Strategies to increase the enrollment of students of rural origin in medical school: recommendations from the Society of Rural Physicians of Canada.
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Biomedical subjects
Publications and source records attributed to James Rourke.
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CONTEXT: Many medical schools would like to provide students with opportunities to learn and perform practical research and to have positive rural learning experiences. Rural physicians often have research ideas, but may lack the skills or assistance to perform the research. PROGRAM DESCRIPTION: The unique Rural Summer Studentship Program (RSSP) at The University of Western Ontario (Western) places students with preceptors in small and mid-sized communities throughout Southwestern Ontario where they have an opportunity to perform rural health research, combined with clinical learning, for 8 weeks in the summer after the first or second year of medical school. Secretarial coordination, research assistant support and senior faculty supervision were provided. OUTCOMES: From 1999-2003 inclusive, 44 students have participated including eight who participated over two summers. Projects were carried out in more than 20 communities with over 30 preceptors. Already, two students have had their research published in peer-reviewed journals and six have presented at major conferences. Participating students indicated an increase in interest in rural and regional medicine and in their knowledge of rural and regional medicine and patient care. They rated the value of RSSP highly as part of their medical education, even compared with other electives/selectives. CONCLUSION: The RSSP model developed at Western provides a highly rated, successful combination of supported medical student research and clinical learning with preceptors in small and mid-sized communities.
CONTEXT: Changing medical education to realign it with societal needs has become a renewed priority in many countries. Advanced training in rural settings to prepare physicians to better serve rural areas has received particular attention around the world. Such initiatives are usually targeted at primary care practitioners. Few initiatives have been designed to enhance specialist training in a rural setting, let alone adapt specialist competency frameworks such as the CanMEDS roles of the Royal College of Physicians and Surgeons of Canada to non-urban medical education. ISSUE: We describe an innovation in medical training for rural competence for specialist physicians using the CanMEDS framework near London, Ontario, Canada. Since 1997, the University of Western Ontario has established its Multi-Specialty Community Training Network (MSCTN) to provide rural and regional training opportunities for specialty residents in anaesthesia, general surgery, internal medicine, paediatrics, obstetrics and psychiatry. It became the first program in Canada to fully adapt the new CanMEDS roles into learning objectives and evaluations. LESSONS LEARNED: Competency-based frameworks like CanMEDS are important because they provide a comprehensive tool to organize outcome-based curricula. The CanMEDS roles framework has been very useful in developing educational goals for rural/regional specialty resident rotations as well as forming a constructive basis for resident, preceptor, and program evaluations. Our experiences with this program may provide lessons for others planning training for specialists in rural settings, and those adopting the CanMEDS competency framework.
OBJECTIVE: Being of rural origin is one of the few predictors of whether medical students choose either family or rural practice as a career. This study investigates what proportion of applicants are of rural origin, what their grades are, and whether they are accepted. DESIGN: Mailed survey using the postal codes of Ontario medical school applicants' residences when they attended secondary school to link them to communities. Applicants of rural origin were defined as having attended secondary school while residing in communities with core populations of fewer than 10 000 people. SETTING: Province of Ontario, its six medical schools, and its 1 500 000 rural citizens (13% of the total population). PARTICIPANTS: All 4948 applicants to Ontario medical schools in 2002 and 2003 who had gone to high school in Ontario. MAIN OUTCOME MEASURES: Proportion of rural applicants among all applicants in the given years. Mean grade point averages (GPA) and Medical College Admission Test (MCAT) scores attained by applicants of both urban and rural origin. Proportion of rural students among all students admitted to medical schools. RESULTS: While 13% of the Ontario population is rural, only 7.3% of Ontario applicants to medical school were of rural origin (P < .001). On average, the GPAs of applicants of rural and urban origin were identical at 3.42 (P = .995 not significant [NS]). The MCAT scores averaged 8.9 for applicants of rural origin and 9.0 for applicants of urban origin (P = .36 NS). Applicants of rural origin were admitted to medical school as frequently as applicants of urban origin (1:5.6 vs 1:4.7, P = .139 NS). CONCLUSION: Although students of rural origin in Ontario apply to medical school less frequently than students of urban origin do, those that do apply have similar grades to those of urban applicants and are equally likely to be accepted.
In many countries the sustainability of rural healthcare systems is being challenged by a shortage of rural physicians and difficulties in recruiting and retaining physicians in rural practice. There are numerous factors that influence efforts in rural physician recruitment and retention, many of which are beyond the scope of the academic medical centre and medical education. Nevertheless, there are strategies that medical schools can adopt to contribute to efforts to recruit and retain physicians in rural communities. Rural student recruitment, admissions policies, rural-oriented medical curriculum, rural practice learning experiences, faculty values and attitudes, and advanced procedural skills training are areas which the medical school has direct control of and which have been shown to influence the likelihood of medical students entering rural primary care practice. The purpose of this paper is to elaborate on some of the key strategies that have been identified in the literature.
The relationships between rural health care and community development were examined over time, for the case-study area of Huron and Perth counties in Southwestern Ontario. The underlying premises were that an historical-geographic study could provide both a perspective on the development of rural health services and explore the interdependent relationship between rural community and health care. The research concentrated on examinations of the 2 key elements of rural health care, namely the rural practitioner and the community hospital. Detailed reconstruction revealed that, over time, both physicians and hospitals moved from a marginal to a central position and identity within the community, in parallel with the stages of community development in the 19th and 20th centuries, with hospitals emerging as major foci of rural sustainability. In the last 2 decades, the strength of the area's rural community health system was successfully marshalled to offset the potentially negative aspects of provincial health care restructuring. This reinforced both the perception and the reality of the interdependence of health services and communities in the predominantly rural area.
To address the increasing need for rural health practitioners, Canada is trying various methods of medical education, including community based residency streams, additional skills training and teamwork models. This paper discusses some of the factors that may affect the effectiveness of these methods.
OBJECTIVE: To compare the scope of practice and degree of personal and professional satisfaction of rural women family physicians with their rural male, urban female, and urban male counterparts. DESIGN: Cross-sectional mailed survey. SETTING: Rural and urban Ontario family practices. PARTICIPANTS: A total of 442 rural and urban family physicians. MAIN OUTCOME MEASURES: Personal and professional characteristics, scope of practice, and degree of personal and professional satisfaction. RESULTS: Rural women family physicians' scope of practice is as broad as that of rural men, and the women are more likely to attend births. They work many more hours on average than their urban counterparts. Rural women incorporate more professional activities into their practices than both male and female urban family physicians do, but they are less satisfied, both personally and professionally. CONCLUSION: Rural family practice provides a broad scope of practice for both women and men, but initiatives are needed to make rural practice more professionally and personally satisfying for both women and men.
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