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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); recruitment often starts in high school and continues through medical school (Wheat 2017, Wheeler 2017). 

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, increasing access to care for rural patients (Cochrane-Grobler 2015, Goodfellow 2016, Wheat 2017, Nelson 2017, McCarthy 2015, Crump 2015).

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 (Wheat 2017, McCarthy 2015, Wendling 2016, Crump 2015, MacDowell 2013, Kane 2013, Petrany 2013). Programs that recruit students with rural backgrounds and have a rural-focused curriculum increase the number of students who choose rural practice locations (Wheat 2017, Crump 2015, Petrany 2013) and remain there over the long-term (Goodfellow 2016, MacDowell 2013, Rabinowitz 2005), often as primary care or family medicine physicians (Nelson 2017, Petrany 2013, Rabinowitz 2012). Surgeons who practice in rural areas during residency are also more likely to remain in rural practice than their peers (Wendling 2016, McCarthy 2015, Deveney 2013).

Minority physicians appear to be more likely to practice in underserved, high-need practice areas than their non-minority peers (Goodfellow 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). The University of Washington School of Medicine’s Targeted Rural Underserved Track (TRUST) provides rural-specific training through a network of residency programs which care for underserved communities in Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) (UWSOM-TRUST).

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

RTT Collaborative - RTT Collaborative. Rural education & training: resources on rural residencies, training tracks, program locations, and financial resources. Accessed on September 13, 2017
UWSOM-TRUST - University of Washington School of Medicine (UWSOM). Targeted Rural Underserved Track (TRUST), caring for underserved communities in Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI). Accessed on September 26, 2017

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 September 8, 2017
Wheat 2017 - Wheat JR, Leeper JD, Murphy S, Brandon JE, Jackson JR. Educating physicians for rural America: Validating successes and identifying remaining challenges with the Rural Medical Scholars Program. The Journal of Rural Health. 2017:1-10. Accessed on September 26, 2017
Wheeler 2017* - Wheeler DL, Hackler JB. Preparing physicians for rural-based primary care practice: A preliminary evaluation of rural training initiatives at OSU-COM. The Journal of the American Osteopathic Association. 2017;117(5):315-324. Accessed on September 26, 2017

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 September 13, 2017
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 September 13, 2017
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 September 8, 2017
Goodfellow 2016 - Goodfellow A, Ulloa JG, Dowling PT, et al. Predictors of primary care physician practice location in underserved urban and rural areas in the United States: A systematic literature review. Academic Medicine. 2016;91(9):1313-1321. Accessed on September 26, 2017
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 September 8, 2017
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 September 8, 2017
McCarthy 2015* - McCarthy MC, Bowers HE, Campbell DM, Parikh PP, Woods RJ. Meeting increasing demands for rural general surgeons. The American Surgeon. 2015;81(12):1195-1200. Accessed on September 26, 2017
Nelson 2017 - Nelson GC, Gruca TS. Determinants of the 5-year retention and rural location of family physicians: Results from the Iowa Family Medicine Training Network. Family Medicine. 2017;49(6):473-476. Accessed on September 26, 2017
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 September 13, 2017
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 September 8, 2017
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 September 8, 2017
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 September 8, 2017
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 September 8, 2017
Wheat 2017 - Wheat JR, Leeper JD, Murphy S, Brandon JE, Jackson JR. Educating physicians for rural America: Validating successes and identifying remaining challenges with the Rural Medical Scholars Program. The Journal of Rural Health. 2017:1-10. Accessed on September 26, 2017

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 September 8, 2017
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 September 8, 2017
SUNY Upstate-RMSP - SUNY Upstate Medical University. Rural Medical Scholars Program (RMSP). Accessed on September 8, 2017
UK-RPLP - University of Kentucky (UK) College of Medicine. Office of Medical Education: Rural Physician Leadership Program (RPLP). Accessed on September 8, 2017
UNM-CRCBH - University of New Mexico (UNM). Center for Rural and Community Behavioral Health (CRCBH). Accessed on September 8, 2017
UWSMPH-WARM - University of Wisconsin School of Medicine and Public Health (UWSMPH). Wisconsin Academy for Rural Medicine (WARM). Accessed on September 8, 2017
UWSOM-TRUST - University of Washington School of Medicine (UWSOM). Targeted Rural Underserved Track (TRUST), caring for underserved communities in Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI). Accessed on September 26, 2017
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 September 8, 2017

Page Last Updated

September 26, 2017

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