Remote versus urban medical training

As a 24-year veteran of a family medicine training program based in a rural setting, I find it unfortunate that Robert McKendry and colleagues did not offer a description of the rural training programs in their article,¹ for example, the number of months of speciality training conducted in towns with less than 30 000 people. I would have found a table describing the site rotations, with information on the number of trainers per site, helpful in deciding if the the results of this study are applicable to our situation in Newfoundland.

One of the strong points of rural clinical teaching rotations is that the resident is often trained in a one-to-one situation with a clinical teacher. A good teacher makes a great rotation but the same site with a poor teacher makes no rotation at all. The process of recruiting rural clinical teachers and saying goodbye to departing ones is both delicate and constant. More information is needed concerning the differences between rural and urban rotations before we can determine the value of the results of McKendry and colleagues. In addition, if there was a difference in examination results between the residents trained in rural and remote settings and those trained in urban settings, perhaps, as the authors note, we should examine the examination.

On another note, I spend a bit of time in a canoe and I was appalled at the picture on the cover of the Sept. 19, 2000, issue of CMAJ. The canoeists were not wearing personal flotation devices. Every year dozens of Canadians drown because they were out on the water underprotected like the 2 people on the cover of our official journal. What next? An article on the joy of driving with a picture of drivers not wearing seat belts?

Signature

William Eaton
Department of Family Medicine Faculty of Medicine Memorial University of Newfoundland St. John's, Nfld.