Halaas Gwen W
Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Rural Remote Health. 2005 Apr-Jun;5(2):453. Epub 2005 Jun 15.
The Rural Physician Associate Program (RPAP) has trained 1063 medical students in rural communities for the past 34 years and produced 658 primary care physicians and 521 physicians who currently practice in rural communities. While the students' experience in this nine-month clerkship is primarily clinic-based, they see patients in the emergency room, assist in surgery, deliver babies, attend physician meetings and participate in community health education. They experience real continuity of care by following a patient from the clinic or emergency room to the operating room and throughout their recovery. They diagnose a pregnancy, deliver the baby and then do the well-child examination in the clinic. The students recognize the value of this experience, as expressed in their final essays. They value the mentoring of the physicians, the relationship with the patients and the experiences in health care in which they play integral part. While the trend toward primary care in medical education is decreasing, the outcome of the RPAP program is holding steady at approximately 80%. Selection is certainly a factor, because many of the students who apply for RPAP have already expressed an interest in primary care. Additionally, the mentoring relationship with their preceptor, professionally and personally, and the ability to observe the lives of other practising physicians provides a reality check that may guide decisions. The enthusiasm for teaching, and the significant engagement with and impact on the community of the physicians may be another factor in deciding on primary care. Practising alongside physicians who find intellectual challenge and rewarding relationships in primary care is essential in continuing to produce primary care physicians of future.
在过去的34年里，农村医师助理项目（RPAP）已经在农村社区培训了1063名医学生，培养出了658名初级保健医生以及521名目前在农村社区执业的医生。虽然这些学生在为期九个月的临床实习中的经历主要以诊所为基础，但他们会在急诊室看诊、协助手术、接生、参加医师会议并参与社区健康教育。他们通过跟踪患者从诊所或急诊室到手术室以及整个康复过程，体验到真正的连续性护理。他们诊断出怀孕情况，接生婴儿，然后在诊所进行儿童健康检查。学生们在期末论文中表达了他们对这段经历价值的认可。他们重视医生的指导、与患者的关系以及他们在其中发挥不可或缺作用的医疗保健经历。虽然医学教育中初级保健的趋势在下降，但RPAP项目的成果稳定在约80%。选拔肯定是一个因素，因为许多申请RPAP的学生已经表达了对初级保健的兴趣。此外，与他们的指导教师在专业和个人方面的指导关系，以及观察其他执业医生生活的能力提供了一种现实检验，可能会指导决策。医生们对教学的热情以及与社区的大量互动和影响可能是决定从事初级保健的另一个因素。与在初级保健中找到智力挑战和有意义关系的医生一起执业，对于持续培养未来的初级保健医生至关重要。
