Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan, USA.
J Am Board Fam Med. 2010 Jan-Feb;23(1):59-66. doi: 10.3122/jabfm.2010.01.090167.
To address the shortage of physicians practicing in rural areas of Michigan, the Wayne State University School of Medicine developed an integrated rural core curriculum to interest students in rural practice careers. Here we focus on the evaluation strategy used to determine the extent to which students in the new rural medicine interest group who self-identified as selecting a rural clerkship or externship did secure a clinical training experience in a rural setting.
Three measures of rurality were compared to determine whether students were placed in rural training settings: (1) the percentage of the county living in rural areas; (2) a county-level dichotomous measure of rural/nonrural; and (3) a dichotomous measure based on urban area boundaries within the county. Practice address and geographic data were integrated into geographic information systems software, which we used to map out rural characteristics of Michigan counties through a process called thematic mapping; this shows characteristic variation by color-shading geographic features. In addition, reference maps were created showing the boundaries of urban areas and metropolitan/micropolitan areas. Once these processes were completed, we overlaid the practice location on the contextual-level geographic features to produce a visual representation of the relationship between student placement and rural areas throughout the state.
The outcome of student placement in rural practices varied by the definition of rural. We concluded that, although students were not placed in the most rural areas of Michigan, they received clerkship or externship training near rural areas or in semirural areas.
This process evaluation had a direct impact on program management by highlighting gaps in preceptor recruitment. A greater effort is being made to recruit physicians for more rural areas of the state rather than urban and semirural areas. Geographic information systems mapping also defined levels of ruralism for students to help them make informed selections of training sties. This is especially important for students who are not sure about a rural experience and might be discouraged by placement in a remote rural area.
为了解决密歇根州农村地区医生短缺的问题，韦恩州立大学医学院开发了一个综合农村核心课程，以激发学生对农村实践职业的兴趣。在这里，我们专注于评估策略，以确定在新的农村医学兴趣小组中，自我选择农村实习或外展实习的学生是否能够在农村环境中获得临床培训经验。
比较了三种农村衡量标准，以确定学生是否被安排在农村培训环境中：（1）农村地区居住的县的百分比；（2）县一级的农村/非农村二分法衡量标准；（3）基于县内城市区域边界的二分法衡量标准。实践地址和地理数据被整合到地理信息系统软件中，我们使用该软件通过主题制图过程来描绘密歇根州各县的农村特征；这通过颜色阴影地理特征显示特征变化。此外，还创建了参考地图，显示城市区域和大都市/都会区的边界。一旦完成这些过程，我们将实践地点叠加到上下文级地理特征上，以生成学生安置与全州农村地区之间关系的可视化表示。
学生在农村实践中的安置结果因农村定义的不同而有所不同。我们得出结论，尽管学生没有被安置在密歇根州最农村的地区，但他们在农村地区附近或半农村地区接受了实习或外展培训。
这种过程评估直接影响了项目管理，突出了导师招聘方面的差距。正在努力招募更多来自该州农村地区的医生，而不是城市和半农村地区。地理信息系统制图还为学生定义了农村程度，以帮助他们做出明智的培训地点选择。对于那些对农村体验不确定的学生来说，这一点尤为重要，他们可能会因为被安置在偏远的农村地区而感到沮丧。
