Bates Joanna, Grand'Maison Paul, Banner Sandra R, Lovato Chris Y, Eva Kevin W
J. Bates was professor emerita, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada, at the time this work was done; ORCID: http://orcid.org/0000-0001-6940-2946 .
P. Grand'Maison is professor, Departments of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Acad Med. 2021 Mar 1;96(3):409-415. doi: 10.1097/ACM.0000000000003560.
Physician shortages and maldistribution, particularly within family medicine, have led many medical schools worldwide to create regional medical campuses (RMCs) for clerkship training. However, Canadian medical schools have developed a number of RMCs in which all years of training (i.e., a combined model that includes both preclerkship and clinical training) are provided geographically separate from the main campus. This study addresses the question: Are combined model RMC graduates more likely to enter postgraduate training in family medicine and rural-focused programs relative to main campus graduates?
The authors used a quasi-experimental research design and analyzed 2006-2016 data from the Canadian Resident Matching Service (CaRMS). Graduating students (N = 26,525) from 16 Canadian medical schools who applied for the CaRMS match in their year of medical school graduation were eligible for inclusion. The proportions of graduates who matched to postgraduate training in (1) family medicine and (2) rural-focused programs were compared for combined model RMCs and main campuses.
Of RMC graduates, 48.4% matched to family medicine (95% confidence interval [CI] = 46.1-50.7) compared with 37.1% of main campus graduates (95% CI = 36.5-37.7; P < .001). Of RMC graduates, 23.9% matched to rural-focused training programs (95% CI = 21.8-25.9) compared with 10.4% of main campus graduates (95% CI = 10.0-10.8; P < .001). Subanalyses ruled out a variety of potentially confounding variables.
Combined model RMCs, in which all years of training take place away from the medical school's main campus, are associated with greater proportions of medical students entering family medicine postgraduate training and rural-focused training programs. These findings should encourage policymakers, health services agencies, and medical schools to continue seeking complements to academic medical center-based medical education.
医生短缺和分布不均，尤其是在家庭医学领域，已促使全球许多医学院创建地区性医学分校（RMC）进行临床实习培训。然而，加拿大医学院已发展出一些地区性医学分校，其所有年份的培训（即包括临床前和临床培训的联合模式）在地理位置上与主校区分开提供。本研究探讨了以下问题：相对于主校区毕业生，联合模式地区性医学分校的毕业生是否更有可能进入家庭医学和以农村为重点的研究生培训项目？
作者采用了准实验研究设计，并分析了来自加拿大住院医师匹配服务（CaRMS）的2006 - 2016年数据。在医学院毕业当年申请CaRMS匹配的16所加拿大医学院的毕业学生（N = 26,525）符合纳入条件。比较了联合模式地区性医学分校和主校区毕业生中匹配到（1）家庭医学和（2）以农村为重点的研究生培训项目的毕业生比例。
地区性医学分校的毕业生中，48.4%匹配到家庭医学专业（9�%置信区间[CI] = 46.1 - 50.7），而主校区毕业生的这一比例为37.1%（95% CI = 36.5 - 37.7；P <.001）。地区性医学分校的毕业生中，23.9%匹配到以农村为重点的培训项目（95% CI = 21.8 - 25.9），而主校区毕业生的这一比例为10.4%（95% CI = 10.0 - 10.8；P <.001）。亚分析排除了各种潜在的混杂变量。
所有年份的培训都在医学院主校区之外进行的联合模式地区性医学分校，与更高比例的医学生进入家庭医学研究生培训和以农村为重点的培训项目相关。这些发现应鼓励政策制定者、卫生服务机构和医学院继续寻求以学术医学中心为基础的医学教育的补充方式。
