David Schmitz

Background and Objectives: Preparing residents for rural family practice requires attention to competency domains not consistently emphasized in urban training environments. This study identified the competency domains suggested to be uniquely important for successful rural practice and strategies to support their development during residency. Methods: In April 2023, two focus groups with 11 family medicine program directors, faculty, and residents were conducted at the Rural Training Track Collaborative Annual Meeting in Missoula, Montana. Eleven semistructured interviews were then conducted with early-career rural family physicians randomly selected from the American Board of Family Medicine National Graduate Survey. Sessions elicited competency domains, curricular gaps, and modes of education. Transcripts were analyzed using inductive content analysis via NVivo software. Results: Competency goals emphasized by participants included confidence, agency, flexibility, adaptability across settings, lifelong learning, emotional resiliency, and continuity. Curricular strategies included key areas such as procedural care and practice management, as well as flexibility and learning in rural places. Key modes of education included direct experiential learning, role modeling, and mentoring, in particular for communication, leadership, and skills in clinical procedures. Conclusions: Competency domains essential for rural practice extend beyond current graduate medical education individual and programmatic evaluative frameworks. Findings underscore the importance of curricular flexibility, rural immersion, and multimodal teaching in fostering not only broad technical skills but also adaptive capacities among rural trainees. This study extends previous work by linking competency domains to specific curricular strategies and educational modalities. The results could be used to guide intentional curricular design to strengthen the rural health workforce.

Background and Objectives: Some graduate medical education programs focus on the preparation of physicians for rural primary care practice. More exploration is needed to understand what is taught and how medical educators prepare resident and fellow physicians for rural practice. The purpose of this scoping review was to identify the primary dimensions of the concept of graduate medical education competencies for rural practice settings and describe the related evidence and gaps in the literature. Methods: In 2024, we used a modified PRISMA-ScR approach to identify studies that addressed the unique training needs and competencies of residents intending practice in a rural area of the United States. For our study, we gathered peer-reviewed materials from a 10 year period (2013–2023) using PubMed as our data source. Results: A total of 423 articles were identified. We screened abstracts and manuscripts, and included 22 articles. Eleven articles (50%) described training in preparation for rural practice, including two concerning fellowship-level graduate medical education. Five (23%) articles described residency or fellowship training occurring in rural areas. Six (27%) articles described studies involving focused training occurring in rural versus nonrural locations. Conclusions: Limited literature exists to systematically define the graduate medical education competencies required for eventual rural practice. This gap necessitates a clearer framework for training and preparing physicians for these settings.

Aims: To examine whether professional quality of life, team cohesion, and organizational commitment were independently associated with intent to leave among nursing personnel. Background: Prior research links professional quality of life with turnover intention, but less is known about joint associations with team cohesion and multidimensional organizational commitment in nursing workforces. Methods: A cross‐sectional electronic survey of 633 nursing personnel in North Dakota used validated measures. Pearson correlations, multiple regression, and post hoc nested regression were conducted. Results: The full model explained 47% of intent‐to‐leave variance. Burnout was positively associated with intent to leave ( β = 0.40, p < 0.001), whereas affective commitment ( β = −0.41, p < 0.001) and continuance commitment ( β = −0.10, p = 0.003) were inversely associated. Secondary traumatic stress (STS) was positively correlated with intent to leave ( r = 0.16) but negatively associated after adjustment ( β = −0.11, p = 0.005); its coefficient reversed when burnout entered. Conclusions: Intent to leave was associated with occupational strain and organizational attachment. The STS reversal is consistent with statistical suppression and should not be interpreted as protective. Implications for Nursing Management: Findings identify burnout and affective commitment as priorities for prospective strategy testing. Longitudinal research should determine whether modifying these domains reduces intent to leave or turnover.

Objective: To determine the distinct influences of rural background and rural residency training on rural practice choice among family physicians.Data Sources and Study Setting: We used a subset of The RTT Collaborative rural residency list and longitudinal data on family physicians from the American Board of Family Medicine National Graduate Survey (NGS; three cohorts, 2016–2018) and American Medical College Application Service (AMCAS).Study Design: We conducted a logistic regression, computing predictive marginals to assess associations of background and residency location with physician practice location 3 years post‐residency.Data Collection/Extraction Methods: We merged NGS data with residency type—rural or urban—and practice location with AMCAS data on rural background.Principal Findings: Family physicians from a rural background were more likely to choose rural practice (39.2%, 95% CI = 35.8, 42.5) than those from an urban background (13.8%, 95% CI = 12.5, 15.0); 50.9% (95% CI = 43.0, 58.8) of trainees in rural residencies chose rural practice, compared with 18.0% (95% CI = 16.8, 19.2) of urban trainees.Conclusions: Increasing rural programs for training residents from both rural and urban backgrounds, as well as recruiting more rural students to medical education, could increase the number of rural family physicians.

Both research and medical education make substantial contributions to rural primary care and health. An inaugural Scholarly Intensive for Rural Programs was conducted in January 2022 to connect rural programs within a community of practice focused on promoting scholarly activity and research in rural primary health care, education, and training. Participant evaluations confirmed that key learning objectives were met, including stimulating scholarly activity in rural health professions education programs, providing a forum for faculty and student professional development, and growing a community of practice that supports education and training in rural communities. This novel strategy brings enduring scholarly resources to rural programs and the communities they serve, teaches skills to health profession trainees and rurally located faculty, empowers clinical practices and educational programs, and supports the discovery of evidence that can improve the health of rural people.

RRH: Rural and Remote Health. Published article number: 7347 - The Pharmacy Community Apgar Questionnaire: a modified Delphi technique to develop a rural pharmacist recruitment and retention tool

Background: Recruiting and retaining medical, nursing, and allied health professionals in rural and remote areas is a worldwide challenge, compromising continuity of care and population health outcomes in these locations. Specifically, pharmacists play an essential and accessible frontline healthcare role, and are often the first point of contact for health concerns. Despite several incentives, there remains a maldistribution and undersupply of pharmacists in rural and remote areas across many parts of the world. Although current systematic reviews have focussed on factors affecting pharmacists’ retention generally, literature specifically focused on rural pharmacist workforce in a global context remains limited. The aim of this systematic review is to identify factors associated with recruitment and retention of the pharmacist workforce in rural and remote settings. Better understanding of these contributors will inform more effective interventional strategies to resolve pharmacist workforce shortages. Methods: A systematic search of primary studies was conducted in online databases, including Medline, Embase, CINAHL, Scopus, Web of Science and PsycINFO, and by hand-searching of reference lists. Eligible studies were identified based on predefined inclusion/exclusion criteria and methodological quality criteria, utilising the Critical Appraisal Skills Programme (CASP) and Good Reporting of A Mixed Methods Study (GRAMMS) checklists. Results: The final review included 13 studies, with quantitative, qualitative, or mixed methods research design. Study-specific factors associated with recruitment and retention of pharmacists in rural practice were identified and grouped into five main themes: geographic and family-related, economic and resources, scope of practice or skills development, the practice environment, and community and practice support factors. Conclusions: The results provide critical insights into the complexities of rural recruitment and retention of pharmacists and confirms the need for flexible yet multifaceted responses to overcoming rural pharmacist workforce challenges. Overall, the results provide an opportunity for rural communities and health services to better identify key strengths and challenges unique to the rural and remote pharmacist workforce that may be augmented to guide more focussed recruitment and retention endeavours.

Addressing nursing shortages in rural areas remains essential, and attracting nursing graduates is one solution. However, understanding what factors are most important or prioritized among nursing students contemplating rural employment remains essential. The study sought to understand nursing student decision-making and what aspects of a rural career need to be satisfied before other factors are then considered. A cross-sectional study over three years at an Australian university was conducted. All nursing students were invited to complete a Nursing Community Apgar Questionnaire to examine their rural practice intentions. Data were analyzed using principal component analysis, and mean scores for each component were calculated and ranked. Overall, six components encompassed a total of 35 items that students felt were important to undertake rural practice after graduating. Clinical related factors were ranked the highest, followed by managerial, practical, fiscal, familial, and geographical factors. Maslow’s Hierarchy of Needs provided a lens to examine nursing student decision-making and guided the development of the Rural Nursing Workforce Hierarchy of Needs model. Each element of the model grouped key factors that students considered to be important in order to undertake rural employment. In culmination, these factors provide a conceptual model of the hierarchy of needs that must be met in order to contemplate a rural career.