Building a community of practice in rural medical education: growing our own together.

CONTEXT: This article chronicles the rise, decline, and recent resurgence of rural training track residency programs (RTTs) in the USA over the past 30 years and the emergence of a healthy community of practice in rural medical education. This has occurred during a time in the USA when federal and state funding of graduate medical education has been relatively stagnant and the rules around finance and accreditation of rural programs have been challenging.

ISSUE: Many of the early family residency programs developed in the 1970s included a curricular focus on rural practice. However, by the 1980s, these programs were not yet producing the desired numbers of rural physicians. In response, in 1986, Maudlin and others at the family medicine residency in Spokane developed the first 1-2 RTT in Colville, Washington. In the 1990s, and by 2000, early news of success led to a peak of 35 active programs. However, over the next decade these programs experienced significant hardship due to a lack of funding and a general decline in student interest in family medicine. By 2010, only 25 programs remained.<b> </b>In 2010, in an effort to sustain the 1-2 RTT as a national strategy in training physicians for rural practice, a federally funded consortium of individuals and programs established the RTT Technical Assistance program (RTT TA). Building on the pattern of peer support and collaboration set by earlier groups, the RTT TA consortium expanded the existing community of practice in rural medical education in support of RTTs. In-person meetings, peer consultation and visitation, coordinated efforts at student recruitment, and collaborative rural medical education research were all elements of the consortium's strategy. Rather than anchoring its efforts in medical schools or hospitals, this consortium engaged as partners a wider variety of stakeholders. This included physician educators still living and practicing in rural communities ('local experts'), rural medical educator peers, program directors, professional groups, academic units, governmental entities such as state offices of rural health, and national associations with a stake in rural medical education. The consortium has succeeded in (1) supporting established and new RTTs, (2) increasing medical student interest in these programs, and (3) demonstrating the effectiveness of this strategy through a minimum dataset and registry of RTT trainees. From a low of 21 programs in 2012, the number has grown to 32, accounting for a total of 68 positions in each year of training. The RTT Collaborative, the non-profit that has emerged as the sustainable product of that federal funding, is now supported by a national cooperative of participating rural programs and continues the work.

LESSONS LEARNED: Growing a community of practice in this fashion requires the organic building of relationships over time. The RTT TA consortium, and now the RTT Collaborative as a sustainable successor, have laid a strong foundation for community-engaged rural health professions education into the future - from each growing their own, to 'growing our own … together.