Letters / Correspondance
Can J Rural Med vol 2 (2):61
© 1997 Society of Rural Physicians of Canada
Preceptors and residents
Rural community settings increasingly are being used for the training of physicians, in an attempt to address physician resource issues and broaden the clinical experiences of physicians-in-training. Rural family physicians are pivotal resources for the training of medical students and family practice residents. As rural preceptors continue to take on further responsibilities in the area of medical eduction, articles such as Rourke and Rourke's "Practical tips for rural family physicians teaching residents" ( Can J Rural Med 1996;1[2]:63-9 ) provide useful advice and suggestions.
Although there is a limited number of such articles, my own experience has provided valuable data.[1] An analysis of 120 telephone interviews, involving medical students on rural rotations and their family practice preceptors, identified 7 effective teaching strategies.
- Actively involve the student by providing adequate supervision and appropriate independence.
- Develop and foster a supportive interpersonal relationship with the student to facilitate learning.
- Emphasize problem-solving and the understanding of general principles.
- Balance clinical and teaching responsibilities.
- Demonstrate clinical and professional competence.
- Use an organized approach, including goal setting and summation.
- Provide the student with ongoing feedback, assessments and evaluations.
These strategies, endorsed by both rural preceptors and medical students, support a number of the tips recommended by Rourke and Rourke. It is hoped that further study of rural-based clinical teaching will validate the role of rural practitioners in medical education and encourage them to expand their responsibilities within the medical curriculum.
James Goertzen, MD,MClSc, CCFP
Director
Department of Family Medicine
University of Manitoba
Winnipeg, Man.
Reference
- Goertzen J, Stewart M, Weston W. Effective teaching behaviours of rural family medicine preceptors. Can Med Assoc J 1995;153(2):161-8.
Split-thickness skin grafting
After recently having had the opportunity to work with some talented colleagues in plastic surgery, in preparation for isolated rural practice, I would like to add to Keith MacLellan's article on split-thickness skin grafting for clean fingertip avulsions ( Can J Rural Med 1996;1[2]:83-5 ). In addition to specific healing time after split-thickness skin grafting, another consideration not mentioned in the article is residual sensation. With the scar contraction that occurs in association with secondary healing, the resulting area may be smaller than if the defect had been grafted primarily -- an issue of importance to those who rely on their fingertip sensation for occupation or recreation. A suggested rule of thumb is to leave defects the size of a dime or smaller to heal by secondary intention and to graft primarily any defects larger than that. In my experience, patients consider residual sensation more important than a shorter period of convalescence; however, the decision should be individualized.
Andrew Kotaska, MD
Waglisla, BC
Recruiting graduates to isolated communities
I would like to join others who have congratulated you on the founding of the Canadian Journal of Rural Medicine. It will fill a need in Canadian medicine.
Recently, I had the pleasure of attending the annual general meeting of the Yukon Medical Association. Before the meeting I was well aware of the difficulties in recruiting Canadian medical graduates to serve in isolated and remote communities and, in particular, the difficulty of recruiting female graduates. Much to my surprise, I found that the Yukon was having no such problems. They are currently in no need of additional physicians, 40% of their practising physicians are female, and they appear to have little or no problem attracting quality locums.
I was also impressed with the incredible sense of community enjoyed by the 40 or so physicians who provide services in the Yukon. I am not sure what lessons there are to be learned from their situation, but it seems to me that they have solved some of the most vexing problems that other isolated and rural communities in northern Canada continue to face.
Since I note that one of the goals of the Society of Rural Physicians of Canada (SRPC) is to encourage and facilitate research into world health questions, it strikes me that this is an area worthy of investigation that could be of tremendous benefit to the rest of Canada.
I look forward to seeing great things from the SRPC.
Derryck H. Smith, MD
President
British Columbia Medical Association
Please send us your comments and opinions. Letters to the editor should be addressed to:
Canadian Journal of Rural Medicine,
Box 1086, Shawville
QC J0X 2Y0
email cjrm@fox.nstn.ca
fax 819 647-2845
