Learning procedural skills in family medicine residency: comparison of rural and urban programs.
OBJECTIVE
To determine whether family medicine residents graduating from rural programs assess themselves as more experienced and competent in a range of procedural skills than graduates of urban programs do.


METHODS
Self-administered written survey.


METHODS
Ontario.


METHODS
Residents from 5 Ontario family medicine programs in 2000 and 2001; a total of 535 surveys were available for analysis (response rate of 78%).


METHODS
Mean self-assessed experience and competence scores for 53 procedures at residency entry, end of year 1, and graduation.


RESULTS
Upon entry, there was no difference in mean procedural experience (2.89 vs 2.85, P = .54) or mean competence (2.34 vs 2.36, P = .88) scores between rural residents and their urban counterparts. There was a significant increase in procedural experience (P < .001) and competence (P < .001) scores during residency training. At graduation, mean experience (3.98 vs 3.70, P < .001) and competence (3.67 vs 3.39, P = .004) scores were significantly higher for rural residents than for their urban colleagues. A statistically larger proportion of residents graduating from rural programs assessed themselves as competent in 16 procedures. These included skills necessary for treating patients in emergency settings (establish intravenous lines for adults and infants, obtain arterial blood gas measurements, intubate adults and neonates, perform cautery for epistaxis, remove corneal foreign body, aspirate or inject knee and shoulder joints, and apply forearm or walking casts), for diagnostic procedures (endometrial biopsy and bone marrow aspiration), and for management of labour and delivery (vaginal delivery; vacuum extraction; and repair of first-, second-, and third-degree tears).


CONCLUSIONS
Graduates of rural programs who have had a substantial component of training in communities of fewer than 10,000 people report greater self-assessed experience and competence in procedural skills than graduates of urban programs do. The difference likely reflects the unique aspects of rural training sites, including preceptors' competence in performing procedures.
Goertzen
James
J
McMaster University, Hamilton, Ont, Canada. jgoertzen@hscn.on.ca
D002983:Clinical Competence / Q000706:statistics & numerical data; D004522:Educational Status; D005194:Family Practice / Q000193:education* / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D009864:Ontario; D019035:Rural Health Services / Q000706:statistics & numerical data*; D017678:Sex Distribution; D013337:Students, Medical / Q000706:statistics & numerical data; D019037:Urban Health Services / Q000706:statistics & numerical data*