Rural Curricular Guidelines Based on Practice Scope of Recent Residency Graduates Practicing in Small Communities

The optimal curriculum for training family physicians for rural practice within a traditional urban-based residency is not defined. We used the scope of practice among recent family medicine graduates of residencies associated with Preparing the Personal Physician for Practice (P4), practicing in small communities, to identify rural curriculum components.

We surveyed graduates 18 months after residency between 2007 and 2014. The survey measured self-reported practice characteristics, including community size, and scope of practice. We compared the subgroups according to practice community size.

Compared to graduates in larger communities, those practicing in small communities were more likely to report a broader scope of clinical practice including: adult hospital care (59% vs 35%), vaginal deliveries (23% vs 12%), C sections as primary surgeon (14% vs 5%) and assistant (21% vs 8%), newborn hospital care (45% vs 24%), and procedures such as endometrial biopsy (46% vs 33%), joint injections and aspirations (89% vs 79%), and fracture care (58% vs 42%). Graduates in small communities were also more often engaged in assessing community health needs (78% vs 64%) and developing community interventions (67% vs 51%) compared to graduates in larger communities. In contrast, graduates in small communities were less likely to have integrated behavioral health (26% vs 46%) and case management support (37% vs 52%).

A rural practice curriculum should include training toward a broad medical scope of practice as well as skills in community-oriented primary care and integrated behavioral health.