Intentional Rural GME: A Study of Competency Needs for Rural Family Medicine

Abstract

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.