The impact of urban-based family medicine postgraduate rotations on rural preceptors/teachers.

BACKGROUND: The use of rural rotations within urban-based postgraduate programs is the predominant response of medical education to the health needs of underserved rural populations. The broader impact on rural physicians who teach has not been reported. METHODS: This study examined the personal, professional, and financial impact of a rural rotations for urban-based family medicine (UBFM) residents on Canadian rural teaching physicians. A survey was created and reviewed by community and academic rural physicians and a cohort of Canadian rural family physicians teaching UBFM residents was sampled. Survey data and free-text responses were assessed using quantitative and qualitative analyses. RESULTS: Participants with rural residency backgrounds perceived a negative impact of teaching UBFM (p = 0.02 personal and professional) and those in a primary rural environment (as defined below) perceived impact as positive (p < 0.001). Rural preceptors often held contrasting attitudes towards learners with negative judgements counter-balanced by positive thoughts. Duration in practice and of teaching experience did not have a significant impact on ratings. CONCLUSION: Being a rural preceptor of UBFM residents is rewarding but also stressful. The preceptor location of training and scope of practice appears to influence the impact of UBFM residents.

CONTEXTE: L'introduction de stages en milieu rural pour les résidents qui effectuent leur formation postdoctorale dans un centre urbain constitue la solution principale adoptée en matière d'éducation médicale pour répondre aux besoins des populations rurales mal desservies. L'impact plus large de ces stages sur les médecins enseignants en milieu rural n'a pas été documenté. MÉTHODES: Cette étude examine les répercussions personnelles, professionnelles et financières du stage réalisé en milieu rural par les résidents de médecine familiale en milieu urbain (MFMU) sur les médecins enseignants en milieu rural au Canada. Un sondage a été créé et revu par des médecins universitaires et communautaires en milieu rural et une cohorte de médecins de famille ruraux enseignant à des résidents de médecine familiale en milieu urbain a été échantillonnée. Les données du sondage et les réponses ouvertes obtenues ont fait l'objet d'analyses quantitative et qualitative. RÉSULTATS: Tandis que les participants possédant une expérience de résidence en milieu rural ont perçu l'effet négatif du fait d'enseigner aux résidents de MFMU (p = 0,02 personnel et professionnel), ceux qui exercent dans un environnement rural primaire (tel que défini ci-dessous) en ont une perception positive (p<0,001). Les superviseurs en milieu rural avaient souvent des attitudes contrastées envers les apprenants, des aspects positifs compensant certains jugements négatifs. La durée d'exercice et l'expérience en l'enseignement n'ont pas eu d'impact significatif sur les évaluations. CONCLUSION: Être un superviseur en milieu rural de résidents en MFMU est gratifiant, mais aussi stressant. Le lieu de formation et le champ d'exercice du superviseur semblent déterminer l'effet qu'ont les stages de résidents de MFMU sur ces superviseurs.

The impact of rural rotations on urban based postgraduate learners: A literature review.

Background/Objective: The rural physician shortage remains an international crisis. Rural rotations are commonly used to address the issue. This review assesses the published evidence of the impact of rural rotations on urban-based postgraduate learners. Methods: The OVID Medline database was searched for eligible articles published in peer-reviewed academic journals between 1980 and 2017. Data were extracted and analyzed to draw inferences about the impact of rural rotations on urban-based postgraduate learners. The methodological quality of included articles was assessed with the Medical Education Research Study Quality Instrument (MERSQI). Results: The search identified 301 articles; 19 studies met inclusion criteria (mean MERSQI score 11.95). Of the various rural rotation characteristics reported, duration was most consistently associated with the eventual rural practice. No consensus of impact was found for other characteristics. Our review provided indications of the cumulative effect of the postgraduate rural rotation, rural origin, and rural intent on rural practice decisions. Conclusions: The importance of rural rotations during urban postgraduate training for the outcome of rural practice is apparent. However, the reliance of medical educational systems on the rural rotation, specifically duration, does not accurately reflect the complexity of the choice to practice in a rural community.

An Axiological Analysis of One Medical School's Admissions Process: Exploring Individual Values and Value Systems.

PURPOSE: Values and value systems are fundamental to medical school admissions processes. An axiological analysis was carried out to explore the individual values and value systems found within the University of Calgary's Cumming School of Medicine's undergraduate admissions process. METHOD: A mixed-methods case study methodology was developed with a focus on applicant characteristics viewed as desirable, the relative value ascribed to applicant characteristics, the values that participants in admissions processes brought to bear, the values that were reflected in the artifacts and procedures used in support of admissions processes, and the values that were expressed at a system, program, or institutional level. The study employed a descriptive audit of admissions processes, a stakeholder survey, stakeholder interviews, and a discourse analysis of admissions materials (all carried out between June and September 2017). RESULTS: The study found that, despite a general sense of satisfaction with the rigor of the admissions process, there was less satisfaction with the final selection it produced. Participants wanted to see more attention paid to responsibilities to patients and society than to gender and ethnic balance. CONCLUSIONS: Those involved with medical school admissions need to be mindful of their value systems and use them to align intent with process and outcomes in selecting tomorrow's physicians. Axiological analysis of medical education processes can play a central role in reviewing and refocusing efforts on meeting an institution's social mission and medical education's social contract.

A longitudinal analysis of symptom clusters in cancer patients and their sociodemographic predictors.

CONTEXT: Exploring the relationships between concurrent symptoms or "symptom clusters" (SCs) longitudinally may complement the knowledge gained from the traditional approach of examining individual symptoms or SCs crosssectionally. OBJECTIVES: To identify consistent SCs over the course of one year and determine the possible associations between SCs and demographic and medical characteristics, and between SCs and emotional distress. METHODS: This study was an exploratory longitudinal analysis of SCs in a large sample of newly diagnosed cancer patients. Patients provided symptom assessment data at baseline, three, six, and 12 months. A factor analysis was conducted (controlling for the patient over time) on pain, fatigue, anxiety, depression, sleep, weight change, and food intake items to identify clusters. A panel regression on each cluster explored associations with demographic and medical characteristics and distress. RESULTS: In total, 877 patients provided baseline data, with 505 retained at 12 months. Three SCs explained 71% of the variance. The somatic cluster included pain, fatigue, and sleep; the psychological cluster included anxiety and depression; and the nutrition cluster consisted of weight and food intake. Low income and treatment with radiation or chemotherapy predicted higher somatic symptom burden. Younger age, being female, low income, and treatment with surgery predicted more psychological symptomatology. Older age and treatment with surgery predicted higher nutritional burden. Patients with higher somatic, psychological, and nutritional symptom burden reported higher distress. CONCLUSION: The presence of SCs across the first year of diagnosis supports the need for routine and ongoing screening for the range of symptoms that may be experienced by patients. Further work is needed to develop interventions that better target individual symptoms that cluster, as well as the entire cluster itself.