Objectives for Rural Programs and Curricula
Objectives for Those Preparing for Rural Practice (and those who will train them)
The primary purpose is to assist faculty who are developing rural programs or advising potential rural physicians. This outline contains some basic objectives. Most of these objectives share common ground with family practice regardless of location. Rural locations (III) and practice management (IV) are unique to small town practice. Rural practice highlights the community role (V) of physicians. Procedures (II), Balance (VI), Comfort with the Generalist Role (VII), and a good Doctor-Patient Relationship (VIII) are extremely important for a successful rural practice. Without competence (I) and good training (IX), physicians probably will not consider a rural location. An outline for the dimensions of rural curricula follows on the next page.
The residency is a period of unbelievable professional growth and development, and with good fortune, may even be accompanied by comparable logarithmic personal enlargement. The resident should make a knowing and informed commitment to be a physician: to take care of patients with compassion, justice, honor, dignity, scholarship, and devotion. Solomon Papper M.D, Doing Right 1983
Those who are interested in rural practice should:
I. Achieve Clinical Competence
II. Acquire Procedural Expertise
III. Explore the Variety of Locations and Practices That Is Rural
IV. Learn About Practice Management, local, state, and national health systems
V. Understand the Important Community Role and the Challenges and Rewards
VI. Develop the Skills to Balance Personal and Professional Life
VII. Become Comfortable with the Generalist Role
VIII. Master the Doctor Patient Relationship
IX. Train in an Environment Where Teaching Is A Top Priority
X. Receive Adequate Emotional and Financial Support from practice, hospital, family, town, state, and nation
| Area | Challenges | Rewards |
| Competence | Apply one's self daily to all years of medical training and daily to learning in practice on and for patients | Wisdom, job well done, appreciation of patients and other physicians, respect, confidence, able to push cutting edge of what you can do well to be able to serve more patients and more effectively |
| Procedures | Extra hours, after hours, extra rotations, travel to rotations, being available, getting in charge | Financial, increased market share, better services for community, confidence in practice abilities, good end to challenging days |
| The Variety That Is Rural | Extra visits, using phone and contacts with people, starting early, making sure the community is a match for you and your family | Better match possible between you and community you choose, better ability to set up practice and hospital, better negotiation skills, better understanding of strengths and weaknesses of local practices, health system |
| Practice Management | Not well taught because it does not have impact until out in practice, must apply self personally and be in good functioning practices and in charge of patient care to learn, small groups and mentor best | Realize that you can practice anywhere, able to adjust self and practice, work with others well, network with other rural doctors and hospital to work with each others strengths and remedy weak areas |
| Community Role | Extra duties expected, contact with challenging people, realization of important education, economic, and leadership areas of town that impact you, lots of extra hours, challenge of keeping balanced | Unbelievable good feelings at regular intervals of really being a part of something special and making a difference in the lives of others, patients and people in the community, Sadly not usually appreciated until you leave a rural community, even after a few years |
| Balance | Must constantly work during training and with family and those in faculty and later colleagues in practice to communicate well, learn to delegate, negotiate with an eye toward the long term good for all involved | At your best when the busyness feeling disappears and you really are accomplishing a great deal often without realizing it |
| Generalist Role | a challenge in an era of specialism and narrow viewpoints at all levels | Thinking in a more global fashion is necessary for continuity care, population based medicine, multidimensional thinking and complex problem solving, any hope for restoring our chronic poverty areas and our chronic dysfunctional patients involves abilities in this area |
| Doctor Patient Relationship | can be very close | can be very close |
| Teaching A Top Priority | In some medical centers, teaching may not be a top priority, seek out teachers who do this and rotations to "become a doctor" | Often get to do more with teachers who know their patients (continuity) and resources (smaller) and their abilities (competence and confidence tested in past) and have good attitudes about service and teaching and learning |
| Support | Still a problem but improving | Clearly you will make all the income that you will need, spending, as always is the real problem and also looking to greener pastures, which are really not as green as they seem |
Canadian recommendations http://www.cfpc.ca/education/rural/ruralpaperexec.asp
The right students, the right facilitators, the right leaders, the right objectives, the right actions....
www.ruralmedicaleducation.org