Impacting at Multiple Points in Rural Medical Education

At the Preprofessional and Medical Student Level      - See Best Early Models

Community Driven Approach

1. Rural practitioners, schools, communities involved in quality education and health careers
2. Rural towns who are proud of students that return to their rural roots, not telling their best students to go to the big city to best use their talents.
3. Community-Oriented Service Projects for students during or prior to health professions training
4. Admission of more students with rural backgrounds, service orientation, rural practice interest, must control all of admissions or at least 10% of class in most medical schools
5. Rural rotations early and often in medical school
6. Rural student interest groups to support those interested in rural practice
7. Specific efforts to educate medical students of the value of rural training and the different rural training models (See Rural Training handout)
8. Rural preceptorships, preferably 9 months or more in the third year of medical school, great learning, assistance with workforce and retention for rural docs and communities, self-replicating
9. Tracks bridging the gaps between steps, college to med, med to grad, grad to practice, perhaps even a focused 7 year preparation for rural practice. See an example of special models and accelerated models here.

At the Graduate Level      see Best Models

1. Primary care training based in rural communities as much as possible
2. Organized rural rotations in rural communities
3. Rural and procedural fellowships covering advanced and procedural obstetrics, colposcopy, orthopedics, endoscopy, acute trauma and cardiac care, surgical assisting, and practice management
4. Focus on confidence building and social skills to improve retention
5. Consider the following hybrid training models, accelerated training would allow development of these for rural, inner city, and leadership (FP Faculty) training within a 7 year period.

• FP/Pharmacy – smallest locations
• FP/mental health – great need
• FP/administrative – public health, small rural health systems
• FP/Obstetrics Programs
• FP/Surgery Residency Program – overseas potential from returning missionaries
• FP/Anesthesia Residency Program – only one left in Canada

At the State and Academic Level

1. Coordinated recruitment database, retreats, dinners, etc.
2. Support for loan repayment, rural community scholarships
3. Support and reward system for rural faculty, at all levels academic, state, and local rural community level
4. Rural primary care research capacity to evaluate, create, and adjust programs to graduate more and better and longer rural physicians
5. Retention programs in and for rural communities
6. Rural network/managed care development, leadership and management training
7. Consider obligations for students to do an initial primary care career of four years before undertaking any specialty training

All of the above should be developed with and for rural communities and practitioners in conjunction with associations of health professionals, state and federal government, and private enterprise (foundations, rural businesses).

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