A Typology for Rural Training and Participating Programs

The RTT Collaborative, May 2023

Describing the wide variety of programs in rural health professions education can be challenging. We have chosen to characterize programs who participate in The RTT Collaborative in the following ways:

Residency Programs in Medicine

  1. Rurally Located Program: Residency training is located primarily in a rural place by at least two federal definitions (see footnotes below) with minimal urban experience (2 required months or less).
  2. Rural Track Program:  A rural track program is a separately accredited program with more than 2 months of urban experience and greater than 50% training in a rural location by at least two federal definitions.
  3. Urban Program with a Rural Track: A defined track for select residents who spend more than 2 months in the urban setting and greater than 50% of their total residency training in a rural location by at least two federal definitions.
  4. Urban Program with a Rural Pathway: Programs with a structured sequence of rural training experiences for select residents, more than 2 months, but less than 50% of total training.
  5. Urban Program with a Rural Focus: As indicated by a mission statement and at least 2 months of required rural experience for all residents but less than 50% structured training for even select residents
  6. A Program with Rural Outcomes: As measured by equal to or greater than 50%  of graduates, or more than three (3) resident graduates a year on a three-year rolling average, locating in an initial rural place of practice by at least two federal definitions. Any of the above types, as well as any urban program, can claim this distinction with appropriate documentation.

For a recently revised version of this evolving typology download a PDF with references: Typology-for-Rural-Training-May-2023.pdf (147.95 KB pdf)

Medical School or other Health Professions Programs

Program with a Rural Track – The following criteria for a rural program in medical school were established empirically in the process of cataloging  rural programs across the US, an organized and deliberate strategy to produce clinicians to rural practice as indicated by all the following:

  • A program name
  • A program-specific goal or objective(s) to recruit, nurture, educate, train, or encourage students toward rural practice
  • A description that explicitly articulates a rural focus
  • A structured sequence or group of activities, courses, electives, selectives, or clerkships (e.g., “track,” “pathway,” “certificate,” “area of concentration” or “longitudinal integrated clerkship in a rural community [rural LIC],” even a rurally located “campus”

Exclusions include:

  • A scholarship program without a structured sequence or group of activities
  • Rural clerkships, even required clerkships, if they are not organized into a program
  • A rurally located medical school with or without a rural mission or program by our definition is a rural school, not a rural program. However, a rurally located medical school campus, ie, a campus that does not separately report graduates to the AAMC or AOA, is a rural program if it otherwise meets the definition

Program with a Rural Focus (as indicated by a mission statement and at least 2 months of required rural experience for all students)

Other Rurally Invested Programs 

Any program that is invested in producing clinicians to rural practice is invited to join The RTT Collaborative and pay an annual participation fee, e.g., a health equity track or fellowship program. Although programs in other disciplines do not have a generally accepted typology at this time, The RTT Collaborative will adapt the above criteria for any participants who are undergraduate, graduate, or post-graduate programs in other disciplines.

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Note:

For rural location, The RTT Collaborative accepts as ‘rural’ any place that is designated as rural by at least 2 federal definitions (See ‘Am I Rural?’)

Rural Track Program (RTP) is new terminology, now being used in federal regulation and accreditation as a replacement for Rural Training Track (RTT or integrated RTT), where residents train in both urban and rural settings and spend greater than 50% of their total training time in a rural location.  CMS and ACGME use the term ‘RTP’ to refer to both accredited programs and not-separately-accredited tracks within a program. The RTT Collaborative has chosen to distinguish these two types, due to their very different governance and rules of finance dictated by participating rural hospital type(s).