Does the site of postgraduate family medicine training predict performanceon summative examinations? A comparison of urban and remote programs

Background: The location of postgraduate medical training is shifting from teaching hospitals in urban centres to community practice in rural and remo te settings. We were interested in knowing-whether learning, as measured by summative examinations, was comparable between graduates who trained in ur ban centres and those who trained in remote and rural settings. Methods: Family medicine training programs in Ontario were selected as a mo del of postgraduate medical training. The results of the 2 summative examin ations the Medical Council of Canada Qualifying Examination (MCCQE) Part II and the College of Family Physicians of Canada (CFPC) certification examin ation - for graduates of the programs at Ontario's 5 medical schools were c ompared with the results for graduates of the programs in Sudbury and Thund er Bay from 1994 to 1997. The comparability of these 2 cohorts at entry int o training was evaluated using the results of their MCCQE Part I, completed just before the family medicine training. Results: Between 1994 and 1997, 1013 graduates of family medicine programs (922 at the medical schools and 91 at the remote sites) completed the CFPC certification examination; a subset of 663 completed both the MCCQE Part 1 and the MCCQE Part II. The MCCQE Part I results for graduates in the remote programs did not differ significantly from those for graduates entering th e programs in the medical schools (mean score 531.3 [standard deviation (SD ) 69.8] and 521.8 [SD 74.4] respectively, p = 0.33). The MCCQE Part II resu lts did not differ significantly between the 2 groups either (mean score 55 5.1 [SD 71.7] and 545.0 [SD 76.4] respectively, p = 0.32). Similarly, there were no consistent, significant differences in the results of the CFPC cer tification examination between the 2 groups. Interpretation: In this model of postgraduate medical training, learning wa s comparable between trainees in urban family medicine programs and those i n rural, community-based programs. The reasons why this outcome might be un expected and the limitations on the generalizability of these results are d iscussed.