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Rural training in medical education

Health Factors: Access to Care
Decision Makers: Educators
Evidence Rating: Scientifically Supported
Population Reach: 20-49% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Rural training tracks and programs focus medical school training and learning experiences on the skills necessary to practice medicine in rural communities. These initiatives often recruit students from rural backgrounds and students who have expressed an interest in practicing medicine in small towns and rural locations (Wendling 2016).

Expected Beneficial Outcomes

Increased availability of physicians in underserved areas
Increased access to care

Evidence of Effectiveness

There is strong evidence that rural training programs increase the number of physicians who choose to practice in rural areas (Quinn 2011, Zink 2010, Rabinowitz 2008, Cochrane-Grobler 2015, Wendling 2016, MacDowell 2013, Petrany 2013, Crump 2015, Rabinowitz 2012).

Rural medical school curricula, regular term or summer rural practice learning experiences, and rural residency programs increase the likelihood that participating students will choose to practice in a rural area (Curran 2004, Wendling 2016, MacDowell 2013, Kane 2013, Petrany 2013, Crump 2015). Programs that recruit students with rural backgrounds and have a rural-focused curriculum increase the number of students who choose rural practice locations (Petrany 2013, Crump 2015) and remain there over the long-term (Rabinowitz 2005, MacDowell 2013), often as primary care or family medicine physicians (Petrany 2013, Rabinowitz 2012). Surgeons who practice in rural areas during residency are also more likely to remain in rural practice than their peers (Deveney 2013, Wendling 2016).

Models indicate that expanding rural training programs to all medical schools would substantially increase the supply of rural physicians (Rabinowitz 2008). 

Implementation

United States

There are a growing number of medical schools with programs that provide rural-specific training. Examples include the state university systems of Minnesota, Missouri, and Illinois (Zink 2010, Glasser 2008); the State University of New York (SUNY) Upstate Medical University’s Rural Medical Scholars Program (SUNY Upstate-RMSP); the Jefferson Medical College Physician Shortage Area Program (PSAP) (Rabinowitz 2005); the University of New Mexico’s Center for Rural and Community Behavioral Health (UNM-CRCBH); and the University of Kentucky’s Rural Physician Leadership Program (RPLP) (UK-RPLP).

Wisconsin

The Wisconsin Academy for Rural Medicine (WARM) provides rural-focused medical training within the University of Wisconsin School of Medicine and Public Health (UWSMPH-WARM).

Implementation Resources

RHIhub-Rural training track - Rural Health Information Hub (RHIhub). Rural training track technical assistance program. Accessed on May 23, 2016
Train Rural - Train Rural. Rural physician training: resources on rural residencies, training tracks, program locations, and financial support and incentives. Accessed on June 6, 2016

Citations - Description

Wendling 2016* - Wendling AL, Phillips J, Short W, Fahey C, Mavis B. Thirty years training rural physicians: Outcomes from the Michigan State University College of Human Medicine Rural Physician Program. Academic Medicine. 2016;91(1):113–119. Accessed on May 31, 2016

Citations - Evidence

Cochrane-Grobler 2015* - Grobler L, Marais BJ, Mabunda S. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database of Systematic Reviews. 2015;(6):CD005314. Accessed on June 6, 2016
Crump 2015* - Crump WJ, Fricker RS, Ziegler CH, Wiegman DL. Increasing the rural physician workforce: A potential role for small rural medical school campuses. The Journal of Rural Health. 2015;00:1–6. Accessed on June 6, 2016
Curran 2004* - Curran V, Rourke J. The role of medical education in the recruitment and retention of rural physicians. Medical Teacher. 2004;26(3):265–72. Accessed on December 10, 2015
Deveney 2013 - Deveney K, Deatherage M, Oehling D, Hunter J. Association between dedicated rural training year and the likelihood of becoming a general surgeon in a small town. JAMA Surgery. 2013;148(9):817–821. Accessed on May 31, 2016
Kane 2013* - Kane KY, Quinn KJ, Stevermer JJ, Porter JL, et al. Summer in the country: Changes in medical students’ perceptions following an innovative rural community experience. Academic Medicine. 2013;88(8):1157–1163. Accessed on May 31, 2016
MacDowell 2013 - MacDowell M, Glasser M, Hunsaker M. A decade of rural physician workforce outcomes for the Rockford Rural Medical Education (RMED) Program, University of Illinois. Academic Medicine. 2013;88(12):1941–1947. Accessed on May 31, 2016
Petrany 2013* - Petrany SM, Gress T. Comparison of academic and practice outcomes of rural and traditional track graduates of a family medicine residency program. Academic Medicine. 2013;88(6):819–823. Accessed on June 6, 2016
Quinn 2011* - Quinn KJ, Kane KY, Stevermer JJ, et al. Influencing residency choice and practice location through a longitudinal rural pipeline program. Academic Medicine. 2011;86(11):1397-406. Accessed on May 20, 2016
Rabinowitz 2005* - Rabinowitz HK, Diamond JJ, Markham FW. Long-term retention of graduates from a program to increase the supply of rural family physicians. Academic Medicine. 2005;80(8):728–32. Accessed on May 20, 2016
Rabinowitz 2008* - Rabinowitz HK, Diamond JJ, Markham FW, Wortman JR. Medical school programs to increase the rural physician supply: A systematic review and projected impact of widespread replication. Academic Medicine. 2008;83(3):235-43. Accessed on November 9, 2015
Rabinowitz 2012* - Rabinowitz HK, Petterson S, Boulger JG, et al. Medical school rural programs: A comparison with international medical graduates in addressing state-level rural family physician and primary care supply. Academic Medicine. 2012;87(4):488–492. Accessed on May 31, 2016
Wendling 2016* - Wendling AL, Phillips J, Short W, Fahey C, Mavis B. Thirty years training rural physicians: Outcomes from the Michigan State University College of Human Medicine Rural Physician Program. Academic Medicine. 2016;91(1):113–119. Accessed on May 31, 2016
Zink 2010* - Zink T, Center B, Finstad D, et al. Efforts to graduate more primary care physicians and physicians who will practice in rural areas: Examining outcomes from the University of Minnesota-Duluth and the rural physician associate program. Academic Medicine. 2010;85(4):599–604. Accessed on November 20, 2015

Citations - Implementation

Glasser 2008* - Glasser M, Hunsaker M, Sweet K, Macdowell M, Meurer M. A comprehensive medical education program response to rural primary care needs. Academic Medicine. 2008;83(10):952–61. Accessed on February 5, 2016
Rabinowitz 2005* - Rabinowitz HK, Diamond JJ, Markham FW. Long-term retention of graduates from a program to increase the supply of rural family physicians. Academic Medicine. 2005;80(8):728–32. Accessed on May 20, 2016
SUNY Upstate-RMSP - SUNY Upstate Medical University. Rural Medical Scholars Program (RMSP). Accessed on June 2, 2016
UK-RPLP - University of Kentucky (UK) College of Medicine. Office of Medical Education: Rural Physician Leadership Program (RPLP). Accessed on May 31, 2016
UNM-CRCBH - University of New Mexico (UNM). Center for Rural and Community Behavioral Health (CRCBH). Accessed on November 23, 2015
UWSMPH-WARM - University of Wisconsin School of Medicine and Public Health (UWSMPH). Wisconsin Academy for Rural Medicine (WARM). Accessed on November 9, 2015
Zink 2010* - Zink T, Center B, Finstad D, et al. Efforts to graduate more primary care physicians and physicians who will practice in rural areas: Examining outcomes from the University of Minnesota-Duluth and the rural physician associate program. Academic Medicine. 2010;85(4):599–604. Accessed on November 20, 2015

Page Last Updated

June 3, 2016

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