharmacists, guest presenters have included Advance Practice Nurses [ 19 ] from rural communities, and a Biologist who works with an Indigenous community on the impacts of climate change on the health of the community.

A variety of assessments are utilized in the course including reflection papers, an online multiple-choice/true–false/short answer midterm exam, written participation in online discussions, in-class student presentations and written summaries of interviews with pharmacists practicing in rural communities. The course is graded on a A,B,C,D,F letter grade scale. A total of 300 points are available across nine activities in the course, ranging in value from 5–50 points. The grading scale used in the course is the professional scale used in all of the college’s courses, an A grade being attained by students who earn at least 93% of the available points while students earning fewer than 60% of available points do not receive a passing grade. The possible number of points available on individual assignments are assigned by the instructor based on the amount of time and effort students are expected to expend on the assignment as well as the quality of each assignment’s deliverable.

At the start of the course students complete a brief 7-point Likert-type questionnaire regarding their familiarity with rural communities and interest in possibly practicing in a rural community. The questionnaires are confidential rather than anonymous as students complete the same questionnaire again at the end of the course. The course director uses student names to match start-of-course and end-of-course questionnaires to measure changes in student attitudes. Students also write a brief paper describing their experiences with rural communities and the reason for their interest in learning (or learning more) about living and practicing in rural communities. The instructor uses this information to tailor presentations in the course for the entire class based on the students’ familiarity with rural communities. This information also familiarizes the instructor with students’ backgrounds, enabling the instructor to invite specific students to share their rural experiences as relevant opportunities arise during live class sessions. The initial questionnaire and interest paper collectively constitute 8.37% of the course grade.

The online midterm examination is based on material provided in the textbook [ 20 ] or during instructor or Resident presentations. Students are tested on their knowledge about what constitutes “rural” as defined by several different U.S. government agencies, rural culture, challenges in rural public health, and opportunities and challenges related to practicing pharmacy in rural communities. The midterm exam score constitutes 16.7% of the course grade.

As mentioned previously, the HyFlex nature of the course accommodates students who are unable to attend the live videoconference sessions. All students, however, participate in weekly written online discussions based on the live videoconference session from that week. Live sessions are recorded so that any student may view and listen to the session at their leisure. In the online discussion, students are asked to respond to an instructor-generated question based on that week’s live class session. Students are asked to post their response first, then comment on the response of at least one other classmate. The Canvas learning management system [ 21 ] facilitates this learning approach, providing the instructor the option to require a student to post their response before reading the responses of classmates. Students who post their responses by the weekly deadline receive full participation credit for the week, rather than being graded on the length of their response or on the number of responses they make to classmates’ postings. As a HyFlex course, students are not awarded extra points for attending the live videoconference session, nor are they penalized for not participating in the live videoconference session. Participation constitutes 16.7% of the course grade.

Indigenous people began living in what today is referred to as Minnesota some 13,000 years ago. Among the earliest identifiable tribes in Minnesota were the Dakota (Sioux) circa 1000 CE and the Anishinaabe (Chippewa, Ojibwe) who arrived in the mid-1700s [ 22 ]. Today, Minnesota is home to four Dakota and seven Anishibaabe reservations [ 23 ], most of these communities being located in rural or frontier Minnesota counties. In contrast to these early inhabitants whose ancestors have lived in Minnesota for hundreds of years, today foreign immigrants are arriving in Minnesota in increasing numbers [ 24 ]. Many of these new arrivals settle in communities outside of the Twin Cities Metro Area [ 25 ]. This spectrum of diversity underlies the importance for healthcare providers to learn to provide culturally-responsive care [ 26 ]; therefore, students in the course learn about Indigenous people or foreign-born immigrants they might encounter if practicing in rural Minnesota. Each student is assigned a particular culture (not their own), and through readings about and/or interviews with members from that culture prepares a brief presentation they share with the class during a live videoconference session. Again, because this is a HyFlex course a student who knows in advance that they will be unable to attend class when they are scheduled to present are able to pre-record their presentation. Pre-recorded student presentations are played during the live course session. This exercise constitutes 16.7% of the course grade.

As students in this course are training to become pharmacists, they interview pharmacists who currently practice in rural communities (or who have practiced in a rural community in the recent past). These interviews supplement the rural pharmacy practice stories provided by the instructor, the Resident, and the pharmacists who present during class videoconference sessions. Most, but not all, of the pharmacists who participate in the course are the instructor’s former students from the UMN College of Pharmacy, Duluth. In addition to pharmacists with practice experience in rural Minnesota, pharmacists in the instructor’s circle of contacts from rural Alaska, Wisconsin and Michigan have participated in the course, as have pharmacists from four different rural Indian Health Service [ 27 ] /Tribal Health Clinics. Potential pharmacist participants are contacted by the course instructor before the course begins to gauge their interest and willingness to participate in a live class session or be interviewed by the students, and are provided with the list of interview questions that will be asked. Characteristics and practice settings of the pharmacists who participated during the first two offerings of the course are presented in Table  1 .

The instructor assigns the students to interview teams of two to three students who conduct structured interviews with the rural pharmacists who practice in community, critical access hospital [ 28 ], health system hospital or Indian Health Service/Tribal Health settings. Each student is assigned to one team to interview a community pharmacist, and then to a different team to interview the health system pharmacist. Where possible, teams are structured to reflect gender diversity and include students from different years in the pharmacy program. Each student team contacts their assigned pharmacist and schedules a telephone or videoconference interview. Interviews are intended to last no more than 30 min, but oftentimes go longer as the conversations between the students and the pharmacist range far beyond the structured questions provided by the instructor.

Each student submits written summaries of their two interviews. Each interview team provides informal presentations about their interviews to the class during a live videoconference class session. Each interview assignment constitutes 16.7% of the course grade.

At the end of the course, students once again complete the 7-point Likert-type questionnaire regarding their interest in possibly practicing in a rural community. The numerical results from this questionnaire are compared to the numerical results of the interest questionnaire that the student completed at the start of the course. Each student also writes a brief reflection paper regarding what they learned in the course about practicing pharmacy in a rural community, and what aspect of the course they found most interesting/helpful in their learning. As with the similar assignments at the beginning of the course, the final questionnaire and final reflection paper constitutes 8.37% of the course grade.

Rural pharmacy elective-topics

Topics presented in the course are listed in Table  2 . Topics for didactic sessions early in the course are based on selected chapters from the textbook required for the course, Foundations of Rural Public Health in America (2022), by Joseph N. Inungu and Mark J. Minelli [ 20 ]. The course also features interdisciplinary and interprofessional components. As noted earlier, one guest presenter is a PhD Biologist employed by one of Minnesota’s American Indian tribes. That individual addresses Climate Justice, explaining the impact of climate change on rural Indigenous communities. Also as noted earlier, a group of rural Advanced Practice Nurses in different subspecialties present a panel session addressing the challenges faced by the communities they serve, and describe how they interact with rural pharmacists in their communities.

Assessing course outcomes

The percentages of students enrolled in the course on each campus who reported growing up in a rural community or having spent considerable time visiting relatives who lived in rural communities were compared using Fisher’s exact test [ 29 ]. For students completing rural interest questionnaires both at the beginning and the end of the course, rating scores from both years and both campuses were combined and paired. Given the ordinal nature of the data, beginning/end of course ratings were evaluated using the Wilcoxon signed-rank test [ 30 ]. A two-tailed alpha value of 0.05 was selected as the criterion to indicate significance in all numerical comparisons.

For the first offering of the course in Spring, 2022 a total of 25 students completed the course. Spring 2023 had 17 students in the course. The demographics of the students in these two cohorts are summarized in Table  3 .

Between the first two offerings of this course, 25 students on the Minneapolis campus enrolled in the course. Of these 25, 10 (40%) reported growing up in a rural community or having spent considerable time visiting relatives who lived in rural communities. Among the 17 Duluth students enrolled in the course between the two years, nine (53%) reported having grown up or otherwise spent considerable time in rural areas. This difference was not statistically significant.

At the beginning and end of the course, students rated their interest in living/practicing in rural community using a 7-point Likert-type scale ranging from “1-No interest” to “7-When can I start?!” The results from the 36 students who completed both the pre and post questionnaires are presented in Fig.  1 .

Interest in Practicing Pharmacy in Rural Communities ( n  = 36)

The total net change in Rural Interest scores across all students completing both questionnaires was + 5 in 2022 and + 2 in 2023, some student scores increasing, others decreasing, and still others remaining the same. Results of the Wilcoxon Signed-Ranks Test were non-significant ( z  = -1.5903; p  = 0.112).

The largest change in scores occurred in the “Not sure” category (middle choice), with only one student remaining unsure of their interest in practicing in a rural community at the end of the course compared to six students at the beginning of the course. Four students who selected “Not sure” at the start of the course expressed lower interest in practicing in a rural community at the end of the course, one of these students moving down three levels from “Not sure” to “No interest.” One student who had selected “Interested” at the beginning of the course also dropped three levels at the end of the course to “Slight interest.” In contrast, several students who had selected “Interested” at the start of the course moved up to “Very Interested” or “When can I start?!”.

At the end of the course, students were asked to reflect on the impact of the course on their interest in practicing pharmacy in a rural community. Among the 42 students enrolled in the course during the first two years, 25 students in their reflection papers explicitly expressed appreciation for being able to interview pharmacists currently practicing in rural communities, while 20 explicitly expressed appreciation for having rural pharmacists and other professionals as guest speakers during class sessions. Two word clouds were generated from students’ reflection papers, one based on student perceptions of the benefits of living/practicing in a rural community (Fig.  2 ), and the other based on student perceptions of the challenges of living/practicing in a rural community (Fig.  3 ).

Word cloud featuring perceived benefits of living and practicing pharmacy mentioned in Rural Pharmacy students’ end-of-course reflection papers. “Courtesy of FreeWordCloudGenerator.com”

Word cloud featuring perceived challenges of living and practicing pharmacy mentioned in Rural Pharmacy students’ end-of-course reflection papers. “Courtesy of FreeWordCloudGenerator.com”

Representative student comments excerpted from their reflection papers regarding what they had heard from rural pharmacists who participated in the course are provided below. Each student’s comment is followed by that student’s final rating of their interest in practicing pharmacy in a rural community (1 = No interest, 7 = When can I start?!):

Before this course I had no interest in practicing rural before but now I’d at least entertain the idea after speaking and interviewing pharmacists that did or currently practice there. (Student selected ratings of 1 and 2) Hearing so many amazing stories, pharmacists are truly more than just “pill counting” because a single pharmacy can connect them with other rural health professionals, expanding the capabilities of rural pharmacists…. (2) If you can dream it you can do it in rural pharmacy. (5) It was great to have [the pharmacist I interviewed] in my network, as [they] said I can contact [them] anytime with questions outside… [of] my interview. I learned that having many contacts in your network, especially in rural areas, is so important…. (6) This class stimulated a future career interest that I already had, but was not sure exactly how to get started and who to ask if I had any questions. I feel like I now have many resources to reach out to when it comes to my future career, which makes me incredibly happy and comfortable. (7)

Students also expressed appreciation for other aspects of the course, whether the students were interested in practicing in a rural community at the end of the course or not. Again, each student’s comment is followed by that student’s final rating of their interest in practicing pharmacy in a rural community (1 = No interest, 7 = When can I start?!):

Even if I do not practice as a rural pharmacist, I will value the exposure and learning that has come from the topics covered in this course. (3) To be frank, I never even entertained the idea of practicing as a rural pharmacist. I’ve always wanted to work in an urban ambulatory care setting…. I did not expect the class to be as eye opening as it truly was…. I’m much more open to serving in a rural community and may consider it strongly . (3) It would be a huge adjustment to move to a rural area since I have grown up in [an urban community] my whole life. I want to work in a rural community since it is rewarding, but it is difficult to leave family behind and essentially start a new life with new people. (4) This is a rural pharmacy class, but it did not feel biased towards only working rural…. I came into this class knowing that I had an interest in rural pharmacy, but I did not expect to come out of this class even more interested in what rural areas have to offer. (6) Before starting this course, I knew that I wanted to practice pharmacy in a rural community…. Many times during this course we stated, “When you’ve seen one rural community, you’ve seen one rural community.” I did not know how true this statement was before this course…. Despite their vast differences, one common underlying theme is the health disparities seen in rural areas. (7)

It is important that health professions students be introduced to rural culture, even if they are “never” going to live/practice in a rural community themselves. With 5–64% of states’ populations living in rural communities [ 1 ], the odds are good that at some point in their careers, health professionals living in large urban centers are going to care for patients who have come from rural communities to receive more specialized care than is available locally [ 31 ]. Being introduced to rural culture can help students provide more culturally responsive care [ 32 ] to patients from rural communities during their careers.

The purpose of this course was to introduce pharmacy students to the advantages and challenges of practicing and living in rural communities. The course was not intended to “change hearts and minds” of students regarding their possible interest in practicing in a rural setting, and as can be seen from the results, students’ “interest in rural” ratings collectively neither significantly increased nor decreased between the beginning and the end of the course. Regardless, from comments in their reflection papers students generally appreciated the course, finding the interviews with rural pharmacists to be particularly valuable. This finding was heartening to the instructor who was initially concerned about the amount of out-of-class work being asked of the students.

Likewise, guest presenters who participated in the live class sessions and pharmacists interviewed by the students informally expressed their satisfaction with participating in the course, and expressed gratitude that this course was being offered. One pharmacist who previously practiced in a remote Alaska community but had recently moved to a major urban center in the “Lower 48” (Alaskan reference to states in the contiguous United States south of the 49th Parallel) expressed how much they enjoyed sharing their stories with the Rural Pharmacy students. The students with which this pharmacist currently works all desire to practice in large urban centers and are not particularly interested in hearing about the pharmacist’s experiences practicing in small, isolated communities. Another pharmacist noted that they really appreciated joining the students virtually in the live classroom, and was going to recommend this approach to other pharmacy schools with which they work as a way to generate interest in rural pharmacy in general, as well as interest in their particular pharmacy as a clinical rotation site.

A few changes were made in the roster of pharmacists participating in the course from year to year; however, most of the guest speakers and pharmacists who were interviewed by the students participated in the course both years. Another change being considered for the next offering of the course is to add a live videoconference session with a Minnesota Department of Agriculture “Farm Counselor” (a Licensed Professional Counselor) who makes in-person “farm calls” to address farm families’ mental health needs within the unique context of farm culture [ 33 ] (MN Dept of Ag, 2023).

A course specifically addressing the benefits and challenges of practicing pharmacy in rural communities was well-received by pharmacy students enrolled in the course, and by the rural guest presenters and rural pharmacists who were interviewed by the students. Even students who have little interest in living or practicing in a rural community can benefit from being introduced to rural culture, helping all students provide more culturally-responsive care for patients from rural communities.

Availability of data and materials

The data analyzed during the current study are not publicly available due to stipulations in the U.S. Family Educational Rights and Privacy Act (FERPA), but are available in de-identified form from the corresponding author on reasonable request.

Abbreviations

Students enrolled in years 1, 2 or 3 of the Doctor of Pharmacy (PharmD) program

Post-Graduate Year 1

Doctor of Pharmacy

Doctor of Philosophy

Pharmacy Practice and Pharmaceutical Sciences

Teaching Assistant

University of Minnesota

United States of America

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Timothy P. Stratton

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T.P.S. solely conceived and undertook all aspects of this project and preparation of this manuscript.

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TPS is Professor of Pharmacy Practice in the University of Minnesota College of Pharmacy, Duluth. He has practiced community, hospital and long-term care pharmacy in frontier communities in Southeast Alaska, and at Indian Health Service/Tribal Health clinics in frontier Alaska and eastern Montana, and in rural Minnesota. He is a member of the Rural Pharmacy Consortium , a Past Chair of the Small and Rural Hospital Section Advisory Group for the American Society of Health-System Pharmacists, and a Past President of the Minnesota Rural Health Association.

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Stratton, T.P. For the rural curious: mixed methods evaluation of a rural pharmacy practice elective. BMC Med Educ 24 , 573 (2024). https://doi.org/10.1186/s12909-024-05539-3

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Received : 18 September 2023

Accepted : 08 May 2024

Published : 24 May 2024

DOI : https://doi.org/10.1186/s12909-024-05539-3

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