“What should medical students learn to be prepared for rural practice? Qualitative analysis of expert interviews with German rural physicians”

Sabine Herget, Kay Klinge, Melanie Nafziger, Stephanie Sauer, Markus Bleckwenn, Tobias Deutsch, Thomas Frese

Keywords: medical education, rural curriculum, rural physicians, rural teaching content

As a contribution to counteracting an increasing physician shortage in rural areas the German universities of Leipzig and Halle-Wittenberg have developed a new teaching project called MiLaMed. Besides targeted advertisement and financial support for all kinds of rural clerkships, new interdisciplinary teaching content addressing rural care has been longitudinally implemented into undergraduate education. Due to a lack of literature describing specific learning content and learning-goals to prepare students for rural practice expert interviews with rural physicians were conducted during the process of curriculum development.

Research questions:
What are the particularities of rural (compared to urban) medical care? Which key competencies should medical students acquire to be prepared for rural practice and which specialties should be involved in a rural curriculum?

Qualitative content analysis of 19 semi-structured telephone interviews with 19 rural physicians (15 general practitioners (GPs), 4 other specialists).

Most interviewees reported that a reduced access to medical specialists due to low specialist density, geographical distances, and partially poor infrastructure is a major point shaping the characteristics of rural practice. As a consequence, GPs typically deal with an expanded spectrum of tasks and patients of any age, and the interface and communication between GPs and specialists is of particular importance. Networking and communication skills, problem-solving abilities, delegation of tasks, telemedicine, and sound knowledge and skills regarding diagnostics and treatment were named as key competencies students should acquire. Besides GPs particularly dermatologists, pediatricians, and orthopedists should support a rural curriculum.

A rural curriculum should address the key competencies highlighted by the study participants including innovative approaches for rural care like telemedicine and delegation. The most relevant disciplines should be involved following an interdisciplinary curricular approach highlighting the interface between generalist and specialist care. The results guided the development of the MiLaMed curriculum.

Points for discussion:
1. In your experience, is there any other difference in rural compared to urban medical care that should be taught in a rural medical curriculum?

2. Is there any experience in building up a rural curriculum in the audience? What subjects are being taught? What is the main focus compared to the regular curriculum?

3. Based on your understanding of rural medicine: Which important aspects were not mentioned in our study?