Putting "rural" into psychiatry residency training programs.
OBJECTIVE
Evidence indicates disparities in the number of psychiatrists practicing in rural America compared to urban areas suggesting the need for a greater emphasis on rural psychiatry in residency training programs. The authors offer suggestions for integrating a rural focus in psychiatry residency training to foster greater competency and interest in rural psychiatry.


METHODS
The authors surveyed the limited rural psychiatry training and the more extensive family medicine rural residency literature to review efforts to develop rural focused training curricula.


RESULTS
Many factors in the rural environment influence mental health care, including overlapping professional-patient relationships, caregiver isolation and stress, limited availability and access to mental health resources, disease stigma, and economic and health status. To enhance both an interest in and the quality of the training for a rural practice, the authors suggest three levels of training for integrating rural factors into psychiatry programs from a basic didactic understanding of the contextual issues affecting rural psychiatry, to creating rural clinical experiences and preceptors, to developing a rural psychiatry fellowship.


CONCLUSIONS
Providing trainees with an understanding of the rural mental health issues and experiences might contribute to trainees' selecting rural practices and enhance the rural competency of psychiatrists.
Nelson
William A
WA
Department of Psychiatry, Dartmouth Medical School, 35 Centerra Parkway-HB7251, Lebanon, NH 03766, USA. william.a.nelson@dartmouth.edu
Pomerantz
Andrew
A
Schwartz
Jonathan
J
D002321:Career Choice; D002983:Clinical Competence; D003479:Curriculum; D005257:Fellowships and Scholarships; D005544:Forecasting; D006301:Health Services Needs and Demand / Q000639:trends; D006801:Humans; D007396:Internship and Residency; D008507:Medically Underserved Area; D011231:Preceptorship; D011570:Psychiatry / Q000193:education*; D012423:Rural Health / Q000706:statistics & numerical data*; D012570:School Admission Criteria / Q000639:trends; D014481:United States; D000078329:Workforce