Multimodal Rural Emergency Medicine Curriculum: Preparing Residents for Rural Practice

Abstract

Background: Rural regions face EM physician shortages. Most training programs are located in cities and lack rural clinical experiences, didactics, and mentorship to excite and prepare residents for rural EM practice. There is limited data on optimal training methods to prepare residents for rural practice. Educational Objectives: 1) Provide a multimodal rural EM curriculum that prepares trainees to work in rural EDs. 2) Evaluate our program quantitatively and qualitatively to assess the opportunities and limitations of rural training. Curricular Design: Our rural EM faculty working group, with extensive experience in rural practice, developed this curriculum based on 2 years of weekly case review from 2 rural critical access hospitals (CAHs). This 3-year program features clinical rotations, lectures, and simulation training. Rotations take place at rural CAHs and remote indigenous hospitals. Lectures and simulation focus on skills required in resource-limited solo practice, such as ventilator management, critical medication mixing, obstetric emergencies, patient transfer logistics, leveraging telemedicine, and prolonged critical care when transport is unavailable. Impact: During each resident's elective, quantitative data on patient volume, acuity, and procedures is collected; each rotation concludes with a qualitative evaluation of new skills, unique experiences, and limitations. Our rural EM curriculum has proven successful over the first 2 years. Quantitatively, residents see patient acuity and procedures similar to academic center rotations but gain unique skills from the challenges of a rural environment. Qualitatively, 7 of 7 residents gained new skills and confidence, with 86% choosing a rural practice. We plan to expand our program, share didactic content with other residencies, and open additional rural clinical experiences to trainees nationwide, with the goal of bridging the gap between urban training programs and rural emergency care needs.