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Canadian Journal of Rural Medicine
../../../ 1998

Literature / Littérature scientifique

CJRM 1999;4(3)171


Enhancing the family medicine curriculum in deliveries and emergency medicine as a way of developing a rural teaching site. Rodney WM, Crown LA, Hahn R, Martin J. Fam Med 1998;30(10):712-9.

Providing services to rural areas south of the border has been no less problematic than it is here in Canada. Several long-standing American programs are now being evaluated, in keeping with the current interest in medical education for rural practice. These evaluations are important to help guide choices currently being considered by those in charge of Canadian training programs. In the early 1990s in Tennessee it was recognized that the training programs based in Memphis were not appropriately training or encouraging graduates for practice in rural areas of the state. A teaching practice in a rural county of western Tennessee was established, with particular attention being given to "special skills in advanced women's healthcare and emergency medicine." Residents are assigned to the site full-time, and faculty members from Memphis provide short-term locum support to the group. The arrangement not only provides continuity of health human resources, but there is evidence that some of the graduates choose to continue to practise in rural areas.


The long-term effect of an innovative family physician curricular pathway on the specialty and location of graduates of the University of Washington. Phillips TJ, Rosenblatt RA, Schaad DC, Cullen TJ. Acad Med 1999;74(3):285-8.

Some rural American states have taken a different approach. In 1971 the states of Washington, Alaska, Montana and Idaho designed a medical education program (WAMI) to train physicians for the member states. The program created a family medicine pathway with a defined medical curriculum as early as the second year of medical school. The stated goals were: "(1) that at least 20% of each class should enter family practice and (2) that an increased number of graduates should enter rural family practice in Washington."

The authors report on the success of the program at the University of Washington a mean of 19 years after the graduation of the 1968­1973 cohort of students. After the implementation of the new curriculum there was a significant increase in the number of physicians who chose family medicine as a specialty at graduation (34% versus 11%). Of the total number of graduating physicians, 27% were still in family practice a mean of 2 decades later.

The degree of success in rural placements was also documented: 21 graduates (3.5%) of the 6 classes studied were still in practice in rural Washington in 1994. This compares with only 2 (0.33%) from the 8 earlier classes. The authors do not state what percentage of the state's total physician cohort (whether or not they are WAMI graduates) serve the 17% of the state's population that is rural.


Rural background and clinical rural rotations during medical training: effect on practice location. Esterbrook M, Godwin M, Wilson R, Hodgetts G, Brown G, Pong R, et al. CMAJ 1999;160(8):1159-63.

In Canada, Queen's University in Kingston, Ont., has recently reported on a study of 159 students of its Family Medicine program who graduated between 1977 and 1991. Initial practice location upon graduation and practice location in 1993 (the year of the survey) were compared, and variables related to choice of rural practice were identified. Of the survey sample, 28.3% chose a rural practice location upon graduation. The authors did not find a significant correlation with either exposure to rural practice during undergraduate or postgraduate training or with sex or age. In contrast, "hometown size was strongly associated with choosing a rural community as the first practice location: physicians from hometowns with less than10 000 people were 2.30 times more likely . . . to choose rural practice than physicians whose hometown had a population of 10 000 or more." Similarly, only hometown size was associated with physicians remaining in rural practice in the years following their initial choice. In this sample, these physicians "were 2.48 times more likely . . . to choose rural practice than physicians from hometowns of 10 000 people or more."

© 1999 Society of Rural Physicians of Canada