Lee Joseph, Walus Andrzej, Billing Rajeev, Hillier Loretta M
Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada.
Postgrad Med J. 2016 Aug;92(1090):436-40. doi: 10.1136/postgradmedj-2015-133577. Epub 2016 Feb 9.
Distributed medical education (DME) programmes, in which training occurs in underserviced areas, have been established as a strategy to increase recruitment and retention of new physicians following graduation to these areas. Little is known about what makes physicians remain in the area in which they train.
To explore the factors that contributed to family physician's decisions to practice in an underserviced area following graduation from a DME programme.
Semistructured inperson interviews were conducted with 19 family physicians who graduated from a DME residency training programme. Programme records were reviewed to identify practice location of DME programme graduates.
Of the 32 graduates to date from this DME programme, 66% (N=21) and all of the interview participants established their practices in this region after completing their residency training. Five key themes were identified from the interview analysis as impacting physicians' decisions to establish their practice in an underserviced area following graduation: familial ties to the region, practice opportunities, positive clerkship and residency experiences, established relationships with specialists and services in the area and lifestyle opportunities afforded by the location.
This study suggests that DME programmes can be an effective strategy for equalising the distribution of family physicians and highlights the ways in which these programmes can facilitate recruitment and retention in underserviced areas, including being responsive to residents' personal preferences and objectives for learning and shaping their residency experiences to meet to these objectives.
分布式医学教育（DME）项目是指培训在服务欠缺地区开展，该项目已被确立为一种策略，旨在增加新医生毕业后到这些地区工作的招聘人数并提高留任率。对于促使医生留在其培训地区的因素，人们知之甚少。
探讨促使家庭医生在完成DME项目毕业后在服务欠缺地区执业的因素。
对19名毕业于DME住院医师培训项目的家庭医生进行了半结构化的面对面访谈。查阅项目记录以确定DME项目毕业生的执业地点。
在该DME项目迄今的32名毕业生中，66%（N = 21）以及所有参与访谈的人员在完成住院医师培训后都在该地区执业。通过访谈分析确定了五个关键主题，这些主题影响着医生毕业后在服务欠缺地区执业的决定：与该地区的家庭关系、执业机会、积极的临床实习和住院医师培训经历、与该地区专科医生和服务机构建立的关系以及该地区提供的生活方式机会。
本研究表明，DME项目可以成为平衡家庭医生分布的有效策略，并突出了这些项目促进在服务欠缺地区招聘和留任的方式，包括响应住院医师的个人偏好和学习目标，并塑造他们的住院医师培训经历以实现这些目标。
