Preparedness for rural community leadership and its impact on practice location of family medicine graduates

OBJECTIVE: To identify non-clinical dimensions of preparedness for rural practice and to determine whether preparedness for rural practice is predictive of rural practice location. DESIGN: Cross-sectional postal survey mailed in 2001. SETTING: Communities across Canada where graduates were practising. SUBJECTS: Graduates (n = 369) of the family medicine residency program at the universities of Alberta (U of A) and Calgary (U of C) between 1996 and 2000, inclusive. INTERVENTIONS: Using a 4-point scale, graduates rated the extent to which the residency program prepared them for eight dimensions of rural practice: clinical demands of rural practice, understanding rural culture, small community living, balancing work and personal life, establishing personal/professional boundaries, becoming a community leader, handling a 'fish bowl' lifestyle, and choosing a suitable community. MAIN OUTCOME MEASURE: Identification of non-clinical dimensions of preparedness for rural practice and whether scores on preparedness scales are predictive of rural practice location. RESULTS: The overall response rate was 76.4%. Factor analysis of the eight preparedness items produced two factors, 'rural culture' and 'rural community leader' which explained 72% of the variance. The alpha coefficient for each factor was 0.87. Odds ratios revealed that family medicine graduates prepared for rural community leadership roles were 1.92 (CI = 1.03-3.61) times more likely to be in rural practice. Rural physicians were also 2.14 (CI = 1.13-4.03) times as likely to have a rural background. CONCLUSIONS: Preparedness to be a rural community leader and having a rural background were predictive of rural practice. Educators should consider this in both family medicine residency admissions policy and practice and when designing and implementing family medicine residency curricula.