Clark Nina M, McClure Paul, Erickson Aaron, Andrilla Holly A, Riha Gordon, Dennis Ashley, Stewart Barclay T, Lynge Dana C, Patterson Davis G
Department of Surgery, University of Washington, Seattle, WA.
School of Medicine, University of Washington, Seattle, WA.
Ann Surg. 2025 Aug 1;282(2):186-192. doi: 10.1097/SLA.0000000000006696. Epub 2025 Mar 19.
To evaluate associations between rural training exposure during surgical residency and eventual practice in a rural community, and whether specific types of exposure were more likely to yield rural surgeons.
Growing deficits in the rural surgery workforce have prompted increased attention toward rural training. However, the association between exposure to rural surgery during residency and practice in rural communities remains limited.
We performed a retrospective cohort study of U.S. general surgery residency graduates from 2011 to 2020. Program information was abstracted from residency websites, the American College of Surgeons, and the American Medical Association. A survey distributed to programs and direct review of residency websites were used to characterize the type of rural surgery exposure offered to trainees. We evaluated associations between exposure to rural surgery in training and ultimate practice in a rural location.
Of 11,407 surgeons, 6.2% reported working in rural communities. Graduates of programs with rural training, according to residency websites or the American College of Surgeons, were more likely to work in rural areas [odds ratio: 1.81 (95% CI: 1.32-2.49) and 2.09 (1.28-3.40)]. Rurally located programs, rural rotations, and programs with a rural mission were associated with greater odds of graduates working in rural areas ( P < 0.05 for all). Rural tracks were not associated with more rural graduates.
Among graduates of general surgery residency programs, rural exposures during training were associated with eventual practice in rural communities. Programs with rural missions, in rural locations, or offering rural rotations produced graduates who were more likely to work in rural areas, while rural track programs did not, highlighting the need for further study of individual rural exposure to establish effective training paradigms. Specific policies facilitating rural exposure and surgical programs in rural communities may be effective methods for addressing workforce deficits.
评估外科住院医师培训期间农村培训经历与最终在农村社区执业之间的关联，以及特定类型的经历是否更有可能培养出农村外科医生。
农村外科劳动力日益短缺，促使人们更加关注农村培训。然而，住院医师培训期间接触农村外科手术与在农村社区执业之间的关联仍然有限。
我们对2011年至2020年美国普通外科住院医师培训毕业生进行了一项回顾性队列研究。项目信息从住院医师培训网站、美国外科医师学会和美国医学协会中提取。通过向项目发放调查问卷以及直接查看住院医师培训网站，来描述提供给学员的农村外科手术接触类型。我们评估了培训期间接触农村外科手术与最终在农村地区执业之间的关联。
在11407名外科医生中，6.2%报告在农村社区工作。根据住院医师培训网站或美国外科医师学会的数据，有农村培训经历项目的毕业生更有可能在农村地区工作[优势比：1.81（95%置信区间：1.32 - 2.49）和2.09（1.28 - 3.40）]。位于农村的项目、农村轮转以及有农村使命的项目与毕业生在农村地区工作的更高几率相关（所有P < 0.05）。农村培训路径与更多农村毕业生无关。
在普通外科住院医师培训项目的毕业生中，培训期间的农村经历与最终在农村社区执业相关。有农村使命、位于农村或提供农村轮转的项目培养出的毕业生更有可能在农村地区工作，而农村培训路径项目则不然，这凸显了需要进一步研究个体农村经历以建立有效的培训模式。促进农村接触和农村社区外科项目的具体政策可能是解决劳动力短缺的有效方法。
