Rural training in medical education
Rural training tracks and programs focus medical school training and learning experiences on the skills necessary to practice medicine in rural communities. These initiatives often recruit students from rural backgrounds and students who have expressed an interest in practicing medicine in small towns and rural locations1; recruitment often starts in high school and continues through medical school2, 3.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased availability of physicians in underserved areas
Increased access to care
What does the research say about effectiveness? This strategy is rated scientifically supported.
There is strong evidence that rural training programs increase the number of physicians who choose to practice in rural areas, increasing access to care for rural patients2, 4, 5, 6, 7, 8.
Rural medical school curricula, regular term or summer rural practice learning experiences, and rural residency programs increase the likelihood that participating students will choose to practice in a rural area1, 2, 7, 8, 9, 10, 11. Programs that recruit students with rural backgrounds and have a rural-focused curriculum increase the number of students who choose rural practice locations2, 8, 11 and remain there over the long-term5, 9, 12, often as primary care or family medicine physicians6, 11, 13. Surgeons who practice in rural areas during residency are also more likely to remain in rural practice than their peers1, 7, 14.
Minority physicians appear to be more likely to practice in underserved, high-need practice areas than their non-minority peers5.
Models indicate that expanding rural training programs to all medical schools would substantially increase the supply of rural physicians15.
How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples
There are a growing number of medical schools with programs that provide rural-specific training. Examples include the state university systems of Minnesota, Missouri, and Illinois16, 17; the State University of New York (SUNY) Upstate Medical University’s Rural Medical Scholars Program18; the Jefferson Medical College Physician Shortage Area Program (PSAP)12; the University of New Mexico’s School of Medicine Rural and Urban Underserved Program19; and the University of Kentucky’s Rural Physician Leadership Program (RPLP)20. The University of Washington School of Medicine’s Targeted Rural Underserved Track (TRUST) provides rural-specific training through a network of residency programs which care for underserved communities in Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI)21.
Implementation Resources
RTT Collaborative - RTT Collaborative. Rural education & training: Resources on rural residencies, training tracks, program locations, and financial resources.
UWSOM-TRUST - University of Washington School of Medicine (UWSOM). Targeted Rural Underserved Track (TRUST), caring for underserved communities in Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI).
Footnotes
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1 Wendling 2016 - Wendling AL, Phillips J, Short W, Fahey C, Mavis B. Thirty years training rural physicians: Outcomes from the Michigan State University College of Human Medicine Rural Physician Program. Academic Medicine. 2016;91(1):113-119.
2 Wheat 2017 - Wheat JR, Leeper JD, Murphy S, Brandon JE, Jackson JR. Educating physicians for rural America: Validating successes and identifying remaining challenges with the Rural Medical Scholars Program. Journal of Rural Health. 2017:1-10.
3 Wheeler 2017 - Wheeler DL, Hackler JB. Preparing physicians for rural-based primary care practice: A preliminary evaluation of rural training initiatives at OSU-COM. The Journal of the American Osteopathic Association. 2017;117(5):315-324.
4 Cochrane-Grobler 2015 - Grobler L, Marais BJ, Mabunda S. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database of Systematic Reviews. 2015;(6):CD005314.
5 Goodfellow 2016 - Goodfellow A, Ulloa JG, Dowling PT, et al. Predictors of primary care physician practice location in underserved urban and rural areas in the United States: A systematic literature review. Academic Medicine. 2016;91(9):1313-1321.
6 Nelson 2017 - Nelson GC, Gruca TS. Determinants of the 5-year retention and rural location of family physicians: Results from the Iowa Family Medicine Training Network. Family Medicine. 2017;49(6):473-476.
7 McCarthy 2015 - McCarthy MC, Bowers HE, Campbell DM, Parikh PP, Woods RJ. Meeting increasing demands for rural general surgeons. The American Surgeon. 2015;81(12):1195-1200.
8 Crump 2015 - Crump WJ, Fricker RS, Ziegler CH, Wiegman DL. Increasing the rural physician workforce: A potential role for small rural medical school campuses. Journal of Rural Health. 2015;00:1-6.
9 MacDowell 2013 - MacDowell M, Glasser M, Hunsaker M. A decade of rural physician workforce outcomes for the Rockford Rural Medical Education (RMED) Program, University of Illinois. Academic Medicine. 2013;88(12):1941-1947.
10 Kane 2013 - Kane KY, Quinn KJ, Stevermer JJ, et al. Summer in the country: Changes in medical students’ perceptions following an innovative rural community experience. Academic Medicine. 2013;88(8):1157-1163.
11 Petrany 2013 - Petrany SM, Gress T. Comparison of academic and practice outcomes of rural and traditional track graduates of a family medicine residency program. Academic Medicine. 2013;88(6):819-823.
12 Rabinowitz 2005 - Rabinowitz HK, Diamond JJ, Markham FW. Long-term retention of graduates from a program to increase the supply of rural family physicians. Academic Medicine. 2005;80(8):728-732.
13 Rabinowitz 2012 - Rabinowitz HK, Petterson S, Boulger JG, et al. Medical school rural programs: A comparison with international medical graduates in addressing state-level rural family physician and primary care supply. Academic Medicine. 2012;87(4):488-492.
14 Deveney 2013 - Deveney K, Deatherage M, Oehling D, Hunter J. Association between dedicated rural training year and the likelihood of becoming a general surgeon in a small town. JAMA Surgery. 2013;148(9):817-821.
15 Rabinowitz 2008 - Rabinowitz HK, Diamond JJ, Markham FW, Wortman JR. Medical school programs to increase the rural physician supply: A systematic review and projected impact of widespread replication. Academic Medicine. 2008;83(3):235-243.
16 Zink 2010 - Zink T, Center B, Finstad D, et al. Efforts to graduate more primary care physicians and physicians who will practice in rural areas: Examining outcomes from the University of Minnesota-Duluth and the rural physician associate program. Academic Medicine. 2010;85(4):599-604.
17 Glasser 2008 - Glasser M, Hunsaker M, Sweet K, MacDowell M, Meurer M. A comprehensive medical education program response to rural primary care needs. Academic Medicine. 2008;83(10):952-961.
18 SUNY Upstate-RMSP - SUNY Upstate Medical University. Rural Medical Scholars Program (RMSP).
19 UNM-RUUP - University of New Mexico (UNM). School of Medicine Rural and Urban Underserved Program (RUUP).
20 UK-RPLP - University of Kentucky (UK) College of Medicine. Medical Student Education: Rural Physician Leadership Program (RPLP).
21 UWSOM-TRUST - University of Washington School of Medicine (UWSOM). Targeted Rural Underserved Track (TRUST), caring for underserved communities in Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI).
Related What Works for Health Strategies
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