Jamieson Jean L, Kernahan Jill, Calam Betty, Sivertz Kristin S
University of British Columbia, Vancouver, British Columbia, Canada.
Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
Rural Remote Health. 2013 Oct-Dec;13(4):2496. Epub 2013 Dec 13.
Numerous strategies have been suggested to increase recruitment of family physicians to rural communities and smaller regional centers. One approach has been to implement distributed postgraduate education programs where trainees spend substantial time in such communities. The purpose of the current study was to compare the eventual practice location of family physicians who undertook their postgraduate training through a single university but who were based in either metropolitan or distributed, non-metropolitan communities.
Since 1998, the Department of Family Practice at the University of British Columbia in Canada has conducted an annual survey of its residents at 2, 5, and 10 years after completion of training. The authors received Ethics Board approval to use this anonymized data to identify personal and educational factors that predict future practice location.
The overall response rate was 45%. At 2 years (N=222), residents trained in distributed sites were 15 times more likely to enter practice in rural communities, small towns and regional centers than those who trained in metropolitan teaching centers. This was even more predictive for retention in non-urban practice sites. Among the subgroup of physicians who remained in a single practice location for more than a year preceding the survey, those who trained in smaller sites were 36 times more likely to choose a rural or regional practice setting. While the vast majority of those trained in metropolitan sites chose an urban practice location, a subgroup of those with some rural upbringing were more likely to practice in rural or regional settings. Trainees from distributed sites considered themselves more prepared for practice regardless of ultimate practice location.
Participation in a distributed postgraduate family medicine training site is an important predictor of a non-urban practice location. This effect persists for 10 years after completion of training and is independent of other predictors of non-urban practice including gender, rural upbringing, and rural undergraduate training. It is hypothesized that this is due not only to a curriculum that supports preparedness for this type of practice but also to opportunities to develop personal and professional roots in these communities.
人们提出了许多策略来增加家庭医生到农村社区和较小区域中心的招聘人数。一种方法是实施分布式研究生教育项目，让学员在这些社区花费大量时间。本研究的目的是比较通过同一所大学进行研究生培训，但分别在大都市或分布式非大都市社区接受培训的家庭医生最终的执业地点。
自1998年以来，加拿大英属哥伦比亚大学家庭医学系在培训结束后的第2年、第5年和第10年对其住院医师进行年度调查。作者获得了伦理委员会的批准，使用这些匿名数据来确定预测未来执业地点的个人因素和教育因素。
总体回复率为45%。在第2年（N = 222），在分布式地点接受培训的住院医师进入农村社区、小镇和区域中心执业的可能性是在大都市教学中心接受培训的住院医师的15倍。这对于留在非城市执业地点更具预测性。在调查前一年以上一直留在单一执业地点的医生亚组中，在较小地点接受培训的医生选择农村或区域执业环境的可能性是其他人的36倍。虽然在大都市地点接受培训的绝大多数人选择城市执业地点，但有一些农村成长经历的亚组更有可能在农村或区域环境中执业。无论最终执业地点如何，来自分布式地点的学员都认为自己为执业做好了更充分的准备。
参与分布式研究生家庭医学培训地点是在非城市执业地点工作的一个重要预测因素。这种影响在培训结束后持续10年，并且独立于其他非城市执业的预测因素，包括性别、农村成长经历和农村本科培训。据推测这不仅是由于支持此类执业准备的课程，还由于在这些社区发展个人和职业根基的机会。
