A Match Made in Rural: Interpreting Match Rates and Exploring Best Practices.

BACKGROUND AND OBJECTIVES: Although rural family medicine residency programs are effective in placing trainees into rural practice, many struggle to recruit students. Lacking other public measures, students may use residency match rates as a proxy for program quality and value. This study documents match rate trends and explores the relationship between match rates and program characteristics, including quality measures and recruitment strategies. METHODS: Using a published listing of rural programs, 25 years of National Resident Matching Program data, and 11 years of American Osteopathic Association match data, this study (1) documents patterns in initial match rates for rural versus urban residency programs, (2) compares rural residency match rates with program characteristics for match years 2009-2013, (3) examines the association of match rates with program outcomes for graduates in years 2013-2015, and (4) explores recruitment strategies using residency coordinator interviews. RESULTS: Despite increases in positions offered over 25 years, the fill rates for rural programs have improved relative to urban programs. Small rural programs had lower match rates relative to urban programs, but no other program or community characteristics were predictors of match rate. Match rates were not indicative of any of five measures of program quality nor of any single recruiting strategy. CONCLUSIONS: Understanding the intricacies of rural residency inputs and outcomes is key to addressing rural workforce gaps. Match rates likely reflect challenges of rural workforce recruitment generally and should not be conflated with program quality.

Building Rural Primary Care Research by Connecting Rural Programs.

Both research and medical education make substantial contributions to rural primary care and health. An inaugural Scholarly Intensive for Rural Programs was conducted in January 2022 to connect rural programs within a community of practice focused on promoting scholarly activity and research in rural primary health care, education, and training. Participant evaluations confirmed that key learning objectives were met, including stimulating scholarly activity in rural health professions education programs, providing a forum for faculty and student professional development, and growing a community of practice that supports education and training in rural communities. This novel strategy brings enduring scholarly resources to rural programs and the communities they serve, teaches skills to health profession trainees and rurally located faculty, empowers clinical practices and educational programs, and supports the discovery of evidence that can improve the health of rural people.

Promoting Health Careers Among Rural K-16 Students: A Mixed-Method Study to Describe Pathway Programs.

Health career pathway programs can promote and prepare rural students in grades kindergarten through college (K-16) for health careers, but little is known about the prevalence and characteristics of these programs in the U.S. This mixed-methods study provides a baseline description of health career pathway programs for rural K-16 students through a scoping review, survey, and semi-structured interviews with program directors. Among 165 programs responding to the survey, motivational or health career awareness (95.1%), health care exposure (92.0%), and mentorship (70.2%) were the most commonly used strategies. About one-third of programs (34.6%) had discontinued at least one strategy in the past three years, often due to loss of funding or a change in priorities. While reported outcomes suggested positive program effects, evaluations lacked rigor to draw definitive conclusions about program success. This study serves to generate hypotheses for further studies examining characteristics of student participants, program strategies and activities, and outcome measurement for health career pathway programs.

Challenges and Best Practices for Implementing Rurally Targeted Admissions in U.S. Medical Schools.

Student attributes can predict future rural practice, but little is known about how medical schools use these factors in admissions. This mixed-methods study examined admissions strategies to recruit and select students likely to practice rurally. Admissions personnel at U.S. allopathic and osteopathic medical schools were surveyed about rurally targeted admissions. Personnel from selected schools were interviewed to understand further targeted admissions practices. Among 185 medical schools, 133 (71.8%) responded. Schools engaged with students from four-year universities through career exploration (89.9%), admissions preparation (57.7%), academic enhancement (47.7%), and articulation agreements (42.9%). Applicant selection practices included preferential scoring in screening (38.2%) and admissions decisions (30.0%), modified MCAT (21.4%) and GPA cutoffs (18.8%), and reserved class slots (20.2%). Personnel from 10 schools identified key themes of motivations, resources, challenges, and recommendations. Understanding how schools identify and admit rurally inclined students is a first step in identifying best practices for addressing rural workforce gaps.

Community assets and capabilities to recruit and retain GPs: the Community Apgar Questionnaire in rural Victoria.

INTRODUCTION: Rural communities continue to experience significant challenges recruiting and retaining physicians. The Community Apgar Questionnaire (CAQ) was developed in Idaho in the USA to comprehensively assess the characteristics associated with successful recruitment and retention of rural physicians. The CAQ has been utilised and validated across the USA; however, its value in rural Australia has not been examined. The objective of this study was to use the CAQ in rural Australia to examine its utility and develop a greater understanding of the community factors that impact general practitioner (GP) recruitment and retention. METHOD: The project conducted structured face-to-face interviews with hospital chief executive officers (CEOs) and directors of clinical services (DCSs) from 14 of the 21 (76%) health services that agreed to participate in rural north-eastern Victoria, Australia. The interviews were undertaken to complete the CAQ, which contains 50 questions centred on factors that influence physician recruitment and retention. Once completed, CAQs were scored by assigning quantitative values to a community's strengths and challenges including the level of importance placed on each factor. As such, the most important factors in physician recruitment, whether they are advantages or challenges for that community, were then weighed for their relative importance. Scores were then combined to create a CAQ score. To ensure reliability and validity of the results, three additional CAQs were purposefully administered to key general practices within the region. RESULTS: The 14 rural communities exhibited cumulative CAQ scores ranging from a high of 387 to a low score of 61. This suggests the tool was sensitive enough to differentiate between communities that were high and low performers in terms of physician recruitment. The groups of factors that had the greatest impact on recruitment and retention were ranked highest to lowest and included medical support, hospital/community support, economic, scope of practice and geographic factors. Overall, the highest individual factors to impact recruitment and retention were perception of quality, hospital leadership, nursing workforce and transfer arrangements. Conversely, the lowest factors and challenges to recruitment and retention were family related, specifically spousal satisfaction and access to schools. CONCLUSIONS: Hume, in rural Victoria, was the first international site to implement the CAQ to differentially diagnose a community's relative strengths and challenges in recruiting and retaining GPs, while supporting health facilities to prioritise achievable goals to improve long-term retention strategies. It provided each community with a tailored gap analysis, while confidentially sharing best practices of other health facilities. Within Hume, open communication and trust between GPs and health facility leadership and nursing staff ensures that GPs can feel valued and supported. Possible solutions for GP recruitment and retention must consider the social, employment and educational opportunities that are available for spouses and children. Participation in the program was useful as it helped health facilities ascertain how they were performing while highlighting areas for improvement.