Thach Sarah B, Hodge Bryan, Cox Misty, Parlier-Ahmad Anna Beth, Galvin Shelley L
Rural Health Initiative, Mountain Area Health Education Center, Asheville, NC.
Hendersonville Family Medicine Residency Program, Mountain Area Health Education Center, Hendersonville, NC.
Fam Med. 2018 Oct;50(9):685-690. doi: 10.22454/FamMed.2018.972692.
Rural health disparities are growing, and medical schools and residency programs need new approaches to encourage learners to enter and stay in rural practice. Top correlates of rural practice are rural upbringing and rurally located training, yet preparation for rural practice plays a role. The authors sought to explore how selected programs develop learners' competencies associated with rural placement and retention: rural life, community engagement, and community leadership.
Qualitative, semistructured phone interviews (n=20) were conducted with faculty of medical schools or family medicine residencies across the United States, Canada, Australia, and South Africa in which success in training rural practitioners was identified in the literature or by leaders of the National Rural Health Association's Rural Medical Educators Group. Participants included 18 physician program directors, one nonphysician program administrator, and one PhD researcher who had studied rural preparation. Interview transcripts were read twice using an inductive process: first to identify themes, and then to identify specific strategies and quotes to exemplify each theme.
Participants' recommendations for rural preparation were: (1) Be intentional about strategies to prepare learners for rural practice; (2) Identify and cultivate rural interest; (3) Develop confidence and competence to meet rural community needs; (4) Teach skills in negotiating dual relationships, leading, and improving community health; and (5) Fully engage rural host communities throughout the training process.
Medical schools and residencies may increase the likelihood of producing rural physicians by implementing these experts' strategies. Educators may select strategies that mesh with the structure and location of their training program.
农村地区的医疗差距正在扩大，医学院校和住院医师培训项目需要新的方法来鼓励学员投身并留在农村医疗实践中。农村医疗实践的首要相关因素是在农村长大以及在农村地区接受培训，但农村医疗实践的准备工作也发挥着作用。作者试图探讨某些项目如何培养学员与农村安置和留任相关的能力：农村生活、社区参与和社区领导力。
对美国、加拿大、澳大利亚和南非的医学院校或家庭医学住院医师培训项目的教员进行了定性的半结构化电话访谈（n = 20），这些教员在文献中或被农村卫生协会农村医学教育者小组的领导人认定为在培训农村医疗从业者方面取得了成功。参与者包括18名医师项目主任、一名非医师项目管理人员以及一名研究农村医疗准备工作的博士研究员。访谈记录采用归纳法阅读了两遍：首先确定主题，然后确定具体策略和引语以例证每个主题。
参与者对农村医疗准备工作的建议是：（1）有意制定策略，让学员为农村医疗实践做好准备；（2）识别并培养农村医疗兴趣；（3）培养满足农村社区需求的信心和能力；（4）教授处理双重关系、领导和改善社区健康的技能；（5）在整个培训过程中让农村接收社区充分参与。
医学院校和住院医师培训项目可以通过实施这些专家策略来提高培养农村医生的可能性。教育工作者可以选择与他们培训项目的结构和地点相契合的策略。
