Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Med Educ. 2020 Feb;54(2):162-170. doi: 10.1111/medu.14015. Epub 2019 Dec 10.
Medical schools of geographically large nations have expanded into rural areas to facilitate the development of a sustainable rural pipeline of physicians. Preceptor, or clinical teacher, recruitment at these sites has been an ongoing challenge. However, residents-as-teachers (RaT) curricula have not been modified to support the development of rural teachers. This study aimed to compare teaching opportunities between rural and urban family medicine residents and to identify mechanisms underlying potential differences.
Year-1 and Year-2 family medicine residents at seven Canadian institutions participated in a mixed-methods study utilising a quantitative survey and a qualitative interview. Rural and urban residents rated the quantity and types of teaching opportunities available during their training, from which a chi-squared analysis was completed. Volunteer respondents participated in a structured interview, from which a thematic analysis was performed.
Rural family medicine residents had fewer opportunities to teach compared to their urban colleagues. This discrepancy was seen across multiple domains, including informal opportunities when on family medicine rotations, χ (4, n = 242) = 45.26, P < .000, Bonferroni's adjusted P < .000. Thematic analysis centred around determining factors influencing teaching opportunities and identified that the academic context, personal factors and programme factors were key dimensions. Within these dimensions, the number of medical students, a desire to be an educator and administrative support were cited as influences on teaching opportunities.
The lack of teaching opportunities for rural trainees is attributable to a combination of practical and organisational factors revealed through thematic analysis. If rural graduates are not comfortable balancing the demands of service and teaching, this could compound the already prevalent issue of rural preceptor recruitment. It is essential to develop a rural-focused RaT curriculum to close this gap and produce competent educators who are ready to inspire generations of rural physicians.
地域辽阔的国家的医学院校已经向农村地区扩展，以促进可持续的农村医生队伍的发展。在这些地点招聘导师或临床教师一直是一个持续存在的挑战。然而，居民作为教师（RaT）课程并未进行修改以支持农村教师的发展。本研究旨在比较农村和城市家庭医学住院医师之间的教学机会，并确定潜在差异的根本机制。
来自加拿大七所机构的第一年和第二年家庭医学住院医师参与了一项混合方法研究，使用了定量调查和定性访谈。农村和城市居民对他们培训期间可获得的教学机会的数量和类型进行了评分，从中完成了卡方分析。志愿受访者参加了结构化访谈，从中进行了主题分析。
与城市同事相比，农村家庭医学住院医师的教学机会较少。这种差异在多个领域都存在，包括家庭医学轮转期间的非正式机会，χ（4，n=242）=45.26，P<.000，经 Bonferroni 校正后的 P<.000。主题分析集中在确定影响教学机会的因素上，确定了学术背景、个人因素和计划因素是关键维度。在这些维度中，医学生的数量、成为教育者的愿望和行政支持被认为是影响教学机会的因素。
农村受训者缺乏教学机会的原因是多方面的，包括通过主题分析揭示的实际和组织因素。如果农村毕业生不适应平衡服务和教学的需求，这可能会加剧农村导师招聘已经普遍存在的问题。必须制定以农村为重点的 RaT 课程，以缩小这一差距，并培养有能力的教育者，为农村医生的一代又一代提供灵感。
