Letters to the Editor
To the Editor:
We read with great interest the recent article by Blanchard and colleagues1 highlighting a relative lack of opportunity for postgraduate medical training in rural and community settings in the United States, and discussing the impact on recruitment that ensues in these areas. Their observations resonated with our own experience in the United Kingdom, and we sought to better understand the experience of training in a rural setting.
We work at a rural district general hospital (DGH) of about 170 beds, which often struggles to recruit adequate numbers of doctors at all grades in both medicine and surgery. This staffing difficulty extends to the primary care services in our rural area of the United Kingdom. In part, this is because the hospital is situated in a rather secluded part of the United Kingdom. Also, there may be a perception that the quality of training in small DGHs is subordinate to larger teaching hospitals. We asked all doctors in their first two years of postgraduate training at our hospital whether they found this to be the case. We had a response rate of 68.4% (13/19), with 84.6% feeling they were adequately prepared for the next stage in their training as a result of working here, and 100% stating they would recommend working here to a colleague. Moreover, all respondents felt they had enough opportunity to attend theater whilst on surgical rotations, and 92.3% felt they had enough opportunity to learn clinical procedural skills. Of the respondents, 53.8% were initially happy to be allocated to this hospital, and interestingly, 92.3% felt their views of working in a rural DGH had changed as a result of this placement.
We agree with Blanchard and colleagues that training in rural centers is an underused opportunity. In terms of medical training, we find that trainees at our hospital feel they are well prepared and have adequate exposure to relevant learning opportunities. Indeed, a study exploring medical students’ perceptions of a rural placement in Australia found that students considered they had a more hands-on experience and that these students achieved better examination results compared with their colleagues rotating in larger teaching hospitals.2
Importantly, increasing training numbers in more rural areas would increase the number of doctors later choosing to practice medicine in relatively remote areas,3 where often the number of doctors is limited by challenges in recruitment.
David M. Williams, MBBS
Foundation Year 2 doctor, Department of General Surgery, Bronglais General Hospital, Aberystwyth, United Kingdom; firstname.lastname@example.org.
Daniel L. Thomas, MBChB
Foundation Year 1 doctor, Department of General Surgery, Bronglais General Hospital, Aberystwyth, United Kingdom.
Zeyad Sallami, MBBS, FRCS (Ed)
Consultant surgeon, Department of General Surgery, Bronglais General Hospital, Aberystwyth, United Kingdom.
1. Blanchard J, Petterson S, Bazemore A, Watkins K, Mullan F. Characteristics and distribution of graduate medical education training sites: Are we missing opportunities to meet U.S. health workforce needs? Acad Med. 2016;91:1416–1422.
2. Birden HH, Wilson I. Rural placements are effective for teaching medicine in Australia: Evaluation of a cohort of students studying in rural placements. Rural Remote Health. 2012;12:2167.
3. Rosenthal TC, McGuigan MH, Anderson G. Rural residency tracks in family practice: Graduate outcomes. Fam Med. 2000;32:174–177.