Graduate medical education for rural physicians: curriculum and retention.

The chronic shortage of rural physicians prompts further consideration of the educational interventions that have been developed to address this issue. Despite rural admission strategies and a variety of undergraduate, graduate and postgraduate curricular innovations, the recruitment and retention of family physicians into many rural areas has not kept pace with the retirement of older general practice physicians. This paper reviews the 1994 American Academy of Family Physicians' rural training recommendations in the light of several recent educational needs assessments. These studies affirm the need for rural residency rotations and the need to maintain and better implement the established rural clinical training guidelines. However, although preparation for rural medical practice has been addressed and is being adequately accomplished in the clinical knowledge and procedural skills areas, instruction and experiences relating to the "realities of rural living" need to be enhanced to increase the retention duration of rural physicians. This can be accomplished with more curricular emphasis on developing community health competencies, including community-oriented primary care (COPC). Physicians who know how to collaborate with community members on health improvement projects have skills that can also facilitate integration and, hence, retention.

Screening applicants for a rural medical education program.

The goal of the Rural Medical Education (RMED) Program of the University of Illinois College of Medicine at Rockford is to train rural family physicians. This article describes the screening instrument developed by RMED to identify appropriate candidates.

Illinois RMED: a comprehensive program to improve the supply of rural family physicians.

BACKGROUND: Rural areas of the United States are perennially medically underserved, and the state of Illinois is no exception. A recent survey showed that 75 of Illinois' 84 rural counties are primary care physician shortage areas. In response to this chronic physician shortage, the Illinois Rural Medical Education (RMED) Program was developed by the University of Illinois College of Medicine at Rockford. The RMED program is a comprehensive, multifaceted program that combines recruitment, admissions, curriculum, support, and evaluation components and is longitudinal across all 4 years of the medical school experience. The admissions process seeks to select students who possess traits indicative of success in eventual rural family practice. These traits are fostered and developed by the 4-year rural curriculum, which emphasizes family medicine, community-oriented primary care, the physician functioning in the context of community, relevant aspects of the "hidden" curriculum, and service learning. After 6 years, RMED has graduated 39 physicians; 69% have gone into family practice, and a total of 82% have selected primary care residencies.

Senior students' evaluations of the usefulness of the Glaxo Pathway Evaluation Program.

PURPOSE: To examine the influence of the Glaxo Pathway Evaluation Program on fourth-year medical students' specialty-choice decisions. METHOD: In February 1992, 274 seniors at three medical schools were asked to complete a 19-item questionnaire regarding their evaluations of the usefulness of the Pathway program in helping them to make their specialty-choice decisions. RESULTS: A total of 237 seniors responded to the survey (though not all responded to all 19 items), indicating that they found the program to be moderately useful. More than half of the students (107 of 207, 51.7%) reported that they had followed the program's decision-making model and found it moderately useful. The students' responses indicated that those components intended to facilitate self-assessment and provide information about the various specialty options were fairly well utilized, i.e., 59.9% of the students had reevaluated the Critical Factors, and 73.6% had compared their individual profiles with the Specialty Profiles, finding both exercises moderately useful. Other follow-up activities had been used variably. CONCLUSION: The students evaluated the program as being moderately useful. The authors conclude that the program is a useful, comprehensive, and reasonably objective tool. Whether students using the program achieve long-term commitment to and satisfaction in their chosen specialties remains to be determined.