Questions to Ask

This series of specific questions address both the content and the context of a program’s rurally oriented teaching.

• What rural-specific content do you teach, e.g. teaching rounds, required rural rotations or projects, or web-based content?
• What is your definition of rural?
• What do you believe are the most important differences between urban and rural practice, and how do you expose students to these differences?
• For what scope of practice do your residents train (procedures, OB, emergency care, public and community health, etc.)?
• What experience will I get in emergency care, intensive care, orthopedics, surgery, pediatrics and obstetrics?
• What percentage of patients from your practice use office calls for acute care, rather than the ER or an urgent care facility?
• What portion of my time as a resident will be spent in a rural place or places?
• Where are those places?
• Can I visit, as part of my rotation or interview?

One key to successful rural practice is the ability to adapt to the needs of the rural community where you live and work. A wide scope of training is a good idea, even if you don’t end up using every skill you have learned.

Programs with more rural-experienced faculty, and particularly where the program director has significant rural practice experience, are more likely to graduate physicians to rural practice.

Unfamiliarity with these groups does not necessarily mean the program does not have a rural focus, but membership in any of these groups indicates a significant commitment to rural medical education.

Get specific percentages and clarify how the program defines rural. Programs lacking information about outcomes likely don’t track them, and training physicians for rural practice may not be important to their mission.

Many traditional residency programs provide excellent training for the scope of rural practice, but limit resident’s ability to train in a rural context, a very important element in preparing for rural practice.

• Can I do any core rotations in a rural site?
• How much elective time is there in the curriculum?
• Will I have malpractice coverage for doing away rotations?
• Are there opportunities for international experience in a rural setting, and have any residents taken advantage of this opportunity in the past 3 years?

Program faculty and residents should be able to articulate this difference, even if they have not fully experienced training in both settings. Residents early in training, just like medical students, may not fully understand the role of context, but will be able to point to differences in content and the process of training.

Rural training track programs, because of their small size and particular community context, often have a niche that makes them unique.

Another advantage of training in a rural context is a patient population closely reflecting patients one can expect to encounter in subsequent rural practice. In addition to a wide technical scope of practice, rural practices often have a wide demographic and patients may represent a large geographical area and culturally diverse community.

RTTs vary in the distance between the rural and urban locations. Programs may have had to find creative ways to increase interaction and mutual learning for training across these two environments, including:

• How often do residents from the two locations physically get together?
• How has your program made the most of the unique differences between your training locations?
• Tell me about your videoconferencing capabilities. How is it working?

A main advantage of training in a rural program is the opportunity to experience life as a doctor in a rural place. Some IRTTs have developed strategies to help residents move from one location to another after the first year of training. For example, it may be possible to live in a rural community midway between the urban and rural residency locations.

• Are there subsidies for travel and/or moving expense?
• Is there a residence requirement for taking home call? (e.g. “you must live within 15 minutes of the hospital”)

Students are often surprised to find technology-oriented or academic jobs in a rural place, thinking that these only exist in urban areas. In addition, opportunities abound for telecommuting or working from home.