Here are a few of the decision areas
Electives - use these to prep for procedures and hands on responsibility. Residency is a time to push your limits while you have backup and supervision, so do it! When in doubt, choose the elective that challenges you more and will teach you more about procedures, practice management, decision-making in office and critical settings.
Day to Day Attitude on rotations - Take personal charge of patient care, evaluate attendings and other residents and see what they have to teach you. Tell attendings that you are preparing for rural practice and therefore need to know more details about caring for patients, when to refer, doing things at rural locations etc.
See how to prepare so that you are ready for
Cesarean Delivery!Moonlighting - Take advantage of this opportunity to visit various sites and learn while doing and getting paid.
Take the personal responsibility to build a clinic practice. Get patients back to visit you. Work with the challenging patients. Work with nurses and staff well.
Interact with nurses and staff for quality - you are designing the type of practice environment that you will have later - need to learn to work with personnel and give critique and compliments. Contact patients a few days later and really find out what goes on after the patient left. Do procedures in clinic.Use the practice management talks. They can be more than a nice series. Relate them to the clinic practice, the CORE rotation, known practices, or other personal experiences - keep the speakers and topics relevant to your needs. Some programs actually have residents present their practice plan to the other residents and faculty. This is a good topic for a noon conference presented by you before you actually get out there and suffer the consequences alone.
Use information sources well -
Don't wait until your last few months to fully utilize fp faculty in clinic- that's what we are paid to do - we tend to be "salaried" and "distracted" with other duties, but never apologize for asking a learning question at any time. We may seem busy, but your best training depends on asking questions.
Use the behavioral folks and videotapes. They can teach you some support and intervention techniques. Not always will you have the luxury of a full complement of consultants in some locations.
Consultants - never miss a chance to show your patients to them, call them frequently about patient management - how can you learn your limits on future patients if you don't learn them on current ones? The best rural doctor I ever saw in this area listened to the consultant give a talk, and then presented a patient that he needed help with, one that was at his limits of knowledge. The answer gave him more and better clinical info and usually the chance to manage that and similar patients will less referrals.
On weekends
Explore rural and different types of rural
Do some early interviews or visits - why not let actual interviews with real people influence you, instead of peers, faculty, programs, and others who may not be "real world". You won't waste the time, it will shape your other choices such as electives, and it will land a few meals and potentially some friends or colleagues.
Leadership development
Being a rural physicians involves community, hospital, and practice leadership. Similarly experience in various settings during training will help prepare you. These include resident positions, hospital positions, clinic, volunteer work, ...etc.
Advisors
Over 1/3 of faculty have been rural physicians. Through rural experiences or through the state academy, you will meet physicians who can advise you. STFM Rural Group members can help you also Rbowman@unmc.edu to match up. A good advisor will get to know you, find out what your strengths and weaknesses are, and explore how you do with personal issues such as management, delegation, balancing career and family, and the practice search. Advisors can help with choice of electives, rotations, etc.
Other items that are important
Be sure to fill out cards or otherwise document your work. Make sure you get credit for a procedure or patient or diagnosis that you did, or why do them?
Family vs practice - Be sure to explore the issues of how much time that you want so spend in work vs practice or learning. Habits may be well set and tough to change for some. What does your spouse think or what do your kids think about the decisions you are making as to when to get home and what you do when home. Medicine makes doctors feel good, patients or nurses or others are patting us on the back, but when we get home the spouse is saying...take out the garbage. Does this influence where you spend your time?
Learn to deal with patients that you like a lot (and spend too much time with) or those you don't like at all (sociopaths, chronics, non-compliants). You need to know how you respond to them, how much you want to please or satisfy them, and learn to separate your problems from theirs.I left my rural practice for many reasons, bad local economy, poor business skills, wife needed another location, but part of being a successful amiable fp is learning how to set limits on yourself and others which I am still learning.
Practice location - Practice searches by residents are hurried, residents are often overwhelmed, many make a decision that they hope will last for many years. Similar decision for residency. Some decisions more subtle during residency - shapes the type of physician that you will be, what do you want to do, where is your comfort level, how much confidence do you have. The more that you can do, the less limited your practice choices and the more income potential you will have, both in negotiated salary, productivity, and managed care pool reserves.
I. What do I have to give you? People learn two ways - their own mistakes and those of others - I'll tell you some mistakes of others and lots of mine. I thought I'd stay initially in my own residency as a faculty member. I would not need too much in procedures and nothing other than routine OB. Later I was led to rural practice in a late decision and needed more. Later still I became a full time faculty member and found out that I really needed all of my residency training, especially procedures and things that I needed for rural practice. The Lesson Is - You never know how to prepare for the future so it pays to learn all that you can in all areas, especially if you are thinking about rural practice or teaching.
II. The FP Curriculum is neatly laid out. It is influenced by local opportunities and restrictions. There are other types of residents to compete with and there are the traditions and competence of previous residents and faculty. There is also the influence of the residency review committee which is distant, but sometimes the formality of the process and the difficulty of jumping through the hoops is a a threat to some of the things that would prepare you for rural practice.
III. The FP Curricula is still the closest to what you need, but it is not the curricula that you would design and choose specifically for rural practice therefore you need to know what to do to use it well. You must take charge - the higher you climb the education ladder, the more individualized the training will need to be. The typical FP curricula is not enough, nor is a passive approach to your education and training.