Pathman D E, Steiner B D, Jones B D, Konrad T R
Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7590, USA.
Acad Med. 1999 Jul;74(7):810-20. doi: 10.1097/00001888-199907000-00016.
To identify educational approaches that best prepare physicians for rural work and small-town living, and that promote longer rural practice retention.
In two mail surveys (1991 and 1996-97), the authors collected data from primary care physicians who had moved to rural practices nationwide from 1987 through 1990. A total of 456 eligible physicians responded to both surveys (response rate of 69.0%). The authors identified those features of the physicians' training that correlated with their self-reported preparedness for rural practice and small-town living, and with how long they stayed in their rural practices. Analyses controlled for six features of the physicians and their communities.
The physicians' sense of preparedness for small-town living predicted their retention duration (hazard ratio, 0.74, p < .0001), whereas their preparedness for rural medical practice did not predict their retention duration after controlling for preparedness for small-town living (hazard ratio, 0.92; p = .27). For the physicians who had just finished their training, only a few features of their training predicted either rural preparedness or retention. Residency rural rotations predicted greater preparedness for rural practice (p = .004) and small-town living (p = .03) and longer retention (hazard ratio, 0.43, p = .003). Extended medical school rural rotations predicted only greater preparedness for rural practice (p = .03). For the physicians who had prior practice experience, nothing about their medical training was positively associated with preparedness or retention.
Physicians who are prepared to be rural physicians, particularly those who are prepared for small-town living, stay longer in their rural practices. Residency rotations in rural areas are the best educational experiences both to prepare physicians for rural practice and to lengthen the time they stay there.
确定能使医生为农村工作和小镇生活做好最佳准备，并促进其在农村长期执业的教育方法。
在两次邮寄调查（1991年以及1996 - 1997年）中，作者收集了1987年至1990年期间全国范围内转向农村执业的基层医疗医生的数据。共有456名符合条件的医生回复了两次调查（回复率为69.0%）。作者确定了医生培训的那些特征，这些特征与他们自我报告的农村执业和小镇生活准备情况以及他们在农村执业的时长相关。分析对医生及其社区的六个特征进行了控制。
医生对小镇生活的准备感预测了他们的留任时长（风险比，0.74，p < 0.0001），而在控制了对小镇生活的准备情况后，他们对农村医疗执业的准备情况并不能预测其留任时长（风险比，0.92；p = 0.27）。对于刚完成培训的医生，其培训的仅有几个特征预测了农村准备情况或留任情况。住院医师农村轮转预测了对农村执业（p = 0.004）和小镇生活（p = 0.03）有更强的准备以及更长的留任时间（风险比，0.43，p = 0.003）。医学院校延长的农村轮转仅预测了对农村执业有更强的准备（p = 0.03）。对于有先前执业经验的医生，其医学培训中没有任何内容与准备情况或留任情况呈正相关。
准备好成为农村医生的医生，尤其是那些为小镇生活做好准备的医生，在农村执业的时间更长。农村地区的住院医师轮转是使医生为农村执业做好准备并延长他们在农村停留时间的最佳教育经历。
