Successful rural rotation: What do learners look for?

CJRM 2006;11(4):304

[see response]

There has been more emphasis in recent years on providing rural rotations to residents and medical students as a way to recruit new rural physicians. A review of the literature demonstrates that there is a clear association between rural placements in training and rural practice.1-3 However, an important question still remains: What do medical students and residents actually want from a rural rotation?

A recent collaboration between medical students/faculty at the University of Toronto and the Rural Ontario Medical Program (ROMP) attempted to answer this question. An online survey was created using Web-based software, and the Web link was emailed by ROMP to past and present medical students and residents who had completed a rural elective through the ROMP. Of the candidates who completed a rural rotation in 2004, 155 (68%) responded to the survey.

One question asked about the importance of various factors in making the rural rotation a positive experience (Table 1).

The results from this survey suggest that medical students and residents highly value opportunities for hands-on training and preceptors who have strong interpersonal and teaching skills. In fact, respondents consistently ranked preceptor characteristics above community factors.

Jonathan R. Kerr, MD
PGY-1, Rural Family Medicine
Queen's University, Kingston, Ont.

John D.D. Neary, MD
PGY-1, Internal Medicine
McMaster University, Hamilton, Ont.

Karl R. Hartwick, MD, CCFP, FCFP
Assistant Professor, Department of Family and Community Medicine
University of Toronto, Toronto, Ont.

Correspondence to: Tim Van Aerde; tim.vanaerde@arfmn.ab.ca

References

1. McDonald J, Bibby L, Carroll S. Recruiting and retaining general practitioners in rural areas: improving outcomes through evidence-based research and community capacity-building. Evidence-based review: Final Report. Ballarat, VIC: Centre for Health Research and Practice, University of Ballarat, 2002.
2. Strasser R. Rural general practice in Victoria: the report from a study of attitudes of Victorian general practitioners to country practice and training. Melbourne, VIC: Department of Community Medicine, Monash University, 1992.
3. Pathman DE, Steiner BD, Jones BD, et al. Preparing and retaining physicians through medical education. Acad Med 1999;74:810-20.

A response

From a personal perspective, the results presented above certainly hold true. According to the evidence presented, the most valued criteria of a rural rotation are the opportunity for hands-on training, and a preceptor's interpersonal and teaching skills. A rural rotation can be one of the best experiences during medical training solely because of the preceptor.

What makes a good preceptor then? Learners highly value both a relationship with their preceptor and clinical independence. Whether it is in the emergency department or in the clinic, an excellent rural preceptor will be an effective teacher, but will also give the learner a level of independence based on their skill level.

Some staff members will often suggest that having students follow them around increases their workload. It is true that students can slow things down. However, as a suggestion to both lessen the workload and improve the teaching experience, a preceptor can let the student examine a patient alone, while continuing to see other patients. This way, the student gains confidence and develops the ability to manage patients independently. Patients will often report satisfaction with the experience as well.

An excellent rural rotation is very dependent on a good preceptor, someone with strong interpersonal and teaching skills, who will give an appropriate level of independence and opportunity for hands-on training. Thus the first priority should be to match trainees with exceptional preceptors, because a positive rural rotation dramatically increases the likelihood that a trainee will eventually return to rural practice.

Tim Van Aerde, MD
PGY-2, Rural Family Medicine
University of Alberta, Edmonton, Alta.

Jonathan R. Kerr, MD
PGY-1, Rural Family Medicine
Queen's University, Kingston, Ont.

© 2006 Society of Rural Physicians of Canada