Bing-You Robert G, Trowbridge Robert L, Kruithoff Catherine, Daggett John L
Medical Education, Maine Medical Center, Portland, Maine, USA.
Maine Medical Center, Portland, Maine, USA.
Rural Remote Health. 2014;14(3):2944. Epub 2014 Aug 21.
Physician shortages in rural areas remain severe but may be ameliorated by recent expansions in medical school class sizes. Expanding student exposure to rural medicine by increasing the amount of prolonged clinical experiences in rural areas may increase the likelihood of students pursuing a career in rural medicine. This research sought to investigate the perspective of rural physicians on the introduction of a rurally based nine-month Longitudinal Integrated Clerkship (LIC).
In this mixed-methods study, nine physician leaders were interviewed from five Maine, USA, rural hospitals participating in an LIC. Semi-structured interviews were audiotaped and transcribed. Qualitative analysis techniques were used to code the transcripts and develop themes. Forty-seven participating rural LIC preceptors were also surveyed through an online survey.
Four major themes related to implementing the LIC model emerged: (1) melting old ways, (2) overcoming fears, (3) synergy of energy, and (4) benefits all-around. The faculty were very positive about the LIC, with increased job satisfaction, practice morale, and ongoing learning, but concerned about the financial impact on productivity.
The importance of these themes and perceptions are discussed within the three-stage model of change by Lewin. These results describe how the innovative LIC model can conceptually unfreeze the traditional Flexnerian construct for rural physicians. Highlighting the many stakeholder benefits and addressing the anxieties and fears of rural faculty may facilitate the implementation of a rural LIC. Given the net favorable perception of rural faculty of the LIC, this educational model has the potential to play a major role in increasing the rural workforce.
农村地区的医生短缺问题仍然严重，但医学院班级规模的近期扩大可能会有所改善。通过增加在农村地区的长期临床经验，让学生更多地接触农村医学，可能会增加学生从事农村医学职业的可能性。本研究旨在调查农村医生对引入为期九个月的农村纵向综合实习（LIC）的看法。
在这项混合方法研究中，对来自美国缅因州五家参与LIC的农村医院的九位医生领导者进行了访谈。半结构化访谈进行了录音和转录。使用定性分析技术对转录本进行编码并确定主题。还通过在线调查对47名参与农村LIC的带教老师进行了调查。
出现了与实施LIC模式相关的四个主要主题：（1）打破旧模式，（2）克服恐惧，（3）能量协同，（4）全面受益。教师们对LIC非常积极，工作满意度、职业士气和持续学习都有所提高，但担心对生产力的财务影响。
在Lewin的三阶段变革模型中讨论了这些主题和看法的重要性。这些结果描述了创新的LIC模式如何在概念上打破农村医生传统的Flexnerian模式。强调众多利益相关者的好处并解决农村教师的焦虑和恐惧可能会促进农村LIC的实施。鉴于农村教师对LIC的总体积极看法，这种教育模式有可能在增加农村劳动力方面发挥重要作用。
