Establishing a rural surgery training program: a large community hospital, expert subspecialty faculty, specific goals and objectives in each subspecialty, and an academic environment lay a foundation

Abstract

Purpose: Although there is great interest in providing training for surgical residents who are interested in practicing in a rural environment, guidelines for creating a curriculum are nonexistent.

Methods: A 1-year clinical fellowship designed for PGY4s with an interest in practicing in a rural or subspecialty-sparse environment was designed. Elements of this fellowship include blocks of time on subspecialty services as well as general surgery. Academically oriented faculty serve as team leaders in the subspecialties. Specific goals and objectives are used to assure proficiency in basic procedures so faculty can "sign off" on procedures for credentialing purposes. A flexible call schedule allows the resident to be available for subspecialty emergencies when they occur. A close relationship exists with the family practice residency, and the rural surgery fellow shares a clinic, provides surgical consultation, and attends joint conferences. Other educational opportunities include M&M, multidisciplinary cancer and gastroenterology conferences, attendance at national meetings, and participation in community outreach programs for underserved populations. Compliance with Residency Review Committee (RRC) work-hour requirements is expected and enforced. A portfolio is kept to demonstrate achievement of goals and objectives and includes a case log for credentialing as well as a 360 degrees evaluation by faculty and staff.

Results: Sparse national data suggest that rural surgeons differ most from their urban/suburban counterparts in terms of endoscopic, gynecologic, and urologic procedures. These data and program proposals were presented to the Utah Medical Education Council, which provided funding for the foundation of a subspecialty-intense clinical fellowship for a PGY4 resident who has started as a pilot program. The year-long clinical fellowship began in July 2008. The experience and evaluation by faculty and residents regarding the pilot program is positive. In a short time, proficiency in basic endoscopic, urologic, and gynecologic procedures was achieved in the pilot program.

Conclusions: A suburban, community hospital with academically oriented faculty is a good environment for training residents interested in rural or subspecialty-sparse working environments. Proficiency and credentials in basic subspecialty procedures and care can be achieved during a 1-year fellowship.