1. JAMES ROURKE, MD, WANDA PARSONS, MD,
NORAH DUGGAN, MD, KATHERINE STRINGER, MD,
MOHAMED RAVALIA, MD, DANIELLE O’KEEFE, MD
THE GEOGRAPHIC PIPELINE TO RURAL FAMILY MEDICINE AT MEMORIAL
3. DISCLOSURE OF COMMERCIAL SUPPORT
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This program has received financial support from Memorial University’s Faculty of Medicine in the form of budget support.
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Potential for conflict(s) of interest:
Dr. James Rourke has received salary from Memorial University’s Faculty of Medicine.
5. CONTEXT
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According to Statistics Canada:
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Newfoundland and Labrador has a
population of 526,977 over
370,510.76 square kilometres
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St. John’s population (including
its metropolitan influence zone) is 196,966
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Corner Brook’s population (including
its metropolitan influence zone) is 27,202
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Metropolitan influence zone is defined
as the population of the city plus the
population of census divisions with a
greater than 50% work flow to the city
6. CONTEXT
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Memorial’s medical school was established in 1967 with a mandate to produce a local supply of physicians to Newfoundland’s largely rural population.
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Training physicians to enter rural family
practice is a key component of
this mandate.
7. INTERVENTION
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Memorial medical school’s ‘pipeline’ approach to training family physicians to practice in rural areas involves:
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high school outreach,
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a holistic approach to
admissions, and
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an emphasis on rural
educational placements.
8. OBJECTIVE
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This study measures and reports on Memorial’s success in recruiting rural students, providing rural educational opportunities, and producing rural doctors.
9. DESIGN
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Data for this study was drawn from the Learners and Locations database at Memorial University and includes admissions data, One45 data, and Canadian Medical Directory data.
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Rural categorizations were developed based on community/city size and integration with larger centers.
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SPSS was used to calculate percentages of rural and urban students and educational weeks spent at rural and urban locations.
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ArcGIS was used to produce maps to show educational placement locations.
10. PARTICIPANTS
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The present study uses data for MUNMED graduating classes 2011 to 2013 and describes student backgrounds and educational placements of these students.
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For demonstrative purposes, the present study also mapped the current practice locations of all MUNMED graduates practicing medicine in Newfoundland and Labrador.
11. MEASURES
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Statistics Canada population data was used to classify students’ backgrounds and educational locations.
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The following categorizations were developed:
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small rural community (<10,000 population)
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small rural city (10,000-24,999 population)
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medium city (24,999-99,999 population)
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large city (100,00-499,999 population)
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very large city (500,000-999,999 population)
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metropolis (over 1,000,000 population)
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Smaller centres with >50% commuting flows to larger centres were categorized in accord with the larger centre.
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Students who spent the majority of their time in rural locations before their 18th birthday were categorized as having a rural background.
12. RESULTS
Our data shows that of the 182 students who graduated from MUNMED from 2011 to 2013, 55 students or 30% had rural backgrounds.
Rural 30%
International 5%
Urban 63%
Unknown 2%
Figure 1. MUNMED student backgrounds, graduating classes 2011-2013
13. RESULTS
For graduating classes 2011 to 2013, 21% of all educational placement weeks that took place in known or electronically tracked locations took place in small rural communities or small rural cities.
14. RESULTS
66% of Year 1 Community Health placement weeks took place in small rural communities and 17% took place in small rural cities.
15. RESULTS
35% of Year 2 Family Medicine Community placement weeks took place in small rural communities and 13% took place in small rural cities.
16. RESULTS
88% of Year 3 Family Medicine placement weeks took place in small rural communities and 6% took place in small rural cities.
17. RESULTS
For MUNMED graduates of 2011 to 2013 who completed Family Medicine residency placements at MUN from July 2011 to September 2013, 15% of placement weeks took place in rural communities and 29% took place in small rural cities.
18. RESULTS
According to Canadian Medical Directory data, of 297 MUNMED graduates currently practicing family medicine in Newfoundland and Labrador:
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64 (22%) are practicing in small rural cities with populations from 10,000 to 24,999.
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44 (15%) are practicing in small rural communities of under 10,000.
19. CONCLUSION
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Our data suggests:
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Memorial University has had success recruiting rural students and providing rural family medicine placements.
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A noteworthy percentage of MUN graduates practicing family medicine in Newfoundland are practicing in rural locations (37%).
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Memorial’s rural pipeline to practice is effective and successful.
20. SUCCESS OF MEMORIAL’S RURAL PIPELINE TO PRACTICE
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There is excellent external evidence that Memorial’s pipeline to rural practice is effective and successful
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In 2008, Memorial won the Rural Education Award from the Society for Rural Physicians of Canada (SRPC)
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SRPC looked for the medical school matching the most graduates to a rural family medicine program in the 2007 Canadian Resident Matching Service (CaRMS) match.
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Memorial excelled by a significant margin, with 26% of total graduates matching to a rural family medicine residency.
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This compares to a national average of approximately 7% and is double the percentage of the next highest medical school.
21. SUCCESS OF MEMORIAL’S RURAL PIPELINE TO PRACTICE
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In 2010, Memorial received the Keith award from the SRPC for having the highest percentage of family medicine training program graduates (52%) working in rural practice 10 years after graduation.
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In 2013, Memorial University received the Keith award again, having 44% of family medicine training program graduates in rural practice 10 years after graduation.
External data sources validate our conclusions
