Availability and Potential Effect of Rural Rotations in Emergency Medicine Residency Programs

Abstract

Increased exposure of emergency medicine (EM) residents to rural rotations may enhance recruitment to rural areas. This study sought to characterize the availability and types of rural rotations in EM residency programs and to correlate rotation type with rural practice after graduation. Program directors from all 126 Accreditation Council for Graduate Medical Education (ACGME)-accredited EM residency programs with at least 2 years of graduates were surveyed. Directors were asked about availability of rural rotations, categorized as: 1) required, 2) elective (with or without predesignated sites), or 3) not available. Completion of rotations and initial practice location after graduation by rotation type were compared. The 111 (88%) directors reported 2,380 graduates over the past 2 years. Rural rotations were required by six (5%) programs, elective at 92 (83%), and not available at 13 (12%). Overall, 197 (8%) residents completed a rural rotation during residency, and 160 (7%) selected their initial job in a rural area. More residents completed an elective rural rotation in programs with versus without a predesignated site (7% vs. 4%, respectively). EM residency graduates were more likely to select a rural job when rural rotations were required (22%), compared to other options: predesignated (7%) or no predesignated (6%) elective or not available (7%; p < 0.001). Elective rural rotations at predesignated sites increase resident exposure to rural areas compared to programs without predesignated sites, but neither approach was associated with rural practice after graduation. EM residency programs that required a rural rotation had increased resident selection of rural jobs, but only 5% of programs had this requirement.