Exposure to U.S. Rural Practice During General Surgery Residency: How do Programs Select Sites and Sustain Rural Rotations?

Abstract

Objective

Despite the dire need for rural surgeons and increasing interest in exposing residents to rural practice, there remains little systematic information about how programs establish and sustain rural rotations.

Design

A website review (12/2022-7/2023) of the 342 civilian surgery programs listed by the ACGME identified those offering elective or required U.S. rural rotations. In addition, all programs were contacted by email to confirm or deny that they offered rural rotations to account for webpage inaccuracies. The effort identified 81 programs (24%). A qualitative design was then adopted, whereby the first author interviewed 58 general surgery program leaders (72% participation rate) to explore strategies used to arrange and sustain rural rotations. Interviews focused on the 2023-24 academic year, were conducted from August 2023 to August 2024, and were recorded, transcribed, and analyzed collaboratively to discern program strategies.

Results

Programs are more likely to use rural training sites outside their healthcare system (59% or 34/58) than inside (41% or 24/58), but system sites were preferred when available. At both site types, programs drew heavily upon professional ties, primarily to program graduates (64% or 37/58). Alumni were eager to help and knew program traditions and expectations. Their presence also bolstered confidence in the educational value of the rotation. Additional alumni joining rural sites were evidence of rotations as a recruitment pathway, thus fostering sustainable relationships. Within-system rotations were easier to arrange and finance than those outside the system.

Conclusions

The results offer practical insights into how a diverse mix of surgery programs across the U.S. select and sustain required and elective rural rotations in the U.S. The prominence of professional ties to program graduates and healthcare-system links are especially notable. Variability across programs in how they select and sustain sites also suggests that many approaches are feasible.