WHAT MAKES A CURRICULA RURAL?
The Basics of Rural Curricula
The decision about what is rural is quite a task. There is better agreement about what is needed for rural training. The STFM Group on Rural Health accepted the task of taking previous AAFP publications as well as information from many rural programs to compile a rural curricula. The ETSU Minifellows in 1992 and 1993 continued this task. The AAFP Committee on Rural Health has joined with the above to produce a document for national publication in the next two years.
Purpose: Rural curricula should facilitate the development of more and better rural family doctors who stay in rural practice.
Goal: The curricula should lead to improved understanding of rural peoples, rural communities, rural practices, and rural health systems as well as developing the skills necessary to functioning effectively in and with the above.
The primary method of accomplishing the goals and objectives is a series of significant rural experiences during training. Rural experiences offer a change from academic life as well as an opportunity for learning that extends beyond mere biomedical knowledge to attitudes and behaviors conducive to successful rural practice.
Due to the need to need to "stand alone" regarding decision-making in rural practice, a more active type of training is necessary. This should be a "hands-on" type of training in procedures and patient management where the student or resident is allowed to bear an appropriate and ever increasing amount of responsibility for patient outcome. Rural physicians must know their limits and know when and how to get help. This also applies to the personal realm where physicians must learn to balance the priorities of self, family, and practice.
Also important in this effort is continuous interactions between rural and primary care faculty, the students and residents, and the rural physicians and sites as all work together to prepare the curricula.
The following categories outline specific objectives for rural curricula:
I. Understanding rural peoples
Recognition of the variety of individuals, their occupations, lifestyles, the impact of these on their health and particularly their views on health and health care providers
II. Understanding rural practices
Examination of a variety of rural practice styles, modes, locations and the practice management skills needed, as well as those particular types of practice unique to rural areas, and the broad variations in rural practices even among individual communities.
Identification of common problems noted when caring for rural patients, methods of dealing with these problems
Illustration of skills in accessing information resources (book, journal, computer, or consultant)
Examination of the broad range of procedural skills practiced by rural physicians as well as experience in some of these procedures
Exposure to medical problems common to rural practice such as infectious and occupational diseases
III. Understanding rural communities
Examination of the variety of rural communities and the structure and function of such communities
Examination of the non-health care components of the community - the government, education, the economy, and how these interact with health care
Observation of the relationship of individuals and their leaders to the community and those outside the community
Examination of the role of community leaders, including rural physicians
Understanding of the importance of strategic planning and community cooperation
Experiencing some of the "bonding" of rural physicians with their communities
IV. Understanding rural health systems
Observation of community variations in the providers, their relationship to one another and the various facilities, and the impact of nearby health systems and health policies (county, state, and federal)
Understanding of rural facilities (hospitals, clinics, centers, and nursing homes) and their operational strengths and weaknesses, including not only day to day function but also strategic planning, community relations, and other measures to increase the viability of rural practices and the local rural health system
Identification of common dysfunctional situations in rural health systems and methods of dealing with them
V. Common ground with Family Medicine
Rural family practice shares the following areas of emphasis with all of family medicine, but the rural situation often demands more of physicians in these areas to be able to go and stay in a rural setting. Many former rural physicians who later chose faculty careers have contributed greatly to medicine's understanding in these areas. These areas include:
The ability to assess the quality of practice
The doctor-patient relationship
The generalist role
Management and leadership issues
personal vs family vs practice needs
effective small groups and organizations
task delegation and saying no
effective negotiation
strategic planning
Not all of the above can or should be crowded into the few months available for training. Each program has its own needs and also has various types of trainees and resources. The curricula is best used to illustrate the types of objectives and resources that can be utilized.
A suggestion for the development of the above curricula is that the curricula be SMART
Specific
Measurable
Attainable
Reasonable
Timely
A final reminder - The most successful rural programs have taken great efforts to be measurable!
Timetable for Developing Rural Programs