Evans David V, Patterson Davis G, A Andrilla C Holly, Schmitz David, Longenecker Randall
Department of Family Medicine, University of Washington.
Fam Med. 2016 Sep;48(8):596-602.
Rural family physicians are in short supply. Rural training can promote rural practice, but the number of family medicine residencies with a rural focus, geographic distribution of training, and training content are poorly understood. This study identified rural-centric family medicine residencies, their training locations, and rurally relevant skills training provided.
The authors identified family medicine residencies offering rural tracks or in rural locations using FREIDA Online®, the American Osteopathic Association "Opportunities," and the American College of Osteopathic Family Physicians Residency Finder online databases. Program personnel completed a survey in 2013 about training locations and content.
Of 583, 171 (29%) family medicine residencies met inclusion criteria. A total of 131 returned surveys (77%). Fifty-eight programs (44% of respondents) required at least 8 weeks of rural training; results describe these rural-centric programs. Programs reported a mean of 43.6 weeks (SD 49.7) of required rural block rotations. Mean hours per week in required rural continuity clinic sessions were 14.3 (SD 12.2). Thirty-nine percent of block rotation sites, 31% of clinic sites, and 21% of full-time training sites reported as rural were urban according to Rural-Urban Commuting Area codes. Over 90% of programs provided training in orthopedic care and emergency skills. Fewer than 60% provided endoscopy and operative obstetrics training.
Though numerous family medicine residencies seek to produce rural physicians, most programs required fewer than 8 weeks of rural training. Programs varied substantially in rurally located training and rurally relevant content. Students seeking rural training should examine program curricula carefully.
农村家庭医生供不应求。农村培训可促进农村医疗服务，但以农村为重点的家庭医学住院医师培训项目数量、培训的地理分布以及培训内容尚不清楚。本研究确定了以农村为中心的家庭医学住院医师培训项目、其培训地点以及所提供的与农村相关的技能培训。
作者通过在线数据库FREIDA、美国骨科协会的“机会”以及美国骨科家庭医师学院住院医师查找器，确定提供农村培训路径或位于农村地区的家庭医学住院医师培训项目。项目人员于2013年完成了一项关于培训地点和内容的调查。
在583个家庭医学住院医师培训项目中，171个（29%）符合纳入标准。共131个项目回复了调查（77%）。58个项目（占受访者的44%）要求至少8周的农村培训；结果描述了这些以农村为中心的项目。项目报告所需农村集中轮转的平均时长为43.6周（标准差49.7）。农村连续性门诊所需的每周平均时长为14.3小时（标准差12.2）。根据城乡通勤区代码，39%的集中轮转地点、31%的门诊地点以及21%报告为农村的全职培训地点实际为城市。超过90%的项目提供骨科护理和急救技能培训。提供内镜检查和产科手术培训的项目不到60%。
尽管众多家庭医学住院医师培训项目旨在培养农村医生，但大多数项目要求的农村培训时间少于8周。各项目在农村培训地点和与农村相关的内容方面差异很大。寻求农村培训的学生应仔细查看项目课程。
