A Typology of Participating Programs***

Randall Longenecker MD and Darin Bell MD, The RTT Collaborative, May 2022

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, with minimal urban experience (less than 3 months)[1]
  2. Rural Track Program[2],[3] This new terminology is now being used in federal regulation and accreditation as a replacement for an RTT or integrated RTT. However, The RTT Collaborative is only using this term for separately accredited programs and is applying the phrase more broadly to include any program bridging rural and urban settings with at least 3 months of urban experience and greater than 50% training in a rural location by at least two federal definitions. (CMS and ACGME only accept locations as ‘rural’ if they are located in either a micropolitan CBSA or a non-metropolitan county; a separately accredited RTP is considered ‘RPT1’ by ACGME definition)
  3. Urban Program with a Rural Track (RTP2 by ACGME definition) This is a not-separately-accredited but defined track within an established program for selected residents who spend greater than 50% of their residency training in a rural location by two federal definitions
  4. Urban Program with a Rural Pathway, a structured sequence of rural training experiences for select residents, 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; also termed in the literature as ‘rural centric’[4])
  6. Urban Program with Rural Outcomes (as measured by equal to or greater than 50%[5] of graduates, or more than 3 residents a year on a three-year rolling average, locating in an initial rural place of practice)

*Program requires a separate ACGME#
**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?’)

For a recently revised version of this evolving typology (and it will continue to evolve) see the following graphic or download this table: Emerging-Typology-9.6.2022.pdf (103 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,[6] 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 (eg, “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 also adapt the above criteria for any participants who are undergraduate, graduate, or post-graduate programs in other disciplines.

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[1] Although 2 months has not been shown to have a definite pedagogical effect, it has been shown to be a useful breakpoint in distinguishing rural centric residencies from those without a rural mission, i.e., there are few residency programs with more than 8 weeks in a rural place that are not RTPs or Rural Tracks. And so, we are using the 2-month measure in this typology.

[2] Previously identified as separately accredited “integrated rural training tracks” or ‘rural track residencies,’ frequently in the prototypical ‘1-2 format’ – 1 year in the urban setting, then 2 years rural.

[3] Medically Underserved Areas and Populations, ACGME, https://www.acgme.org/what-we-do/accreditation/medically-underserved-areas-and-populations/

[4] Patterson DG, Andrilla CHA, Garberson LA. Preparing Physicians for Rural Practice: Availability of Rural Training in Rural-Centric Residency Programs. J Grad Med Educ. 2019 Oct;11(5):550-557. doi: https://doi.org/10.4300/JGME-D-18-01079.1. PMID: 31636825; PMCID: PMC6795329.

[5] Meyers P, Wilkinson E, Petterson S, Patterson DG, Longenecker R, Schmitz D, Bazemore A. Rural Workforce Years: Quantifying the Rural Workforce Contribution of Family Medicine Residency Program Graduates, J Grad Med Educ December 2020;12 (6): 717–726. https://doi.org/10.4300/JGME-D-20-00122.1

[6] Longenecker RL, Andrilla CHA, Jopson AD, Evans DV, Schmitz D, Larson EH, Patterson DG. Pipelines to Pathways: Medical School Commitment to Producing a Rural Workforce. J Rural Health 2021 Sep;37(4):723-733.  doi: https://doi.org/10.1111/jrh.12542.  Epub 2020 Nov 26.