RURALMED is the largest of any rural medical lists in Canada, it has about five hundred members. If you are only going to subscribe to one you should subscribe to it as the best from other lists often gets cross posted. Local political matters are often handled with more specifics on restricted regional rural lists such as those available from the BC and Alberta regional pages. There is a french language list Med Rurale français. Pour ceux qui voudraient ou aimeraient exprimer leurs idées, leurs opinions en français, s'incrive au Med Rurale français! Il s'agit d'en faire la demande dans un message électronique adressé à lamarche@comnet.ca

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RuralMed Archives

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If you are a SRPC member you may obtain a password from Lee Teperman. Information expressed on Rural Med are the views of the author(s) and not necessarily of the SRPC except when labelled as policy.

RuralMed Posting 4/9/2003

The Nebraska graduate programs focus in areas near and dear to Canada. The focus is on small rural practices with 2 - 4 docs. This focus resulted in some unique programs starting with admissions and extending through medical school and into residency. The result is one of the highest retention levels of students and residents in the state and in rural areas in the nation.

Admissions of the kids from rural areas that are likely to return is the foundation. This includes leadership of admissions by a former rural doc and a special program that admits rural high school kids to medical school. They attend one of two small rural colleges prior to entry (RHOP program).

Activities for medical students during the M-1 and M-2 year are important, including the rural student interest group, the counseling program that understands the culture shock of going from rural to urban, the family practice club, the volunteer opportunities at the underserved clinic, and the Student Alliance for Global Health group with the opportunity to go to Jamaica on a medical mission. These service opportunities seem to cement the resolve of the students interested in rural practice.

The medical school has an early emphasis on primary care and visits to preceptors and small groups led mostly by FP docs in the first two years. At the end of the M-1 year the students all go out for 3 - 4 weeks with a rural preceptor. In the M-3 year the required FP 2 month rotation is taught in rural Nebraska by rural docs. Then things really get focused for some.

5 students choose a Combined IM/FP program that prepares them for rural practice beginning with the M-4 year. These students graduate at the M-4 year and go thru the match, most choose 1-2 rural training track programs

5 students choose an Accelerated Rural Training Program beginning also in the M-4 year. The rotations are set to increase in intensity and responsibility over the next two years. There is no wasted M-4 year in this group. The advance in knowledge and maturity of this group is superb. ARTP residents work with the director to design a final year of training with procedures, OB, anesthesia, surgery etc. Many times the residents train with the surgeons they will use as referral physicians. Often the resident knows where they will locate and use the final year to specifically prepare. My worries prior to the onset of the program in 1992 were that the group would not leave Omaha after 7 years of training there with only a few months away. Despite this, the ARTP group has the same stellar track record for rural location and small rural location as the RTT programs. Overall our residents have gone from 40% rural to 60% rural.

Article by Jim Stageman, Jeff Harrison and myself now published in most recent Journal of the American Board of FP

Canada may only need a 3-2-1 model of medical school, residency, and fellowship. There is great focus and flexibility in this program.

I also think a model with 3 years medical school, 1 year of a rural preceptorship (Syracuse RMED), and 2 years of residency would not only provide some of the best training, it would help with retention of rural physicians. This would fit within parameters of current training without the hassle of convincing hospitals and others to accept orders from M-4 student/residents in the transitional year of the accelerated program.

Our nation's graduate accrediting leadership is trying to extinguish accelerated training, but we are trying to point out how necessary this is, given the poor primary care focus in medical school and the great needs of rural communities.

To me, the most important point made by the Nebraska approach, including the accelerated program, is how much better we can prepare students if we have a generalist and rural focus throughout all the years of medical school and residency.

Robert C. Bowman, M.D., Co-Chairman Rural Medical Educators Group of the National Rural Health Association

UNMC Department of Family Medicine Director of Rural Health Education and Research

Email: rbowman@unmc