Creating a Rural Surgery Track and a Review of Rural Surgery Training Programs

Mercier, Phillip J.; Skube, Steven J.; Leonard, Samantha L.; McElroy, Ashley N.; Goettl, Tyler G.; Najarian, Melissa M.; Termuhlen, Paula M.; Chipman, Jeffrey G.

doi:10.1016/j.jsurg.2018.09.004

Cited by 22 publications

(19 citation statements)

References 14 publications

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“…35 Some residency programs have opted for either offering a rural general surgery residency or ensuring that the majority of a resident's rotations take place at a rural or community site. 36 Gastroscopy and colonoscopy remain essential components of a general surgeon's practice and were the most commonly performed procedures across all communities. Sigmoidoscopy appears to be primarily performed in communities with more than 100 000 residents.…”

Section: Discussionmentioning

confidence: 99%

General surgery in Canada: current scope of practice and future needs

Schroeder

Sheppard

Wilson

et al. 2020

cjs

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Background: The scope of practice of general surgeons in Canada is highly variable. The objective of this study was to examine the demographic characteristics of general surgeons in Canada and compare surgical procedures performed across community sizes and specialties. Methods: Data from the Canadian Institute for Health Information's National Physician Database were used to analyze fee-for-service (FFS) care provided by general surgeons and other providers across Canada in 2015/16. Results: Across 8 Canadian provinces, 1669 general surgeons provided FFS care. The majority of the surgeons worked in communities with more than 100 000 residents (71%), were male (78%), were aged 35-54 years (56%) and were Canadian medical graduates (76%). Only 7% of general surgeons practised in rural areas and 14% in communities with between 10 000 and 50 000 residents. Rural communities were significantly more likely to have surgeons who were international medical graduates or who were older than 65 years. The surgical procedures most commonly performed by general surgeons were hernia repairs, gallbladder and biliary tree surgery, excision of skin tumours, colon and intestine resections and breast surgery. Many general surgeons performed procedures not listed in their Royal College of Physicians and Surgeons of Canada training objectives. Conclusion: Canadian general surgeons provide a wide array of surgical services, and practice patterns vary by community size. Surgeons practising in rural and small communities require proficiency in skills not routinely taught in general surgery residency. Opportunities to acquire these skills should be available in training to prepare surgeons to meet the care needs of Canadians. Contexte : La pratique des chirurgiens généralistes au Canada varie grandement. Cette étude visait à examiner les caractéristiques démographiques des chirurgiens généralistes au Canada et à comparer les interventions réalisées selon la spécialité et la taille des collectivités. Méthodes : Des données de la Base de données nationale sur les médecins de l'Institut canadien d'information sur la santé ont été utilisées pour analyser les soins rémunérés à l'acte dispensés par des chirurgiens généralistes et d'autres fournisseurs de soins au Canada en 2015-2016. Résultats : Dans 8 provinces canadiennes, 1669 chirurgiens généralistes ont fourni des soins rémunérés à l'acte. La majorité d'entre eux travaillaient dans des collectivités de plus de 100 000 résidents (71 %), étaient des hommes (78 %), avaient entre 35 et 54 ans (56 %) et avaient obtenu leur diplôme de médecine au Canada (76 %). Seuls 7 % des chirurgiens généralistes travaillaient en région rurale et 14 %, dans des collectivités comptant entre 10 000 et 50 000 résidents. En région rurale, la probabilité que les chirurgiens soient des diplômés internationaux en médecine ou aient plus de 65 ans était significativement plus élevée. Les interventions les plus fréquentes étaient la réparation d'une hernie, la chirurgie de la vésicule biliaire et des voies biliaires, l...

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Section: Discussionmentioning

confidence: 99%

General surgery in Canada: current scope of practice and future needs

Schroeder

Sheppard

Wilson

et al. 2020

cjs

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“…Building on prior studies from the RPAP cohort , [4][5]7 this study serves to promote further investigation and discussion around outcomes of rural focused programs on medical student career development. RPAP historically has had higher rates of alumni who practice rural medicine when compared to those who did not participate in the LIC.…”

Section: Resultsmentioning

confidence: 99%

“…Factors such as having a rural background and interests, as well as completing rural clerkships have been described as influencing the choice to practice rural general surgery. [4][5][6][7][8] Previous exploration of the Rural Physician Associate Program (RPAP) cohort from the University of Minnesota has found that practicing surgeons who had rural training in a Longitudinal Integrated Clerkship (LIC) during medical school were more likely to practice in a rural community, validating this assumption within Minnesota. 4,8 Surgical clerkships on longitudinal rotations, such as RPAP, have developed a variety of experiences, mimicking the medical student rural experience, as a way of introducing and nurturing interest in rural general surgery practice.…”

Section: Introductionmentioning

confidence: 98%

Do Rural Longitudinal Integrated Clerkships Impact Choice of Residency Type and/or Permanent Community Practice in Surgery?

Maki

Riley

Christensen

et al. 2021

JRMC

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Purpose: Rural general surgery experiences during medical school appear to have influenced the decision of prospective general surgery applicants to pursue residency programs that provide rural surgery opportunities. This is an analysis of a single cohort, rural-focused, longitudinal integrated clerkship to determine if there is an association between type of residency program and completion of a rural-focused longitudinal integrated clerkship. Methods: An institutional database of de-identified, self-reported data was reviewed to identify rural-focused longitudinal integrated clerkship alumni who matched into a surgical residency program. Findings: Of the seventy-five alumni who chose a surgical residency program, 40 (53.3%) matched into a university-affiliated residency program, and 32 (42.6%) matched into an independent-academic program. There was no association between type of residency program and completion of a rural-focused longitudinal integrated clerkship. Conclusions: A rural-focused longitudinal integrated clerkship can help increase the rural physician workforce within both the state and region of the sponsoring institution. To facilitate heightened interest in rural general surgery, these types of programs should continue to be promoted.

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“…This reinforces previous work showing the importance of rural training in residency and supporting the conventional wisdom that physicians tend to locate near where they trained. 30,31 For context, there were 301 Accreditation Council for Graduate Medical Education (ACGME)-accredited surgery residency programs as of the 2017-2018 academic year, 32 and according to the American College of Surgeons, only 14 programs focused on rural surgery. 33 Of these, 5 were wholly located in less-urban counties.…”

Section: Discussionmentioning

confidence: 99%

Movers and Stayers: What Birthplaces Can Teach Us About Rural Practice Choice Among Midwestern General Surgeons

Hughes

Williams

Brooks

2020

The Journal of Rural Health

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This study compares practicing rural Midwestern general surgeons born in urban areas to those born in rural areas to describe the association between birthplace and current practice location. Methods: The 2017 AMA MasterFile was used to study general surgeons in the Midwest Census Division. Surgeons were assigned to categories based on birthplace and current practice locations: urban-urban stayers, urban-rural movers, rural-rural stayers, and rural-urban movers. Urban and rural classifications corresponded to the metropolitan and nonmetropolitan definitions with Rural-Urban Continuum Codes (urban, RUCCs 1-3; rural, RUCCs 4-9). Bivariate tests and logistic regression were used to determine factors associated with rural practice choice. Findings: There were 3,070 general surgeons in the study population: 70.6% urban-urban stayers, 13.1% urban-rural movers, 10.7% rural-urban movers, and 5.7% rural-rural stayers. Rural areas netted 74 surgeons (327 rural-urban movers versus 401 urban-rural movers). Logistic regression results found different factors predicted rural practice among urban-born versus rural-born surgeons. Older urban-born surgeons were more likely to practice rurally, as were male surgeons, DOs, and those trained in less-urban residency programs. Among rural-born surgeons, more rural birthplaces and having trained at a less-urban residency were associated with practicing rurally. Conclusions: Recruiting urban-born surgeons to rural areas has proven successful in the Midwest; our findings show urban-born surgeons outnumber rural-born surgeons in rural communities. Given the ongoing need for surgeons in rural areas, urban-born surgeons should not be overlooked. Findings suggest educators and community leaders should expand less-urban training opportunities given their potential influence on all general surgeons.

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Creating a Rural Surgery Track and a Review of Rural Surgery Training Programs

Cited by 22 publications

References 14 publications

General surgery in Canada: current scope of practice and future needs

General surgery in Canada: current scope of practice and future needs

Do Rural Longitudinal Integrated Clerkships Impact Choice of Residency Type and/or Permanent Community Practice in Surgery?

Movers and Stayers: What Birthplaces Can Teach Us About Rural Practice Choice Among Midwestern General Surgeons

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