의학교육을 통한 농어촌지역 의사 양성과 유지

의학교육을 통한 농어촌지역 의사 양성과 유지

Preparing and Retaining Rural Physicians through Medical Education

Donald E. Pathman, MD, MPH, Beat D. Steiner, MD, MPH, Brett D. ]ones, MA; and Thomas R. KOnrad, PhD

목적 : 농어촌지역에서의 진료, 소도시에서의 삶에 대한 준비를 시켜서 농어촌지역에서의 진료지속성을 더 높일 수 있는 교육적 접근법을 밝히기 위함.

PURPOSE: To identify educational approaches that best prepare physicians for rural work and small-town living, and that promote longer rural practice retention.

방법 : 우편을 통한 두 번의 설문조사에서 저자들은 1987년에서 1990년 사이에 농어촌지역으로 옮긴 일차의료의사들로부터 정보를 모았다. 총 456명이 응답하였다. 저자들은 의사들의 수련과정의 특성 중 '농어촌지역에서의 진료', '소도시에서의 삶'에 대한 준비정도와 연관이 있는 것을 꼽았으며, 자신들이 얼마나 오래 머물렀는지를 응답하였다. 의사들과 그들이 있는 지역의 여섯 가지 특성을 통제하여 분석하였다. 

METHOD: In two mail surveys (1991 and 1996-97), the authors collected data from primary care physicians who had moved to rural practices nationwide from 1987 through 1990. A total of 456 eligible physicians responded to both surveys (response rate of 69.0%). The authors identified those features of the physicians' training that correlated with their self-reported preparedness for rural practice and small-town living, and with how long they stayed in their rural practices. Analyses controlled for six features of the physicians and their communities.

결과 : 

의사들이 스스로 얼마나 소도시의 삶에 준비가 되었느냐가 얼마나 농어촌 진료를 유지하였는가를 예측하는 요인이었다. 반면, 농어촌진료에 대한 준비도는 농어촌 진료 유지기간을 예측하지 못했다. 

이제 막 수련을 마친 의사들에 대해서는 그들이 받은 수련의 일부 특징들이 농어촌 진료 준비도와 유지기간을 예측하였다. 레지던트 기간의 농어촌 로테이션은 농어촌 진료의 준비도, 소도시에서의 삶, 그리고 긴 농어촌 진료 유지를 가장 잘 예측하는 것으로 드러났다. 확장된 농어촌지역 로테이션(Extended medical school rural rotation)은 농어촌지역 진료 준비도를 더 높여주는 것으로 나타났다. 

(수련을 마친고) 진료 경험이 있는 의사들의 경우에는, 소도시 삶에 준비가 되었다고 응답한 사람이 농어촌 진료를 더 오래 유지하였다. 레지던트 기간의 농어촌 로테이션이 의사들을 농어촌 진료에 준비시키고, 더 오래 진료를 유지하도록 하는데 있어서 가장 좋은 교육적 경험이었다.

RESULTS:

The physicians' sense of preparedness for small-town living predicted their retention duration (hazard ratio, 0.74, p < .0001), whereas their preparedness for rural medical practice did not predict their retention duration after controlling for preparedness for small-town living (hazard ratio, 0.92; p = .27). For the physicians who had just finished their training, only a few features of their training predicted either rural preparedness or retention. Residency rural rotations predicted greater preparedness for rural practice (p = .004) and small-town living (p = .03) and longer retention (hazard ratio, 0.43, p = .003). Extended medical school rural rotations predicted only greater preparedness for rural practice (p = .03). For the physicians who had prior practice experience, nothing about their medical training was positively associated with preparedness or retention.

결론 : 농어촌 의사가 될 준비가 되었다고 응답한 의사들은, 특히 그 중에서도 소도시 삶에 준비가 되었다고 응답한 의사들은 농어촌 진료를 더 오래 유지하는 경향이 있었다. 레지던트 기간의 농어촌 로테이션이 의사들을 농어촌 진료에 준비시키고, 더 오래 진료를 유지하도록 하는데 있어서 가장 좋은 교육적 경험이었다.

CONCLUSION:

Physicians who are prepared to be rural physicians, particularly those who are prepared for small-town living, stay longer in their rural practices. Residency rotations in rural areas are the best educational experiences both to prepare physicians for rural practice and to lengthen the time they stay there.

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Acad Med. 1999 Jul;74(7):810-20.

Preparing and retaining rural physicians through medical education.

Pathman DE, Steiner BD, Jones BD, Konrad TR.

Source

Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7590, USA. don_pathman@unc.edu

Abstract

PURPOSE:

To identify educational approaches that best prepare physicians for rural work and small-town living, and that promote longer rural practice retention.

METHOD:

In two mail surveys (1991 and 1996-97), the authors collected data from primary care physicians who had moved to rural practices nationwide from 1987 through 1990. A total of 456 eligible physicians responded to both surveys (response rate of 69.0%). The authors identified those features of the physicians' training that correlated with their self-reported preparedness for rural practice and small-town living, and with how long they stayed in their rural practices. Analyses controlled for six features of the physicians and their communities.

RESULTS:

The physicians' sense of preparedness for small-town living predicted their retention duration (hazard ratio, 0.74, p < .0001), whereas their preparedness for rural medical practice did not predict their retention duration after controlling for preparedness for small-town living (hazard ratio, 0.92; p = .27). For the physicians who had just finished their training, only a few features of their training predicted either rural preparedness or retention. Residency rural rotations predicted greater preparedness for rural practice (p = .004) and small-town living (p = .03) and longer retention (hazard ratio, 0.43, p = .003). Extended medical school rural rotations predicted only greater preparedness for rural practice (p = .03). For the physicians who had prior practice experience, nothing about their medical training was positively associated with preparedness or retention.

CONCLUSION:

Physicians who are prepared to be rural physicians, particularly those who are prepared for small-town living, stay longer in their rural practices. Residency rotations in rural areas are the best educational experiences both to prepare physicians for rural practice and to lengthen the time they stay there.