Insights from outstanding rural internal medicine residency rotations at the University of Washington

Purpose. Despite being well suited to provide the breadth of care needed in rural areas, few general internists become rural physicians. Little formal rural residency training is available and no formal curricula exist. For o ver 25 years the University of Washington School of Medicine has provided e lective WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) rural residency rotations to expose residents to the rewards and challenges of rural pract ice. This study identified the characteristics of outstanding rural residen cy rotations. Method. The key preceptors at three outstanding rural residency sites were interviewed about their experiences, teaching strategies, and opinions abou t curriculum. Their responses were categorized. Seven university-based resi dents and eight training at WWAMI sites recorded and rated the value of ove r 1,500 learning encounters. Results. The preceptors agreed that outstanding rotations were led by enthu siastic preceptors who served as role models for excellence. These precepto rs provided residents with meaningful responsibilities and emphasized indep endent decision making based on the history and physical examination. They stressed supervised independence and self-directed learning with frequent s tructured feedback for residents. The residents rated the learning value of patient encounters in rural locations significantly higher than that of th ose in university clinics. Conclusions. Exceptional rural residency experiences involve excellent role models who provide meaningful responsibility and emphasize core skills usi ng a learner-centered approach. Rural training experiences should be suppor ted, and the suggestions of outstanding preceptors should be used to develo p and disseminate a curriculum that will better prepare residents for rural practice.