The impact of urban-based family medicine postgraduate rotations on rural preceptors/teachers.

BACKGROUND: The use of rural rotations within urban-based postgraduate programs is the predominant response of medical education to the health needs of underserved rural populations. The broader impact on rural physicians who teach has not been reported. METHODS: This study examined the personal, professional, and financial impact of a rural rotations for urban-based family medicine (UBFM) residents on Canadian rural teaching physicians. A survey was created and reviewed by community and academic rural physicians and a cohort of Canadian rural family physicians teaching UBFM residents was sampled. Survey data and free-text responses were assessed using quantitative and qualitative analyses. RESULTS: Participants with rural residency backgrounds perceived a negative impact of teaching UBFM (p = 0.02 personal and professional) and those in a primary rural environment (as defined below) perceived impact as positive (p < 0.001). Rural preceptors often held contrasting attitudes towards learners with negative judgements counter-balanced by positive thoughts. Duration in practice and of teaching experience did not have a significant impact on ratings. CONCLUSION: Being a rural preceptor of UBFM residents is rewarding but also stressful. The preceptor location of training and scope of practice appears to influence the impact of UBFM residents.

CONTEXTE: L'introduction de stages en milieu rural pour les résidents qui effectuent leur formation postdoctorale dans un centre urbain constitue la solution principale adoptée en matière d'éducation médicale pour répondre aux besoins des populations rurales mal desservies. L'impact plus large de ces stages sur les médecins enseignants en milieu rural n'a pas été documenté. MÉTHODES: Cette étude examine les répercussions personnelles, professionnelles et financières du stage réalisé en milieu rural par les résidents de médecine familiale en milieu urbain (MFMU) sur les médecins enseignants en milieu rural au Canada. Un sondage a été créé et revu par des médecins universitaires et communautaires en milieu rural et une cohorte de médecins de famille ruraux enseignant à des résidents de médecine familiale en milieu urbain a été échantillonnée. Les données du sondage et les réponses ouvertes obtenues ont fait l'objet d'analyses quantitative et qualitative. RÉSULTATS: Tandis que les participants possédant une expérience de résidence en milieu rural ont perçu l'effet négatif du fait d'enseigner aux résidents de MFMU (p = 0,02 personnel et professionnel), ceux qui exercent dans un environnement rural primaire (tel que défini ci-dessous) en ont une perception positive (p<0,001). Les superviseurs en milieu rural avaient souvent des attitudes contrastées envers les apprenants, des aspects positifs compensant certains jugements négatifs. La durée d'exercice et l'expérience en l'enseignement n'ont pas eu d'impact significatif sur les évaluations. CONCLUSION: Être un superviseur en milieu rural de résidents en MFMU est gratifiant, mais aussi stressant. Le lieu de formation et le champ d'exercice du superviseur semblent déterminer l'effet qu'ont les stages de résidents de MFMU sur ces superviseurs.

An equity-oriented admissions model for Indigenous student recruitment in an undergraduate medical education program.

BACKGROUND: With the 2015 publication of the Truth and Reconciliation Commission of Canada's calls to action, health professional schools are left grappling with how to increase the recruitment and success of Indigenous learners. Efforts to diversify trainee pools have long looked to quota-based approaches to recruit students from underserved communities, though such approaches pose dilemmas around meaningfully dismantling structural barriers to health professional education. Lessons shared here from developing one multi-layered admissions strategy highlight the importance of equity-rather than equality-in any recruitment for learners from medically underserved communities. SUMMARY: The promotion of fairness in the recruitment of future practitioners is not just a question of equalizing access to, in this case, medical school; it involves recognizing the wider social and structural mechanisms that enable privileged access to the medical profession by members of dominant society. This recognition compels a shift in focus beyond merely giving the disadvantaged increased access to an unfair system, towards building tools to address deeper questions about what is meant by the kind of excellence expected of applicants, how it is to be measured, and to what extent these recruits may contribute to improved care for the communities from which they come. CONCLUSION: Equity-based approaches to student recruitment move health professional schools beyond the dilemma of recruiting students from marginalized backgrounds who happen to be most similar to the dominant student population. Achieving this requires a complex view of the target population, recognizing that disadvantage is experienced in many diverse ways, that barriers are encountered along a spectrum of access, and that equity may only emerge when a critically, socially conscious approach is embedded throughout institutional practices.

BACKGROUND: Depuis la publication en 2015 d'un appel à l'action de la Commission de vérité et réconciliation du Canada, les établissements de formation en sciences de la santé sont à la recherche de moyens d'accroître le recrutement et la réussite des apprenants autochtones. Les efforts visant à diversifier le bassin d'apprenant ont longtemps été axés sur la mise en place de quotas pour les étudiants issus de communautés mal desservies, mais de telles approches entraînent des choix difficiles quant au démantèlement approprié des obstacles structurels à la formation professionnelle dans le domaine de la santé. Les leçons tirées de l'élaboration d'une stratégie d'admission à plusieurs niveaux montrent l'importance de l'équité ­ plutôt que de l'égalité ­ dans tout recrutement d'apprenants issus de communautés défavorisées. CORPS DU TEXTE: : La promotion de l'équité dans le recrutement des futurs praticiens va bien au-delà de la garantie d'un accès égal, dans ce cas, à l'école de médecine; elle passe par la reconnaissance des mécanismes sociaux et structurels plus larges qui donnent aux membres des couches dominantes de la société un accès privilégié à la profession médicale. Cette reconnaissance exige de ne plus se contenter de donner aux personnes défavorisées un meilleur accès à un système injuste, mais à mettre en place des outils permettant de s'attaquer aux problématiques sous-jacentes liées au type d'excellence attendu des candidats, à la manière dont elle doit être mesurée et à la contribution que ces recrues peuvent apporter à l'amélioration des soins pour les communautés dont elles sont issues. CONCLUSION: Les approches fondées sur l'équité permettent aux écoles professionnelles de santé de dépasser le dilemme du recrutement d'étudiants issus de milieux marginalisés qui se trouvent être les plus semblables à la population étudiante dominante. Pour y parvenir, il faut adopter une vision complexe de la population cible et reconnaître que les désavantages sont vécus de nombreuses manières différentes, qu'il y a tout un éventail d'obstacles à l'accès, et, enfin, que l'équité ne sera pas établie tant qu'on n'aura pas intégré une approche critique et socialement consciente à l'ensemble des pratiques institutionnelles.

Factors perceived to influence rural career choice of urban background family physicians: A qualitative analysis.

BACKGROUND: Urban background physicians are the main source of physician supply for rural communities across Canada. The purpose of this study was to describe factors that are perceived to influence rural career choice and practice location of urban background family medicine graduates. METHODS: We conducted a qualitative, descriptive study employing telephone interviews with 9 urban background family physicians practicing in rural locations. Those who completed residency training between 2006 and 2011, were in rural practice, and had an urban upbringing were asked: when the decision for rural practice was made; factors that influenced rural career choice; and factors that influenced choice of a particular rural location. Emerging themes were identified through content analysis of interview data. RESULTS: We identified four themes as factors perceived to influence rural career choice - variety/broad scope of rural practice, rural lifestyle, personal relationships, and positive rural experience/physician role models. We also identified factors in four areas perceived to influence the choice of a particular rural practice location - having lived in the rural community, spousal influence, personal lifestyle, and comfort with practice expectations. CONCLUSION: Decisions for rural career choice and rural practice location by practicing urban background family medicine graduates are based on clinical practice considerations, training experience, as well as personal and lifestyle factors.

CONTEXTE: Les médecins provenant d'un milieu urbain représentent la principale source de médecins pour les communautés rurales au Canada. Cette étude vise à décrire les facteurs qui sont perçus comme influençant un choix de carrière en milieu rural pour les diplômés en médecine familiale provenant d'un milieu urbain. MÉTHODES: Nous avons mené une analyse qualitative et descriptive à l'aide d'entrevues téléphoniques avec neuf diplômés en médecine familiale provenant d'un milieu urbain. On posait les questions suivantes à ceux qui avaient terminé leur résidence entre 2006 et 2011, qui pratiquaient en milieu rural et qui avaient grandi en milieu urbain : à quel moment la décision de s'établir en milieu rural a-t-elle été prise? Quels sont les facteurs qui ont influencé le choix de carrière en milieu rural? Quels facteurs ont influencé le choix d'un emplacement rural particulier. Les thèmes émergents ont été relevés par l'analyse du contenu des données d'entrevue. RÉSULTATS: Nous avons répertorié quatre thèmes comme facteurs perçus pour influencer le choix d'une carrière en milieu rural : la variété et la portée élargie d'une pratique en milieu rural, le style de vie rural, les relations personnelles et des expériences rurales positives/modèles de rôle de médecin en milieu rural. Nous avons également relevé quatre thèmes perçus pour influencer le choix de s'établir dans un milieu rural particulier : avoir vécu dans cette communauté rurale, l'influence du conjoint, le style de vie personnel et se sentir à l'aise avec les attentes de ce milieu de pratique. CONCLUSION: Les décisions d'un choix de carrière en milieu rural par des diplômés en médecine familiale provenant d'un milieu urbain et maintenant en pratique, sont fondées sur des considérations de pratique clinique, l'expérience de la formation ainsi que des facteurs personnels et de style de vie.

The impact of rural rotations on urban based postgraduate learners: A literature review.

Background/Objective: The rural physician shortage remains an international crisis. Rural rotations are commonly used to address the issue. This review assesses the published evidence of the impact of rural rotations on urban-based postgraduate learners. Methods: The OVID Medline database was searched for eligible articles published in peer-reviewed academic journals between 1980 and 2017. Data were extracted and analyzed to draw inferences about the impact of rural rotations on urban-based postgraduate learners. The methodological quality of included articles was assessed with the Medical Education Research Study Quality Instrument (MERSQI). Results: The search identified 301 articles; 19 studies met inclusion criteria (mean MERSQI score 11.95). Of the various rural rotation characteristics reported, duration was most consistently associated with the eventual rural practice. No consensus of impact was found for other characteristics. Our review provided indications of the cumulative effect of the postgraduate rural rotation, rural origin, and rural intent on rural practice decisions. Conclusions: The importance of rural rotations during urban postgraduate training for the outcome of rural practice is apparent. However, the reliance of medical educational systems on the rural rotation, specifically duration, does not accurately reflect the complexity of the choice to practice in a rural community.

Does the Medical College Admission Test (MCAT) predict licensing examination performance in the Canadian context?

BACKGROUND: Research on the predictive validity of the Medical College Admissions Test (MCAT) on licensing examination performance is varied in its conclusions, with only a few studies examining this relationship in a Canadian context. We assessed the predictive validity of the MCAT on successful performance on the Medical Council of Canada Qualifying Examination (MCCQE) Part 1 by students attending the Cumming School of Medicine. METHODS: Prospective data were collected on MCAT score and sub-section scores, MCCQE decision, multiple mini interview (MMI) performance, gender, and age. The cohort was divided into a derivation cohort (2013 and 2014) and validation cohort (2015 and 2016). Students were dichotomized into pass or fail on MCCQE. Multiple logistic regression in which our dependent variable was MCCQE Part I examination success at the first attempt was used, and potential explanatory variables were age, gender, MCAT total score, and sub-scores for the biological sciences (MCAT-BS), physical sciences, and verbal reasoning, GPA, and MMI ratings. RESULTS: For the derivation cohort MCAT-BS was associated with success on the MCCQE Part I. The odds ratio for this association of 1.37 (95% confidence interval [1.01, 1.85], p = 0.04). When we applied the MCAT-BS to our validation cohort the odds ratio of MCCQE Part I examination success was 1.42 [1.10, 1.83], p = 0.007) and the area under the ROC curve was 0.66 [0.54, 0.79]). CONCLUSION: The MCAT-BS predicted successful performance on the MCCQE Part 1 Examination in the Canadian setting.

An Axiological Analysis of One Medical School's Admissions Process: Exploring Individual Values and Value Systems.

PURPOSE: Values and value systems are fundamental to medical school admissions processes. An axiological analysis was carried out to explore the individual values and value systems found within the University of Calgary's Cumming School of Medicine's undergraduate admissions process. METHOD: A mixed-methods case study methodology was developed with a focus on applicant characteristics viewed as desirable, the relative value ascribed to applicant characteristics, the values that participants in admissions processes brought to bear, the values that were reflected in the artifacts and procedures used in support of admissions processes, and the values that were expressed at a system, program, or institutional level. The study employed a descriptive audit of admissions processes, a stakeholder survey, stakeholder interviews, and a discourse analysis of admissions materials (all carried out between June and September 2017). RESULTS: The study found that, despite a general sense of satisfaction with the rigor of the admissions process, there was less satisfaction with the final selection it produced. Participants wanted to see more attention paid to responsibilities to patients and society than to gender and ethnic balance. CONCLUSIONS: Those involved with medical school admissions need to be mindful of their value systems and use them to align intent with process and outcomes in selecting tomorrow's physicians. Axiological analysis of medical education processes can play a central role in reviewing and refocusing efforts on meeting an institution's social mission and medical education's social contract.

Scope of practice of family medicine graduates who completed a rural versus urban program.

INTRODUCTION: In Canada, rural-based family medicine residency programs were established largely in response to a shortage of rural physicians and the perception that urban-based training programs were not meeting the needs of rural populations. Examinations of practice patterns of physicians trained in rural and urban programs are lacking. The purpose of this study was to compare the scope of practice of family medicine graduates who completed a rural versus an urban residency program, by practice location. METHODS: This was a cross-sectional, mail-out, questionnaire survey of 651 graduates who had completed the family medicine residency program at the University of Alberta or the University of Calgary, Alberta, Canada during 2006-2011. Rural program graduates lived and trained in regional settings and spent a considerable amount of time in smaller rural and remote communities for their clinical experience. The training of urban program graduates was primarily based in large urban settings and family medicine clinical experience was based in the community. Practice location (rural, urban) was classified by population size of the town/city at which physicians practiced. Scope of practice was ascertained through four domains of care: types of care, clinical procedures, practice settings and specific populations. Items within each domain were rated on a five-point scale (1='not part of practice', 5='element of core practice'). Mean rating scores for items in the domains of care were compared between urban and rural program graduates using ANOVA. RESULTS: A total of 307 (47.2%) graduates responded to the survey, of whom 173 were categorized as urban program graduates and 59 as rural program graduates. Overall, rural program graduates exhibited a broader scope of practice in providing postnatal care, intrapartum care/deliveries, palliative care, office-based and in-hospital clinical procedures, emergency care, in-hospital care, home visits, long-term care, and caring for rural and Aboriginal populations. Irrespective of program completed, those in a rural practice location had a broader scope of practice than those in urban practice. Urban and rural program graduates in rural locations tended to have a similar scope of practice. In urban locations, rural program graduates were more likely to include intrapartum care/deliveries as part of their clinical practice. Rural program graduates were more likely to practice in rural locations than urban program graduates. CONCLUSION: A combination of site of training (rural or urban program) and location of practice appear to work together to influence scope of practice of family physicians. A conceptual framework that summarizes the factors that have been reported to be associated with the scope of family practice is proposed.

A critical scoping review of the connections between social mission and medical school admissions: BEME Guide No. 47.

BACKGROUND: Despite a growing focus on the social accountability of medical schools, there has been no substantive review of admissions related to the social mission of medical schools. This paper reports on a critical scoping review of the connections between social mission and medical school admissions. METHODS: Searches of seven bibliographic databases identified 1258 unique articles. After filtering for relevance, 71 articles were considered for final review. The results of the data extraction were synthesized using a combination of qualitative and quantitative techniques. RESULTS: Five reviewers conducted 149 data extractions from 71 papers. Social missions tended to focus either on access and equity issues for applicants from underrepresented populations or on the career choices of medical graduates and how they meet particular social needs. The connection between social missions and admissions was often implied but rarely considered or evaluated directly. There was a notable absence of empirical evidence, with calls for reform or program descriptions far outweighing the number of papers based on empirical findings. CONCLUSIONS: Despite the move to social missions in medical education, there remains little direct connection between missions and admissions and little evidence reflecting the efficacy or impacts of making this connection.

Implications of not matching to a first-choice discipline: a family medicine perspective.

BACKGROUND: Family medicine is often selected as an alternate career choice by medical students who do not match to their first choice discipline. Consequently, family medicine residency programs accept and train some residents who prepared for and intended a career in another specialty. The implications of this warrant investigation. METHODS: Graduates (2006-2011) of Albertan family medicine residency programs were surveyed to examine differences between physicians who indicated family medicine was their first choice discipline and those who indicated that it was not their first choice. Survey questions targeted practice location, preparedness for practice, perceptions of family medicine, lifestyle satisfaction, and well-being. Principal components analysis was used to examine the factor structure of our survey items and ANOVA and Chi square were used to compare mean scores and proportions, respectively. RESULTS: The overall response rate was 47.2% (307/651). Most (263) respondents reported that family medicine was their first choice discipline (yes-group); 42 respondents indicated that it was not (no-group) and two did not answer. The two groups were similar demographically. The no-group reported significantly lower mean scores on perceptions of family medicine. There were no significant differences between the two groups in their preparedness for practice and measures of lifestyle satisfaction and well-being. CONCLUSION: Irrespective of their perceptions of the discipline, the respondents who did not match to their first choice discipline found family medicine to be a viable career option.

Well-being of family medicine graduates.

OBJECTIVE: To determine family medicine graduates' professional and personal well-being, general health status, stress levels, coping strategies, and the degree to which they felt supported or isolated in professional life; and to compare findings by sex, practice location, and location of medical school (Canadian medical graduates [CMGs] vs international medical graduates [IMGs]). DESIGN: Retrospective, cross-sectional survey. SETTING: University of Alberta in Edmonton and the University of Calgary in Alberta. PARTICIPANTS: A total of 651 graduates who completed one of the family medicine residency programs during 2006 to 2011. MAIN OUTCOME MEASURES: Using a 5-point Likert scale, graduates rated their general health status, their personal and professional well-being, their level of stress, and the degree to which they felt supported or isolated in professional life. Respondents also identified important life events, their caregiving roles, and stress-coping strategies. RESULTS: Of 651 graduates, 307 (47.2%) responded to the survey. Personal and professional well-being and general health status were rated as very good or excellent by 72.0%, 76.6%, and 74.7% of graduates, respectively. Overall, 39.3% reported high or extremely high levels of stress, with CMGs exhibiting significantly higher stress levels than IMGs (P = .02). Stress scores were inversely related to personal and professional well-being and health status. In terms of coping strategies, a significantly greater proportion of female than male graduates reported talking to colleagues (76.5% vs 64.3%; P = .026) and seeking professional counseling (18.7% vs 6.1%; P = .002). Also, a significantly greater proportion of IMGs than CMGs (52.9% vs 32.5%; P = .003), as well as those in rural (35.8%) or urban (49.3%) practices than those in metropolitan locations (30.1%) (P = .03), turned to spiritual or religious practices for stress management. Of all respondents, 54.8% felt highly or extremely supported and 18.4% felt isolated in their professional lives. CONCLUSION: While family medicine graduates are primarily healthy and have a strong sense of personal and professional well-being, many experience high levels of stress. Coping strategies generally include social contact with family, friends, or colleagues and differ by sex, whether respondents are CMGs or IMGs, and practice location. Professional isolation appears to be prevalent in both rural and urban practice locations. Physician well-being programs should include a multifaceted approach to accommodate a range of physician preferences.

Precepting at the time of a natural disaster.

BACKGROUND: Natural disasters strike communities that have varied degrees of preparedness, both physical and psychological. Rural communities may be particularly vulnerable as they often do not have the infrastructure or resources to prepare in advance. The psychological impact of a natural disaster is amplified in learners who may be temporary members of the community and therefore cannot draw on personal support during the crisis. They may turn to their clinical preceptors for guidance. CONTEXT: The Slave Lake fire (population 6782) in May 2011 and the High River flood (population 12 920) in June 2013 are examples of natural disasters that have occurred in rural Alberta, Canada. At the time of these critical incidents, three medical students and one family medicine resident from the two provincial medical schools were participating in rotations in these communities. INNOVATION: Although disasters occur rarely, there is a need for guidelines for preceptors from the learner perspective. Accordingly, using a modified Delphi approach, we captured the experiences of learners that were then refined into two themes, each containing three recommendations: considerations for action during a natural disaster and considerations for action after the acute crisis has passed. Although disasters occur rarely, there is a need for guidelines for preceptors from the learner perspective IMPLICATIONS: Our recommendations provide suggestions for practical solutions that build on the usual expectations of mentors and may benefit the student-teacher relationship at the time of a disaster and beyond. They are meant to initiate discussion regarding further study aimed towards creating recommendations for preceptor response that may cross disciplines.

Supporting Veterinary Preceptors in a Distributed Model of Education: A Faculty Development Needs Assessment.

Effective faculty development for veterinary preceptors requires knowledge about their learning needs and delivery preferences. Veterinary preceptors at community practice locations in Alberta, Canada, were surveyed to determine their confidence in teaching ability and interest in nine faculty development topics. The study included 101 veterinarians (48.5% female). Of these, 43 (42.6%) practiced veterinary medicine in a rural location and 54 (53.5%) worked in mixed-animal or food-animal practice. Participants reported they were more likely to attend an in-person faculty development event than to participate in an online presentation. The likelihood of attending an in-person event differed with the demographics of the respondent. Teaching clinical reasoning, assessing student performance, engaging and motivating students, and providing constructive feedback were topics in which preceptors had great interest and high confidence. Preceptors were least confident in the areas of student learning styles, balancing clinical workload with teaching, and resolving conflict involving the student. Disparities between preceptors' interest and confidence in faculty development topics exist, in that topics with the lowest confidence scores were not rated as those of greatest interest. While the content and format of clinical teaching faculty development events should be informed by the interests of preceptors, consideration of preceptors' confidence in teaching ability may be warranted when developing a faculty development curriculum.

Recruitment and retention of physicians in rural Alberta: the spousal perspective.

INTRODUCTION: The overall geographic distribution of physicians in Canada, including Alberta, is misaligned with the population distribution. Some strategies, such as debt repayment, are currently in practice to increase recruitment and retention of physicians in rural locations. Of the factors influencing choice of practice location, 'spousal influence' is considered to play a significant role in recruitment and retention of physicians in literature. Most studies have focused on the physicians' perspective of their spouses' influence on staying in a rural location. This study is unique as it approaches rural recruitment and retention from the perspective of the physician spouse. METHODS: The physician population for this study consisted of doctors practicing in rural southern Alberta. Participants were recruited via an email invitation and were invited to complete an online survey. The survey collected information regarding physician demographics and some relationship characteristics. The email invitation also contained a link to a second survey specific to the physician spouse or partner, asking a similar panel of questions. Physicians were asked to request their spouse or partner to complete this survey. Semi-structured interviews were conducted for those who consented to be contacted for interviews. RESULTS: Descriptive statistical analysis of the survey data was carried out. Thematic analysis of the qualitative interview data was conducted and was organized into three sections. The first and second sections present the personal experiences of rural recruitment and rural retention. The third section presents recommendations made by physicians and spouses to improve these processes. Specific interview quotes led the authors to derive themes under each section. CONCLUSIONS: The results of this study raise the voice and profile of the spouse in the process of rural recruitment and retention. In this study, the spouses of Canadian medical graduates were a positive influence in rural recruitment and retention, while the spouses of international medical graduates were generally less supportive of a rural lifestyle. Considerations to accommodate the educational, professional and cultural needs of the physician spouse must be incorporated into policy if large areas of underserved rural communities will continue to rely on international recruitment.

Exploring the Teaching Motivations, Satisfaction, and Challenges of Veterinary Preceptors: A Qualitative Study.

Optimization of clinical veterinary education requires an understanding of what compels veterinary preceptors in their role as clinical educators, what satisfaction they receive from the teaching experience, and what struggles they encounter while supervising students in private practice. We explored veterinary preceptors' teaching motivations, enjoyment, and challenges by undertaking a thematic content analysis of 97 questionnaires and 17 semi-structured telephone interviews. Preceptor motivations included intrinsic factors (obligation to the profession, maintenance of competence, satisfaction) and extrinsic factors (promotion of the veterinary field, recruitment). Veterinarians enjoyed observing the learner (motivation and enthusiasm, skill development) and engaging with the learner (sharing their passion for the profession, developing professional relationships). Challenges for veterinary preceptors included variability in learner interest and engagement, time management, and lack of guidance from the veterinary medicine program. We found dynamic interactions among the teaching motivations, enjoyment, and challenges for preceptors. Our findings suggest that in order to sustain the veterinary preceptor, there is a need to recognize the interplay between the incentives and disincentives for teaching, to foster the motivations and enjoyment for teaching, and to mitigate the challenges of teaching in community private practice.

Practice locations of longitudinal integrated clerkship graduates: a matched-cohort study.

INTRODUCTION: Longitudinal integrated clerkships (LICs) have been introduced as an innovative model to impart medical education. In Canada, most LIC experiences are situated in rural communities. Studies have reported equivalence in graduates from rural LICs and traditional rotation-based clerkships (RBCs) in their performance in residency, as well as in national medical licensure examinations. We sought to determine the impact of rural LICs in terms of practice location of graduates. METHODS: A matched cohort was developed on the basis of student background and sex to compare practice location of rural LIC and RBC graduates. We used the χ(2) test to assess the association between type of clerkship stream and practice location. RESULTS: We found an association between participation in a rural LIC and rural practice location. CONCLUSION: Rural LIC programs play an important role in introducing students to rural medicine and may be an effective tool in responding to the shortage of rural practitioners.

INTRODUCTION: Les stages cliniques longitudinaux intégrés (SCLI) ont été introduits à titre de modèles de formation médicale novateurs. Au Canada, la plupart des expériences de SCLI se déroulent en milieu rural. Des études ont fait état d'une équivalence entre les diplômés ayant opté pour un SCLI en milieu rural ou l'habituel stage clinique hospitalier (SCH) pour ce qui est de leur rendement durant leur résidence et de leurs résultats aux examens nationaux menant à l'obtention du permis d'exercice. Nous avons voulu mesurer l'impact des SCLI en milieu rural sur le lieu de pratique des diplômés. MÉTHODES: Une cohorte assortie a été formée sur la base des antécédents et du sexe des étudiants afin de comparer le lieu de pratique des diplômés selon qu'ils avaient fait un SCLI en milieu rural ou un SCH. Nous avons utilisé le test du χ2 pour évaluer le lien entre le type de stage clinique et le lieu de pratique. RÉSULTATS: Nous avons découvert un lien entre la participation à un SCLI en milieu rural et la pratique en milieu rural. CONCLUSION: Les programmes de SCLI en milieu rural sont importants pour initier les étudiants à ce type de pratique et pourraient être un outil efficace pour répondre à la pénurie de médecins en milieu rural.

Determinants of an urban origin student choosing rural practice: a scoping review.

INTRODUCTION: The shortage of physicians in rural and remote communities is an ongoing problem. Many studies have shown that the rural background of a student (ie rural origin) is a primary factor in recruiting physicians for practice in rural communities. Scoping reviews are primarily done to gauge the extent of literature on the research question at hand, typically with an intent that future research in that area is a constructive addition to pre-existing knowledge. This scoping review focuses on factors that predispose urban-origin students to choose a carrier in rural medicine. METHODS: The study used Arksey and O'Malley's guidelines for a scoping review of the literature, which, in contrast to a traditional systematic review, is brief yet comprehensive. Medline (Ovid) and PubMed databases were used to review literature published between 1 January 1970 and 30 November 2014. After removing duplicates, articles were screened based on inclusion and exclusion criteria set up by the research team. The literature search resulted in 435 articles, 418 of which were excluded, leaving 17 articles for comprehensive review. RESULTS: Out of these 17 studies, the following four factors that suggest why urban-origin medical students may choose rural practice were generated: geographic diffusion of physicians in response to economic forces such as debt repayment and financial incentives (five studies), scope of practice and personal satisfaction (five studies), undergraduate and postgraduate rural training (nine studies) and premedical school mindset to practice rurally (five studies). CONCLUSIONS: Urban-origin students may choose rural practice because of market forces as well as financial incentives. The participation in undergraduate and postgraduate rural training is reported to positively alter the attitude of urban-origin students. A small subset of these students has a predetermined mindset to practice rurally at the time of matriculation. Obstacles for choosing a rural carrier include, but are not limited to lack of job and education opportunities for spouses/partners, lack of recreational and educational opportunities for children, and obscure opportunities for continuing medical education.

Rural longitudinal integrated clerkships: changing interests and demographics of medical students.

INTRODUCTION: The University of Calgary Longitudinal Integrated Clerkship (UCLIC) is an integrated curriculum of at least 32 weeks' duration based in rural communities. Rural LICs have been proposed as a method to respond to the needs of underserved rural communities; therefore, assessing evolving learner interest and demographics over time is of importance to rural communities. METHODS: Three surveys were administered to first-year medical students at the University of Calgary from the classes of 2009, 2010 and 2015. The surveys assessed demographic information as well as interest in and attitudes toward pursuing a rural-based LIC. RESULTS: Overall, 42% of students (76% of decided students) reported that they would consider the rural UCLIC. Between 2009 and 2010, the proportion of students who would not consider the UCLIC decreased from 25% to 8%, and thereafter was maintained at that level. Over the same period, interest among students considering Royal College of Physicians and Surgeons of Canada (RCPSC) specialties significantly increased. Although student attitudes about the value of the LIC were consistently positive, students remained concerned about social considerations. CONCLUSION: There has been an increase in student willingness to consider a rural LIC, most significantly among students interested in RCPSC specialties. Career plans and demographics of students continue to influence their interest in and attitudes toward LICs.

INTRODUCTION: Le stage intégré longitudinal (SIL) de l'Université de Calgary (ou UCLIC pour University of Calgary Longitudinal Integrated Clerkship) est un programme intégré d'une durée minimale de 32 semaines en communauté rurale. Les SIL ruraux ont été proposés comme moyen de répondre aux besoins des communautés rurales moins bien desservies; il est donc important pour les communautés rurales de suivre l'évolution des intérêts et des caractéristiques démographiques des stagiaires au fil du temps. MÉTHODES: Trois sondages ont été administrés à des étudiants de première année de médecine à l'Université de Calgary des promotions de 2009, 2010 et 2015. Les sondages portaient sur leurs données démographiques de même que sur leur intérêt et leurs attitudes à l'endroit d'un SIL en milieu rural. RÉSULTATS: Dans l'ensemble, 42 % des étudiants (76 % des étudiants décidés) ont déclaré qu'ils envisageraient un SIL en milieu rural. Entre 2009 et 2010, la proportion d'étudiants qui n'envisageaient pas un tel stage a diminué de 25 %, à 8 %, et par la suite s'est maintenue à ce niveau. Au cours de la même période, l'intérêt à l'égard de ce stage chez les étudiants qui envisageaient une spécialisation du Collège royal des médecins et chirurgiens du Canada (CRMCC) a significativement augmenté. Même si leurs attitudes à propos de la valeur d'un SIL sont demeurées favorables, les étudiants ont dit se soucier des enjeux sociaux. CONCLUSION: On a constaté que les étudiants envisagent plus volontiers un SIL en milieu rural s'ils souhaitent faire une spécialisation du CRMCC. Les plans de carrière et les caractéristiques démographiques continuent d'influer sur leurs intérêts et leurs attitudes à l'endroit des SIL.

Specialty resident perceptions of the impact of a distributed education model on practice location intentions.

OBJECTIVES: There is an increased focus internationally on the social mandate of postgraduate training programs. This study explores specialty residents' perceptions of the impact of the University of Calgary's (UC) distributed education rotations on their self-perceived likelihood of practice location, and if this effect is influenced by resident specialty or stage of program. METHODS: Residents participating in the UC Distributed Royal College Initiative (DistRCI) between July 2010 and June 2013 completed an online survey following their rotation. Descriptive statistics and student's t-test were employed to analyze quantitative survey data, and a constant comparative approach was used to analyze free text qualitative responses. RESULTS: Residents indicated they were satisfied with the program (92%), and that the distributed rotations significantly increased their self-reported likelihood of practicing in smaller centers (p < 0.05). The findings suggest that the shift in attitude is independent of discipline, program year, and logistical experiences of living at the distributed sites, and is consistent across multiple cohorts over several academic years. CONCLUSION: The findings highlight the value of a distributed education program in contributing to future practice and career development, and its relevance in the social accountability of postgraduate programs.