The impact of rural rotations on urban based postgraduate learners: A literature review

Abstract

Background/Objective: The rural physician shortage remains an international crisis. Rural rotations are commonly used to address the issue. This review assesses the published evidence of the impact of rural rotations on urban-based postgraduate learners.

Methods: The OVID Medline database was searched for eligible articles published in peer-reviewed academic journals between 1980 and 2017. Data were extracted and analyzed to draw inferences about the impact of rural rotations on urban-based postgraduate learners. The methodological quality of included articles was assessed with the Medical Education Research Study Quality Instrument (MERSQI).

Results: The search identified 301 articles; 19 studies met inclusion criteria (mean MERSQI score 11.95). Of the various rural rotation characteristics reported, duration was most consistently associated with the eventual rural practice. No consensus of impact was found for other characteristics. Our review provided indications of the cumulative effect of the postgraduate rural rotation, rural origin, and rural intent on rural practice decisions.

Conclusions: The importance of rural rotations during urban postgraduate training for the outcome of rural practice is apparent. However, the reliance of medical educational systems on the rural rotation, specifically duration, does not accurately reflect the complexity of the choice to practice in a rural community.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Total accumulated time: The literature is replete with reports of rural experiences but generally assumes that learners have a single rural experience of significant duration. Yet, learners may undertake several short stints in rural communities, perhaps doing shadowing experiences. Therefore, the consideration of “total accumulated time” is of value. Given the absence of a standard underlying unit of measurement, we have defined “total accumulated time” as the sum of the weeks or months in a specific learning environment (e.g. rural family medicine teaching in a community of <20,000 people) during the whole of a postgraduate training program.

Additional information

Notes on contributors

Rebecca L. Malhi

Rebecca Malhi, PhD is a research associate, Distributed Learning and Rural Initiatives (DLRI), in the Cumming School of Medicine, at the University of Calgary in Alberta, Canada.

Jodie Ornstein

Jodie Ornstein, MD is a clinical lecturer at the Cumming School of Medicine, University of Calgary in Alberta, Canada.

Douglas Myhre

Douglas Myhre, MD is a professor in the Department of Family Medicine and at the time of writing, the Associate Dean, Distributed Learning and Rural Initiatives (DLRI), in the Cumming School of Medicine, at the University of Calgary in Alberta, Canada.