Context: Medical schools of geographically large nations have expanded into rural areas to facilitate the development of a sustainable rural pipeline of physicians.Preceptor, or clinical teacher, recruitment at these sites has been an ongoing challenge. However, residents-as-teachers (RaT) curricula have not been modified to support the development of rural teachers. This study aimed to compare teaching opportunities between rural and urban family medicine residents and to identify mechanisms underlying potential differences.
Methods:Year-1 and Year-2 family medicine residents at seven Canadian institutions participated in a mixed-methods study utilising a quantitative survey and a qualitative interview. Rural and urban residents rated the quantity and types of teaching opportunities available during their training, from which a chi-squared analysis was completed. Volunteer respondents participated in a structured interview, from which a thematic analysis was performed.Results: Rural family medicine residents had fewer opportunities to teach compared to their urban colleagues. This discrepancy was seen across multiple domains, including informal opportunities when on family medicine rotations, χ 2 (4, n = 242) = 45.26, P < .000, Bonferroni's adjusted P < .000. Thematic analysis centred around determining factors influencing teaching opportunities and identified that the academic context, personal factors and programme factors were key dimensions. Within these dimensions, the number of medical students, a desire to be an educator and administrative support were cited as influences on teaching opportunities.
Conclusions:The lack of teaching opportunities for rural trainees is attributable to a combination of practical and organisational factors revealed through thematic analysis.If rural graduates are not comfortable balancing the demands of service and teaching, this could compound the already prevalent issue of rural preceptor recruitment. It is essential to develop a rural-focused RaT curriculum to close this gap and produce competent educators who are ready to inspire generations of rural physicians.
Do not delay advance care planning (ACP) conversations.Recall and describe a clinical encounter in which you were called on to choose wisely I recently accepted the wife of one of my patients into my practice. They are both in their 80s, very independent, and fearful of coronavirus disease 2019 (COVID-19). In our meet and greet, while updating her profile in her electronic medical record (EMR), I broached the topic of ACP. While she had previously been very healthy, owing to the uncertainty surrounding the COVID-19 pandemic, she was quite open to having the discussion.This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to www.cfp.ca and click on the Mainpro+ link.
Background: The scholar competency of the CanMEDS-FM framework requires residents to develop teaching skills, and with the number of rural residency positions tripling over the last decade, it is essential for residency programs to provide rural residents with teaching opportunities. The purpose of this study was to investigate the differences in teaching opportunities offered to urban and rural family medicine residents at the University of Manitoba.Methods: The 117 urban and rural family medicine residents were surveyed to quantify their interactions with medical students. Specific respondents were interviewed to provide context to the survey.Results: On family medicine, only 20% of rural residents reported frequent opportunities to informally teach, compared to 57% of urban residents. Similarly, 86% of urban residents reported organized teaching opportunities compared to only 5% of rural residents. Residents placed high value in receiving additional teaching opportunities.Conclusion: This study suggests that there are fewer teaching opportunities for rural family medicine residents compared to urban residents at the University of Manitoba. Given the small sample size, a larger study could determine whether this trend exists across the country. It will be incumbent on residency programs to ensure rural residents have the opportunities to become competent educators.
The authors argue that more focused efforts are needed to improve postgraduate rural specialty training and that rural training sites need to be included as essential partners within academic medicine.
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