Primary Care and Population Medicine Program, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
J Surg Educ. 2022 Mar-Apr;79(2):315-321. doi: 10.1016/j.jsurg.2021.09.001. Epub 2021 Sep 20.
There is a steady decline in the general surgery workforce in rural areas of the United States. In response, some surgery residency programs have developed rural tracks to encourage rural practice and adequately prepare trainees for this setting.
To compare the practice type and location of graduates from general surgery residency programs with and without a dedicated rural track between 2011-2020.
General surgery residency programs with and without a rural track were identified using the American Medical Association Residency and Fellowship Electronic Interactive Database and the Rural Surgery Program list from the American College of Surgeons. Graduates of these programs who entered general surgery practice between 2011-2020 were subsequently identified from individual residency program websites and tracked to their current practice setting using a Google search of first and last name and residency affiliation. Practice location was identified by zip code or county name and coded by Rural-Urban Continuum Codes (RUCC, Economic Research Service, USDA).
We identified 2,582 general surgery residency graduates from 2011 to 2020 across 66 residency programs. Of these graduates from programs without a rural track, 23.6% entered general surgery practice without additional fellowship training, compared to 34.0% from residency programs with a rural track (p = 0.019). Community or University-based program designation was not associated with decision to enter general surgery practice over fellowship training (p = 0.420). Proportion of graduates entering rural practice as defined by RUCC groups 7-9 was not associated with having a rural program track or with community or university-based program status.
Residency programs with a rural track produce a higher proportion of graduates entering general surgery compared to fellowship, though they are no more likely than programs without a rural track to produce graduates who ultimately practice in rural areas.
美国农村地区的普通外科劳动力持续减少。为此，一些外科住院医师培训计划设立了农村轨道，以鼓励农村实践，并为受训者做好充分准备。
比较 2011-2020 年期间具有和不具有专门农村轨道的普通外科住院医师培训计划的毕业生的实践类型和地点。
使用美国医学协会住院医师和研究员电子交互数据库以及美国外科医师学院的农村手术计划清单确定具有和不具有农村轨道的普通外科住院医师培训计划。从各个住院医师培训计划网站确定这些计划的毕业生，在 2011-2020 年期间进入普通外科实践，并通过使用 Google 搜索姓名和居住地点来追踪他们当前的实践地点。实践地点通过邮政编码或县名确定，并按农村-城市连续体代码（RUCC，美国农业部经济研究局）编码。
我们确定了 66 个住院医师培训计划中 2011 年至 2020 年的 2582 名普通外科住院医师培训毕业生。在没有农村轨道的培训计划中，23.6%的毕业生在没有额外专科培训的情况下进入普通外科实践，而有农村轨道的培训计划中则有 34.0%（p=0.019）。社区或大学为基础的计划指定与是否选择进入普通外科实践而不是选择专科培训没有关系（p=0.420）。根据 RUCC 组 7-9 定义的进入农村实践的毕业生比例与农村计划轨道或社区或大学为基础的计划地位无关。
具有农村轨道的住院医师培训计划产生的进入普通外科的毕业生比例高于进入专科培训的毕业生比例，尽管与没有农村轨道的培训计划相比，他们产生最终在农村地区执业的毕业生的可能性并不高。
