背景:全球农村地区面临普通外科医生短缺,限制农村人口获得手术治疗。虽然个人和实践相关的因素在美国已经得到了充分的研究,我们需要更好地了解社区特征在外科医生位置选择中的作用。这项研究旨在了解与社区特征相关的外科医生的深层含义,以便为跨越农村外科医生劳动力途径的努力提供信息。从早期的教育暴露中,本科和研究生医学教育,招聘和保留。
方法:我们进行了定性,对美国中西部普通外科医生进行的关于社区特征的作用和意义的描述性访谈研究,探索他们的背景,教育,练习位置选择,和未来的计划。我们专注于农村外科医生,并使用了城市比较组。我们使用便利和雪球采样,然后亲自和通过电话进行了采访,并对其进行数字记录和专业转录。我们进行感应编码,并继续收集数据,直到达到代码饱和。我们使用专题网络分析来组织代码并得出结论。
结果:共有37名普通外科医生(22名农村和15名城市)参加。面试时间超过52小时。三个全球主题描述了农村外科医生如何联系不同,往往更深,与他们的城市同事相比,具有某些社区特征的含义:物理环境象征,卫生资源与实践范围的关系,以及激烈的角色重叠(职业和个人角色)的含义。所有受访者都谈到了这三个主题,但是他们发现的含义在城市和农村外科医生之间有着重要的不同。自然景观和社区基础设施代表了农村外科医生的自治和自由。他们还分享了设施,设备,工作人员,职工教育,和外科合作伙伴结合起来,创造了与城市同行不同的实践范围。通常,农村外科医生发现,当他们需要将患者转移到更高视力的机构时,这些资源是支配的。农村外科医生经历了激烈的角色重叠,因为他们关心的病人也是朋友和邻居。
结论:农村外科医生与城市外科医生相比,将不同的含义与某些社区特征相关联。当他们与准农村外科医生合作时,教育工作者和农村社区应强调卫生资源如何转化为理想的实践范围。他们还应该与学员分享角色重叠的现实,它既可以是多么紧张和压力,也可以是多么令人满意。教育者应在医疗和外科教育中纳入农村社会背景,寻找更多与农村社区合作的机会,为学习者提供农村环境的第一手经验,资源,和角色重叠。
BACKGROUND: Rural areas worldwide face a general surgeon shortage, limiting rural populations\' access to surgical care. While individual and practice-related factors have been well-studied in the US, we need a better understanding of the role of community characteristics in surgeons\' location choices. This study aimed to understand the deeper meanings surgeons associated with community characteristics in order to inform efforts spanning the rural surgeon workforce pathway, from early educational exposures, and undergraduate and graduate medical education, to recruitment and retention.
METHODS: We conducted a qualitative, descriptive interview study with general surgeons in the Midwestern US about the role and meaning of community characteristics, exploring their backgrounds, education, practice location choices, and future plans. We focused on rural surgeons and used an urban comparison group. We used convenience and snowball sampling, then conducted interviews in-person and via phone, and digitally recorded and professionally transcribed them. We coded inductively and continued collecting data until reaching code saturation. We used thematic network analysis to organize codes and draw conclusions.
RESULTS: A total of 37 general surgeons (22 rural and 15 urban) participated. Interviews totaled over 52 hours. Three global themes described how rural surgeons associated different, often deeper, meanings with certain community characteristics compared to their urban colleagues: physical environment symbolism, health resources\' relationship to scope of practice, and implications of intense role overlap (professional and personal roles). All interviewees spoke to all three themes, but the meanings they found differed importantly between urban and rural surgeons. Physical landscapes and community infrastructure were representative of autonomy and freedom for rural surgeons. They also shared how facilities, equipment, staff, staff education, and surgical partners combined to create different scopes of practice than their urban counterparts experienced. Often, rural surgeons found these resources dictated when they needed to transfer patients to higher-acuity facilities. Rural surgeons experienced role overlap intensely, as they cared for patients who were also friends and neighbors.
CONCLUSIONS: Rural surgeons associated different meanings with certain community characteristics than their urban counterparts. As they work with prospective rural surgeons, educators and rural communities should highlight how health resources can translate into desired scopes of practice. They also should share with trainees the realities of role overlap, both how intense and stressful it can be but also how gratifying. Educators should include the rural social context in medical and surgical education, looking for even more opportunities to collaborate with rural communities to provide learners with firsthand experiences of rural environments, resources, and role overlap.