Summary of findings for rural surgical training
| Publication | Country | Context | Primary findings |
|---|---|---|---|
| Burkholder and Cofer, 2007 (30) | United States | Assessment of rural training perceptions and availability of rural training opportunities in American general surgical residency programs | 36% of training programs have a rural track Research-based programs were less likely to have a rural track; program directors were less likely to indicate rural training as a part of their program’s mission, and they were less likely to indicate that there is a shortage of rural surgeons Opinions were divided on the adequacy of a broad general surgery training program in preparation for rural surgery practice Program directors stated that orthopedics and gynecology are important aspects of a rural training program |
| Cofer et al., 2011 (32) | United States | Survey of rural surgeons’ attitudes toward training | 20% of the 237 respondents completed fellowship training; reasons included to obtain additional skills or increase in comfort 81% indicated that there would be benefit to rural track residency programs; 80% indicated that their ideal candidate would not need subspecialty training |
| Deal et al., 2018 (87) | United States | Needs assessment of skills in rural surgery | 237 rural surgeons responded; 82% stated that rural surgery opportunities during residency training is important The following training needs were identified: endoscopy, advanced laparoscopy, trauma management, wound care, and basic non–general surgery procedures (cesarean delivery, carpal tunnel, amputation) |
| Deveney and Hunter, 2009 (34) | United Stated | Description of the rural training model in Oregon and its outcomes | One-year training program in a rural setting with formal training rotations in non–general surgery specialties (obstetrics and gynecology; urology; ear, nose, and throat) 10 graduates completed the program; 5 were working in rural or small community practices |
| Deveney et al., 2013 (35) | United States | Outcomes of a rural training model in Oregon | Residents who completed the rural track were more likely to remain in general surgery, as opposed to subspecialty training regardless of career goals at the start of residency; they were also more likely to enter rural practice |
| Doty et al., 2006 (36) | United States | Survey of graduates from a rural-based training program on practice setting and demographics; assessment of procedure logs compared with national average | Graduates of a rural broad-based training program were more likely to enter rural practice; 83% of practising graduates reported working in a rural setting, and 71% reported that they were raised in a rural community Assessment of procedure logs indicated that graduates performed significantly more non–general surgery procedures compared with the national average |
| Fader and Wolk, 2009 (88) | United States | Description of a residency program’s rural surgery track | Dedicated training year at a rural hospital in preparation for rural or international practice Hospital characteristics including limited number of trainees outside of general surgery Additional areas of training in the sixth year were tailored to the needs of the hospital |
| Giles et al., 2009 (89) | United States | Assessment of a general surgery program’s rural rotation | The rural rotation was well received and educational according to a resident survey Improved endoscopy exposure for residents; the rotation increased resident interest in rural surgery as a career choice |
| Gillman and Vergis, 2013 (90) | Canada | Survey of graduating residents comfort level when performing general surgery and non–general surgery procedures | Most residents were comfortable with breast, gallbladder disease, and colorectal procedures; few were comfortable with more advanced procedures, including gastrectomy, advanced laparoscopy, and procedures outside of core general surgery |
| Glenn et al., 2017 (44) | United States | Tele-mentoring interest in rural surgery | 78.9% of survey respondents indicated that tele-mentoring was useful for acquiring new skills, or dealing with unexpected intraoperative findings |
| Halverson et al., 2014 (91) | United States | Evaluation of a multidisciplinary skills course for rural surgeons | Mentoring and teaching of skills beyond the normal scope of general surgery; overall, it was felt to be beneficial to practising surgeons |
| Heneghan et al., 2005 (47) | United States | Assessment of practice and motivations of rural compared with urban surgeons | In a survey of 421 surgeons, rural surgeons indicated that they would have benefited from non–general surgery training in residency and would have equally benefited from advanced laparoscopy training |
| Jarman et al., 2009 (48) | United States | Assessment of the characteristics of general surgery graduates | 79% of practising rural surgeons had completed a rural clerkship, compared with 37% of urban surgeons |
| Kent et al., 2015 (92) | United States | Description of rural training program | Developed a rural training program with broad surgical specialty exposure, including exposure to rural mentorship and an emphasis on endoscopy, obstetrics, and orthopedics; 18 months of rural rotations |
| Landercasper et al., 1997 (51) | United States | Comparison of procedure logs from practising rural surgeons compared with graduating residents | Residents completed fewer gynecologic and orthopedic procedures than practising rural surgeons |
| Milligan et al., 2009 (93) | United States | Assessment of a rural surgical rotation in senior general surgery residency | Resident case logs from participating residents more similar to caseload of rural surgeon Following implementation of rotation, more graduates selected rural practice as a career |
| Mercier et al., 2019 (53) | United States | Assessment of rural training opportunities and description of new rural track | 27 programs required rural rotations, 10 offered rural electives, and 4 had designated rural track match positions Designed program for residents to complete training at rural sites throughout their 5-year program |
| Moesinger and Hill, 2009 (54) | United States | Description of 1-year rural residency program | One-year fellowship to be completed in postgraduate year 4 for residents interested in rural practice; rotations within general surgery and non–general surgery specialties |
| Reynolds et al., 2003 (74) | United States | Assessment of training procedures in a rural community training centre | Graduating residents completed a high volume of advanced laparoscopic procedures in a rural training setting and reported confidence with those procedures |
| Stiles et al., 2019 (60) | United States | Survey of rural surgeons assessing scope of practice and preparedness | 43 rural surgeons surveyed frequently performed procedures from other specialties, including gynecology, otolaryngology, urology, and vascular, and reported preparedness to perform these procedures on graduation |
| Undurraga Perl et al., 2015 (94) | United States | Assessment of procedures performed by general surgeons in critical access hospitals, compared with those performed by residents Compared the procedure logs of residents who completed a rural rotation with those who did not | Practising general surgeons performed a significantly higher proportion of endoscopy, hernia, biliary, and gynecology than residents; residents completed more cardiothoracic, vascular, liver, and pancreas procedures Residents who completed a rural rotation completed more procedures than nonrural residents |
| Zuckerman, 2007 (66) | United States | Telephone survey of rural and urban surgeons, assessing endoscopy volume and training needs | 63% of rural surgeons wanted additional endoscopy training in their residency compared with 43% of urban surgeons |