Principle 1: Support increased broad scope GME training in and for rural communities to supply, recruit, and retain the necessary physician workforce to address access to care and rural health care equity.
Support for Principle 1: GME training in rural areas and toward a broad scope of practice uniquely addresses challenges in access to care and rural health equity through the provision of service and growth of a rural physician workforce. Rural workforce shortages exist and persist despite efforts to implement effective evidence-backed strategies1. Disparities associated with unmet rural health needs contribute to a rural-urban mortality gap1. Resident training in rural communities includes clinical rotations and/or programs in rural communities. Rural training is important to produce a rural workforce2; urban programs may provide rural experiences resulting in rural workforce.
Principle 2: Initiate and maintain community engagement in support of rural GME training programs through public awareness, engagement of community leaders and organizations, funding opportunities, and partnerships with academic centers, health systems, hospitals, and larger residency programs.
Support for Principle 2: Rural community engagement and support are necessary to develop and sustain successful rural GME training programs and experiences. Community-engaged medical education benefits students and medical residents by providing authentic rural practice exposure and experience, and benefits communities by improving access to health professionals. Further, community-engaged medical education fosters collaboration to address the community’s needs.
Principle 3: Advocate for federal and state GME funding that directly supports rural-located programs and programs serving rural populations, and that promotes accountability for workforce outcomes.
Support for Principle 3: Funding of rural GME requires unique strategies to meet population and geographic needs. Dedicated rural GME funding is necessary to support training residents in rural areas for rural practice. Funding models with payments going directly to the residency program will help support the development of training at non-hospital sites. For accountability in GME funding, measurements should be established to monitor the contribution of the GME investment to the health and socioeconomic status of people living and working in underserved rural communities. Additionally, GME funding should be monitored for the adequacy and sustainability of rural GME programs.
Principle 4: Build sponsoring institution support for expansion of rural GME programs through partnerships with academic centers, health systems, hospitals, larger residency programs and other similar entities.
Support for Principle 4: Governance partnerships with health systems, hospitals, academic medical centers, and/or larger residency programs are necessary to expand rural-focused GME. Collaboration, mutual understanding, and healthy governance are critical to meeting accreditation standards and aligning leadership, funding, and regulatory requirements for successful rural GME. Strong and consistent sponsoring institution support will help produce rural GME program stability and result in fewer unintended negative consequences for existing and developing rural programs. Governance and resources for rural GME programing need to be aligned to provide academic support, institutional sponsorship, and leadership.
Principle 5: Support accreditation standards that provide the flexibility necessary for rural GME while maintaining educational standards.
Support for Principle 5: Flexibility is needed to provide education in the locations and situations conducive to rural practice while meeting educational standards and requirements. Programs need to meet residency requirements and educational standards in addition to providing education in the full scope of care needed in rural locations. The unique nature of rural-focused residency training leads to opportunities and challenges in the variety and volume of educational experiences. Academic support, institutional sponsorship and leadership development need to be aligned with rural GME program accreditation requirements. Opportunity exists to collaborate with the Accreditation Council on Graduate Medical Education (ACGME) in its process for Medically Underserved Areas/Populations and Graduate Medical Education to align accreditation standards for rural practice.
Principle 6: Support ongoing evaluation and dissemination of evidence related to rural GME for accountability toward the impact on workforce and rural health disparities.
Support for Principle 6: Ongoing evaluation is needed in rural health professions education and training for the purpose of performance improvement, program evaluation, and new evidence of GME impact on important rural population health outcomes. Rural Training Tracks (RTTs) are an example of educational programs that have demonstrated evidence of rural workforce outcomes. There also is a need to develop and adopt specific nomenclature with consistent definitions of rural programs, rural training pathways, integrated residencies, rural-centric programs, and other similar terms. Workforce shortages in rural areas in multiple specialties continue to need to be measured and addressed, including family medicine, internal medicine, pediatrics, and psychiatry, and possibly obstetrics/gynecology and general surgery.
1. Hawes EM, Weidner A, Page C, Longenecker R, Pauwels J, Crane S, Chen F, Fraher E. A Roadmap to Rural Residency Program Development, JGME; Journal of Graduate Medical Education August 2020;12(4):384-7.
2. Meyers P, Wilkinson E, Petterson S, Patterson D, Longenecker R, Schmitz D, Bazemore A. Rural Workforce Years: Quantifying the Rural Workforce Contribution of Family Medicine Residency Graduates. J Grad Med Educ (2020) 12 (6): 717–726. https://doi.org/10.4300/JGME-D-20-00122.1
(B1999) (July 2021 BOD)