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. 2018 Mar;64(3):e115-e125.

Pathways to rural family practice at Memorial University of Newfoundland

James Rourke  1 , Danielle O'Keefe  2 , Mohamed Ravalia  3 , Scott Moffatt  4 , Wanda Parsons  5 , Norah Duggan  6 , Katherine Stringer  7 , Michael Jong  8 , Kristin Harris Walsh  9 , Janelle Hippe  9
Affiliations

Pathways to rural family practice at Memorial University of Newfoundland

James Rourke et al. Can Fam Physician. 2018 Mar.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Can Fam Physician. 2018 May;64(5):331. Can Fam Physician. 2018. PMID: 29760250 Free PMC article. No abstract available.

Abstract
in English, French

Objective: To assess Memorial University of Newfoundland's (MUN's) commitment to a comprehensive pathways approach to rural family practice, and to determine the national and provincial effects of applying this approach.

Design: Analysis of anonymized secondary data.

Setting: Canada.

Participants: Memorial's medical degree (MD) graduates practising family medicine in Newfoundland and Labrador as of January 2015 (N = 305), MUN's 2011 and 2012 MD graduates (N = 120), and physicians who completed family medicine training programs in Canada between 2004 and 2013 and who were practising in Canada 2 years after completion of their postgraduate training (N = 8091).

Main outcome measures: National effect was measured by the proportion of MUN's family medicine program graduates practising in rural Canada compared with those from other Canadian family medicine training programs. Provincial effect was measured by the location of MUN's MD graduates practising family medicine in Newfoundland and Labrador as of January 2015. Commitment to a comprehensive pathways approach to rural family practice was measured by anonymized geographic data on admissions, educational placements, and practice locations of MUN's 2011 and 2012 MD graduates, including those who completed family medicine residencies at MUN.

Results: Memorial's comprehensive pathways approach to training physicians for rural practice was successful on both national and provincial levels: 26.9% of MUN family medicine program graduates were in a rural practice location 2 years after exiting their post-MD training from 2004 to 2013 compared with the national rate of 13.3% (national effect); 305 of MUN's MD graduates were practising family medicine in Newfoundland and Labrador as of 2015, with 36% practising in rural areas (provincial effect). Of 114 MD students with known background who graduated in 2011 and 2012, 32% had rural backgrounds. Memorial's 2011 and 2012 MD graduates spent 20% of all clinical placement weeks in rural areas; of note, 90% of all first-year placements and 95% of third-year family medicine clerkship placements were rural. For the 25 MUN 2011 and 2012 MD graduates who also completed family medicine residencies at MUN, 38% of family medicine placement weeks were spent in rural communities or rural towns. Of the 30 MUN 2011 and 2012 MD graduates practising family medicine in Canada as of January 2015, 42% were practising in rural communities or rural towns; 73% were practising in Newfoundland and Labrador and half of those were in rural communities and rural towns.

Conclusion: A comprehensive rural pathways approach that includes recruiting rural students and exposing all medical students to extensive rural placements and all family medicine residents to rural family practice training has resulted in more rural generalist physicians in family practice in Newfoundland and Labrador and across Canada.

Objectif: Évaluer la façon particulière choisie par l’Université Memorial de Terre-Neuve (UMT) pour amener les étudiants en médecine à choisir une pratique rurale et déterminer les effets d’une telle méthode aux niveaux national et provincial.

Type d’étude: Une analyse anonymisée de données secondaires.

Contexte: Le Canada.

Participants: Des médecins (MD) diplômés qui pratiquaient la médecine familiale à Terre-Neuve et au Labrador en janvier 2015 (N = 305), les diplômés en médecine de 2011 et 2012 à l’UMT (N = 120), et les résidents qui avaient complété leur programme de formation en médecine familiale au Canada entre 2004 et 2013 et qui pratiquaient toujours au Canada 2 ans après la fin de leur formation de deuxième cycle (N = 8091).

Principaux paramètres à l’étude: L’effet national a été mesuré en comparant la proportion des diplômés en médecine familiale de l’UMT qui pratiquaient en région rurale au Canada avec la proportion des diplômés des autres programmes canadiens de médecine familiale. L’effet provincial a été mesuré par le lieu de pratique des diplômés en médecine de l’UMT qui pratiquaient la médecine familiale à Terre-Neuve et au Labrador en janvier 2015. L’engagement à utiliser une méthode particulière pour favoriser une pratique rurale a été mesuré par les données géographiques anonymisées portant sur les admissions, les stages de formation et les lieux de pratique des diplômés de 2011 et 2012 à l’UMT, incluant ceux qui ont complété leur résidence en médecine familiale à l’UMT.

Résultats: La méthode instaurée par l’UMT pour former des médecins qui pourront pratiquer en zone rurale s’est avérée un succès au niveau tant national que provincial : 26,9 % des diplômés du programme de médecine familiale de l’UMT pratiquaient en région rurale 2 ans après avoir complété leur formation de deuxième cycle entre 2004 et 2013, alors que le taux national était de 13,3 % (l’effet national); 305 des diplômés en médecine de l’UMT pratiquaient en médecine familiale à Terre-Neuve et au Labrador en 2015, dont 36 % en région rurale (l’effet provincial). Sur 114 étudiants dont les antécédents étaient connus et qui ont obtenu leur diplôme en 2011, 32 % avaient un passé rural. Les diplômés en médecine de 2011 et 2012 à l’UMT passaient 20 % de toutes leurs semaines de stage clinique en région rurale; à noter que 90 % de tous les stages de première année et 95 % des stages de troisième année de résidence en médecine familiale étaient ruraux. Sur les 25 étudiants qui ont complété leur résidence en médecine familiale à l’UMT en 2011 et en 2012, 38 % de leurs semaines de stage en médecine familiale se déroulaient dans des communautés ou des municipalités rurales. Sur les 30 diplômés en médecine de 2011 et 2012 à l’UMT qui pratiquaient au Canada en janvier 2015, 42 % pratiquaient dans des communautés ou des municipalités rurales; 73 % pratiquaient à Terre-Neuve et au Labrador, et la moitié d’entre eux se déroulaient dans des communautés ou des municipalités rurales.

Conclusion: L’adoption d’un méthode particulière favorisant une pratique en région rurale comprtant un recrutement qui favorise les étudiants d’origine rurale et qui expose tous les étudiants en médecine à des stages en milieu rural et tous les résidents en médecine familiale à une formation en médecine rurale a fait en sorte qu’il y a maintenant plus de médecins généralistes qui pratiquent la médecine familiale rurale à Terre-Neuve, au Labrador et au Canada.

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Figures

Figure 1.
Figure 1.
Map showing locations of all MUN MD graduates practising FM in Newfoundland and Labrador as of January 2015: N = 305. FM—family medicine, MD—medical doctor, MUN—Memorial University of Newfoundland.
Figure 2.
Figure 2.
Map showing total year-1 and year-2 medical student clinical placement weeks spent in all location types for MUN MD in 2011 and 2012 graduating classes MD—medical doctor, MUN—Memorial University of Newfoundland.
Figure 3.
Figure 3.
Map showing total year-3 clerkship placement weeks spent in all location types for MUN 2011 and 2012 MD graduates FM—family medicine, MD—medical doctor, MUN—Memorial University of Newfoundland.
Figure 4.
Figure 4.
Map showing total postgraduate placement weeks spent in all location types for MUN FM residents from its 2011 and 2012 MD graduating classes FM—family medicine, MD—medical doctor, MUN—Memorial University of Newfoundland.
Figure 5.
Figure 5.
Map showing practice locations for MUN 2011 and 2012 MD graduates practising FM in Newfoundland and Labrador as of January 2015 FM—family medicine, MD—medical doctor, MUN—Memorial University of Newfoundland.
See this image and copyright information in PMC

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