An Exploratory Study of a Novel Approach to Improve Readiness for a Rural Family Medicine Residency.

BACKGROUND AND OBJECTIVES: Transitioning from medical school to residency is challenging, especially in rural training programs where a comprehensive scope of practice is needed to address rural health disparities. Oregon Health & Science University partnered with Cascades East Family Medicine Residency in Klamath Falls, Oregon to create an integrated fourth-year medical student experience (Oregon Family medicine Integrated Rural Student Training (Oregon FIRST). Participants may then enter this residency to complete their training with the intention to practice in rural underresourced settings. METHODS: In this exploratory study, we conducted key informant interviews with 9 of ten Oregon FIRST participants to determine how Oregon FIRST contributed both to their readiness for residency training and their choice to practice in rural underserved locations. Interviews were conducted between June 10, 2020 and July 8, 2020. We analyzed field notes taken during interviews for emergent themes using classical content analysis. RESULTS: Emergent themes included logistical ease, relationship development, key curricular elements, and commitment to rural practice. Overwhelmingly, Oregon FIRST participants reported the experience had many challenging and demanding components because they served as subinterns for their entire fourth year of medical school, but this prepared them very well for internship. When asked if they would choose to enroll in Oregon FIRST again, given what they now know about physician training and patient care, all nine (100%) said they would. CONCLUSIONS: This study demonstrated that Oregon FIRST students felt better prepared for the rigors of residency and are committed to practicing in rural areas.

Implementation of Advanced Access in a Family Medicine Residency Practice.

Several models of scheduling have been documented in the literature, including the traditional model, the carve-out model, and the advanced access model. We describe the implementation of the advanced access model in our clinic, which has been very successful. Advanced access has decreased third next available appointments to less than seven days for many of our providers and has increased individual primary care physician continuity for 40% of our providers. Interestingly, we had no gains in patient satisfaction, which is consistent with other previously published studies on advanced access.