This area is an absolute must. The institution's mandate must be stated, understood, and applied. There should be no other major agendas for the institution. This is particularly difficulty when NIH research funds top 13 billion and billions more tempt medical schools to fund teaching with subspecialists or hospital-oriented care. This is enforced by accreditation bodies of medical education who evaluate the research and academic practice areas and can choose to penalize primary care-focused schools. The teaching of rural primary care can be inhibited by the development of non-primary care residencies, the expansion of other primary care residencies
beyond the resources (patients, faculty, staff) available to train physicians, or the expansion of subspecialty private practice domains. Research can pose a problem as a focus on "pure" research rather than rural or applied research can deflect the institution. A priority on academic development can take faculty and other resources away from primary care. Small institutions are far less able to support multiple missions or mandates.
New programs take money to start. Rural programs need to begin small and build up. Each project feeds into the next. Many sources of funding are possible but it takes time and faculty resources to evaluate and pursue the best ones. The best sources have been state and federal funds, but our growing health care burden threatens both sources. Both have strings and restrictions and there is always the threat economic hard times. Constant communication with the legislatures is a necessity. With a true institutional mandate, medical school funds should be a source. Grants are also a possibility, but often leave programs short of people (coordinators, secretaries, faculty time) and equipment resources. Adequate resources to manage the grants often don't come until years later due to delays in hiring.
Faculty must be experienced in rural health. They should be committed, enthusiastic, and able to work together as a team. There must be enough faculty for an adequate critial mass. Rural faculty must have access to the latest information on rural and family practice programs in order to best pursue teaching resources, funding, and other necessary elements for the rural programs. Networking and travel expenses are necessary. Faculty development encompassing all the above is essential. The Status of Rural Medical Education outlines current progress.
It is necessary for information and resources to be assimilated into a vision that is do-able for the institution. This will involve change, political struggle, tact, diplomacy, and a willingness to invoke the institutional mandate when necessary. See Jack Verby or Tom Bruce for more information.
Included in this draft are suggestions for objectives and subject areas. The curricula demands careful selection of faculty, sites, and communities -all those who impact on the environment of rural medical education. Those interested in more detailed work might choose to look at Objectives for Rural Programs, Core Topics, The Basics of Rural Curricula, Evaluating a Rural Program, Facilitating Resident Recruitment to Underserved Areas or Dimensions in Rural Medical Education.