Harvard Medical School, Boston, USA.
Massachusetts General Hospital, 100 Cambridge St STE 1600, Boston, MA, 02140, USA.
J Gen Intern Med. 2023 Aug;38(11):2607-2612. doi: 10.1007/s11606-023-08044-3. Epub 2023 Feb 2.
Rural communities in the USA on average experience higher mortality rates and greater physician shortages than urban communities, especially rural communities that are historically Black, American Indian, and Alaska Native. Graduate medical education resources in the USA are concentrated within teaching hospitals in non-rural settings. The federal government has recently established several pathways to expand rural graduate medical education. In the 2010s, most of the expansion and innovation in rural graduate medical education occurred in family medicine. In the 2020s, internal medicine has also begun to increase its rural graduate medical education footprint. Rural internal medicine residency training models include Rural Track Programs (RTPs), in which training is split between urban and rural training sites. RTPs, though the cornerstone of rural residency expansion in family medicine, raise complex issues in internal medicine. We review the structure of RTPs, alternate rural residency training pathways, and the facilitators and challenges of each pathway with respect to internal medicine training.
美国农村社区的平均死亡率和医生短缺率高于城市社区，尤其是那些历史上以黑人和美洲印第安人以及阿拉斯加原住民为主的农村社区。美国的医学研究生教育资源集中在非农村地区的教学医院。联邦政府最近建立了几条途径来扩大农村地区的医学研究生教育。在 21 世纪 10 年代，农村医学研究生教育的大部分扩展和创新发生在家庭医学领域。在 21 世纪 20 年代，内科也开始增加其农村医学研究生教育的足迹。农村内科住院医师培训模式包括 Rural Track Programs（RTP），其中培训分为城市和农村培训地点。RTP 虽然是家庭医学领域扩大农村住院医师培训的基石，但在内科领域却引发了复杂的问题。我们回顾了 RTP 的结构、替代农村住院医师培训途径，以及每种途径对内科培训的促进因素和挑战。
