Rural Surgery Preparedness After Graduation From a Surgical Residency

General surgeons in rural communities face unique challenges due to broad scopes of practice with limited support and difficulties providing training. In 1998, this academic medical center initiated a rural program consisting of senior level rotations in rural communities. We surveyed past residents to determine scope of practice, level of preparedness, and recommendations.

The survey was sent to n = 89 residents and n = 34 surveys were completed. Of those, 85% took part in the rural program, 23.5% practice in a zip code defined as rural by HRSA, and 53% had fellowship training most commonly vascular (n = 5), critical care (n = 5), cardiothoracic (n = 3), and MIS (n = 3). Most common procedures reported were MIS (64.7%), vascular (38.2%), cardiothoracic (26.5%), hepatobiliary (23.5%), and pediatric (23.5%).

Over 97% of participants were satisfied/very satisfied with their overall program, and 94% were satisfied/very satisfied with their preparedness for rural surgery. When prompted with, "A general surgery program must have some type of rural specific specialized curriculum and extended rotations to facilitate a career path in rural general surgery," 41.2% responded strongly agree, 47.1% agree, and 11.8% neutral. Recommendations for bolstering a rural program included urology (59%), MIS (59%), vascular (56%), OBGYN (47%), and pediatrics (38%). Regarding non-surgical education, residents felt underprepared for billing (79.4%) and administration (50.0%).

Although satisfaction scores were high, improvements to better prepare surgeons for rural practice include increasing residents' exposure and training in OBGYN, MIS, vascular, urology, and billing and administration. These results should direct programs to prepare surgeons for effective rural practice.