Rural medical education: Boundless opportunities

Leaving Edmonton for training broadens horizons for students, residents

By Keri Sweetman

On any weekday at the University of Alberta's Faculty of Medicine & Dentistry, hundreds of students from more than 20 departments can be seen in the halls and classrooms of the Edmonton Clinical Health Academy. It's a busy place.

But students from the faculty can also be found in large and small health settings in other cities and towns in Alberta, in northern Canada and in rural and urban centres across the globe. When it comes to learning and clinical placements, the faculty encourages its students to spread their wings.

"We want students to go out and learn in different places because we want them to go out and work in different places," says Jill Konkin, Associate Dean, Division of Community Engagement.

"If all we ever do is have them learn next to the Walter C. Mackenzie Health Sciences Centre … then that's all they'll know and that's all they'll feel is important."

For undergraduate medical students, the Rural Integrated Community Clerkship (ICC), a core clerkship opportunity, allows them to meet all the competencies of the third-year MD program in rural Alberta. There is also a second-year gastrointestinal course delivered outside of Edmonton and a mandatory third- year, one-month rural placement for those not in the ICC.

About 25 to 30 medical students also do placements overseas each year in various countries. One of the faculty's long-running international partnerships is with the Patan Academy of Health Sciences, based in Kathmandu, Nepal.

"Patan is a school that is oriented toward graduating physicians who will serve the needs of their communities, particularly rural," says Konkin. "We are learning from them as well."

Ramona Kearney, Associate Dean of Postgraduate Medical Education, says rural-based programs are one way her office connects medical residents to the community.

"We have two years of family medicine residency situated either in the city or in three of our
smaller urban communities … . Fort McMurray, Grande Prairie and Red Deer are the three home bases for 40 of our residents in family medicine.

The idea is if that's your home base and that's where you train, we hope that will entice (residents) to start a practice in one of those smaller areas."

Rural Integrated Community Clerkship

In 2017, the U of A's Rural Integrated Community Clerkship marked a decade of immersing medical students into the daily routine of rural physicians. Rather than completing their core rotations in Edmonton, third-year medical students in the rural clerkship program spend 10 months living and learning in northern and central Alberta rural communities, where they are based in family medicine clinics under the mentorship of local physician preceptors and follow patients to all venues of care including the hospital inpatient ward, operating room, labour and delivery suite, patients' homes, public health clinics and more.

To date, about 190 participants have been placed in communities such as Camrose, Edson, Hinton, Ponoka, St. Paul, Sylvan Lake, Westlock and Whitecourt.
Students who do the rural clerkship are more likely to choose careers as family doctors or generalists, often working in underserved communities, but also go into other competitive specialities.

Andrew Halladay, MD '13, completed the Rural Integrated Community Clerkship program and now practises as a family physician in Whitecourt and is a preceptor. "This is an excellent program," he says. "I don't think I would be as good a doctor today if I didn't go through it."