Objective Rural rotations have become increasingly common. However, little is known about whether they offer educational benefits for residents who do not eventually practice in rural facilities. Design Starting with an ACGME-provided roster of general surgery programs, the authors conducted a website review (12/2022-7/2023) of the 342 civilian programs located in U.S. states to identify 81 programs (24%) offering elective or required rural rotations in the U.S. Because previous research is scant, the authors then adopted a qualitative approach and designed a semistructured interview schedule to learn from program leaders what educational benefits their rural rotations might provide residents and whether any noted benefits applied to all residents or just those open to practicing in a rural location. The first author conducted 30-minute telephone interviews with 58 general surgery program leaders for a participation rate of 72% (58 of 81). Interviews were conducted in 2 blocks (8/2023-11/2023 and then 7/2024-8/2024) and focused on the 2023-24 academic year. Interviews were recorded, transcribed, and analyzed collaboratively by the first three authors. Results All program leaders described how their rural rotations provide educational benefits that transcend the issue of practice location. The authors identify and describe 4 prominent themes from the interviews: access to cases, particularly those deemed core or "bread-and-butter" general surgery; exposure to rural practitioners who model broad-spectrum general surgery; insights into resource-limited practice settings; and the learning advantages of increased responsibility, leadership development, and mentorship typically present in small rural facilities. Conclusions Program leaders touted the educational benefits of rural rotations for all residents, a finding that might prompt more programs to consider such opportunities. Academic-rural partnerships could become a routine component of residencies.

OBJECTIVE:Despite the dire need for rural surgeons and increasing interest in exposing residents to rural practice, there remains little systematic information about how programs establish and sustain rural rotations. DESIGN:A website review (12/2022-7/2023) of the 342 civilian surgery programs listed by the ACGME identified those offering elective or required U.S. rural rotations. In addition, all programs were contacted by email to confirm or deny that they offered rural rotations to account for webpage inaccuracies. The effort identified 81 programs (24%). A qualitative design was then adopted, whereby the first author interviewed 58 general surgery program leaders (72% participation rate) to explore strategies used to arrange and sustain rural rotations. Interviews focused on the 2023-24 academic year, were conducted from August 2023 to August 2024, and were recorded, transcribed, and analyzed collaboratively to discern program strategies. RESULTS:Programs are more likely to use rural training sites outside their healthcare system (59% or 34/58) than inside (41% or 24/58), but system sites were preferred when available. At both site types, programs drew heavily upon professional ties, primarily to program graduates (64% or 37/58). Alumni were eager to help and knew program traditions and expectations. Their presence also bolstered confidence in the educational value of the rotation. Additional alumni joining rural sites were evidence of rotations as a recruitment pathway, thus fostering sustainable relationships. Within-system rotations were easier to arrange and finance than those outside the system. CONCLUSIONS:The results offer practical insights into how a diverse mix of surgery programs across the U.S. select and sustain required and elective rural rotations in the U.S. The prominence of professional ties to program graduates and healthcare-system links are especially notable. Variability across programs in how they select and sustain sites also suggests that many approaches are feasible.

About 20 years ago I found myself as a new faculty member charged with educational leadership in a new setting. My chair took me on a field trip to Toronto to witness the workings of the Wilson Center, a multidisciplinary research and educational innovation center founded there by Richard Reznick, who was at that time Chair of Surgery at the University of Toronto. While there I witnessed the creative power and depth of insight gained by viewing surgical education through a multidisciplinary lens, grounded in behavioral as well as surgical science.

Background A shortage of general surgeons is predicted in the future, with particular impact on rural surgery. This is an exploratory analysis on a rural-focused longitudinal integrated clerkship to determine if such clerkships can be used to increase interest and recruitment in rural general surgery. Methods An institutional database was reviewed to identify students who became general surgeons after completing a rural-focused longitudinal integrated clerkship. Telephone interviews were conducted on a portion of these surgeons. Results Fifty-seven students (3.6%) completing the rural-focused longitudinal integrated clerkship became general surgeons. Of those participating in phone interviews, most (90%) decided to become surgeons during their experience while all stated that preclinical years did not influence their specialty decision. Conclusions A substantial portion of these surgeons went on to practice in rural communities. Pre-existing rural and primary care-focused education could help to address the future projected shortage of rural general surgeons.

This book examines headhunting—contingency recruiting—in the wake of two profound changes in the labor market. The first is the emergence and explosive rise of various forms of social media, most prominently LinkedIn, which have made information about employers, jobs, and job-seekers much more widely available. The second is the unraveling of internal labor markets and the fraying of the ties between employers and employees, which started in the 1980s and 1990s, and accelerated in the wake of the bursting of the dotcom bubble and the Great Recession. Both changes created the possibility that employers and candidates would be able to find each other without the benefit of labor-market intermediaries like headhunters. The book explains why headhunting survived these changes: employers still need headhunters to find good candidates quickly. In a high-tech world, it is relatively easy to find large numbers of apparently qualified prospective candidates. Headhunters, however, determine which of these prospects are truly viable candidates and they invest time and effort in converting prospects into candidates. They bring high-touch search to a high-tech labor market.

Background: Nurse Practitioners and Physician Assistants - called non-physician practitioners or NPPs - are common, but little is known about their educational promise and problems. Methods: General surgery faculty in 13 residency programs were surveyed (N = 279 with a 71% response rate) and interviewed (N = 43) about experiences with NPPs. The survey documents overall patterns and differences by program type and primary service; interviews point to deeper rationales and concerns. Results: NPPs reduce faculty and resident workloads and teach residents. NPPs also reduce resident exposure to educationally valuable activities, and faculty sometimes round, make decisions, and operate with NPPs instead of residents. Interviews indicate that NPPs can overly reduce resident involvement in patient care, diminish resident responsibility and decision making, disrupt team dynamics, and compete for procedures. Conclusions: NPPs both enhance and hinder surgical education and highlight the need to more clearly articulate learning outcomes for residents and activities necessary to achieve those outcomes. (c) 2017 Elsevier Inc. All rights reserved.