Back to Objectives for Rural Programs and Curricula
III. Explore the different types of rural locations and practices - Robert Bowman
Carl Hammerschlag was asked by a Native American patient if he could dance. He shuffled his feet a bit and the patient said, "That’s good." Realizing that there was some purpose to the patient’s request, Carl asked him if he would dance as well. The patient adjusted his oxygen cannula and danced vigorously right there on his bed. Carl paused for a moment, then asked the patient if he could teach him to dance like that. The healer said, "I can teach you my steps, but you must hear your own music."
Likewise you must choose the type of practice and town and hospital and environment that best matches you.
This community study lends support to the belief that the ability of a community to attract physicians is closely related to the ability of that community to confront problems and take necessary actions - Improving Rural Health 1984 p 66
Curricular Dimensions: Processes (Career Choice and Development)
Description:
Since few medical students have the rural backgrounds that could influence them to choose primary care or a rural location, many of those we hope to recruit to rural practice are from urban backgrounds. There are major differences in the environment of rural and urban locations. The initial contacts that urban people have with rural communities can be frustrating. The value system and slower pace of rural towns takes time to appreciate, just as it takes time to learn about any different type of culture. Rural communities and practices are highly variable. Personalities are more of a factor in smaller settings. This can have a positive or negative effect. There are fewer "middle men". Students in training are more likely to work with bosses, directors, and managers as they work in rural organizations and facilities, rather than with only staff as in urban environments.
The physician's spouse is an important part of rural practice. He or she needs to experience rural communities. The job and social relationships of a spouse are critical for a successful rural practice.
Subject Areas:
The choice of a rural site involves much more than considerations of teachers, facilities, health personnel, and hospitals. In rural areas other practitioners are visible. Contact with the community is important. Students should access people in the community. Some communities are more open and willing to do this. The choice of preceptors similarly involves more in rural siteswhere preceptors are teachers, advisors and role models. Preceptors should be enthusiastic about teaching and care about students. They should also be comfortable as physicians, as generalists, and as community servants.
The faculty role in rural rotations is different. Faculty must help students to use their rotations and electives appropriately. Faculty developing rural sites must consider many factors:
Preceptors - There must be rural preceptors who are enthusiastic about teaching. Two or more physicians who work closely together are a minimum. The physicians must not be overwhelmed by service needs. Patient care services must not eclipse the time and effort needed for quality teaching. The preceptor role involves more than teaching. Part of the impact is as a role model. Quality preceptors also act in an advisory role to students.
Facilities - Training also involves the use of facilities. These facilities (hospitals, clinics, nursing homes) must have adequate staff who understand the needs of physicians in training. Rural practice should not be dependent on facilities as in most residency training, including family practice.
The Community Itself - Faculty have a choice of rural communities as training sites. Often this is more than the resources available. People who can reach out and involve students in the community are very important. Quality rural experiences involve the students in the life of the community. The rural difference is the people there. Faculty should visit and work with rural communities to prepare a quality experience.
Methods:
Continuity vs block
Faculty must choose between a continuity rural experience or block rotations. Continuity experiences of a day a week or every two weeks are useful for integrating and comparing the rural experience. Block training of one or two months immerses trainees in the rural community. The most successful student programs are blocks of training over 6 months in length. Rural training tracks allow residents to spend more than half of their 36 months in a rural area where they are most likely to learn about rural primary care.
Elective vs Mandatory
No one likes mandatory training of any kind but students and residents need to see rural (or family practice) to at least give them a chance to experience it first hand. At the least they will see primary care practiced without the dominance of subspecialists, hospitals, and technology. Brief experiences may act to confirm previous expectations (bad or good). A few trainees seem to be influenced by quality rural experiences if these occur early enough in training. Longer experiences of 4 months to two years can be very influential.
Innovative use of limited curricular time
A month in community medicine could be utilized as a rural teaching experience. In many ways rural communities are ideal community medicine sites as the potential preceptors are conveniently located, work with each other, and often wear a number of community medicine hats (Contact: Forrest Lang at ETSU for info).
Faculty advisors
It is important that advisors understand the needs of students and residents preparting for rural practice. They should review progress at least twice a year with particular attention to electives, evaluations, and personal issues (practice search, balancing medicine and personal needs).
Recruiting New Rural Practitioners