The Dalhousie University experience of training residents in many small communities.
BACKGROUND: Dalhousie University Faculty of Medicine provides a fully integrated postgraduate medical education program that prepares both primary care and other specialist physicians. Training takes place in many urban and rural communities. METHOD: In 1991-92 reviews were undertaken of the practice locations of (1) the 200 graduates of primary care residencies between 1987 and 1991 who were licensed to practice in one of the four Atlantic provinces and (2) the 371 graduates of other specialty residences between 1981 and 1991, regardless of practice location but including only those programs with more than ten graduates. The graduates of primary care programs had received training in either one-year rotating internships or two-year family medicine programs. RESULTS: Of the primary care trainees, 130 (65%) remained in practice in Atlantic Canada; of these trainees, 74 (57%) had practices in rural locations. For the other specialist trainees, 50% or more of those with practices in the Atlantic provinces practiced in rural locations in the following specialties: general surgery, internal medicine, ophthalmology, and otolaryngology. CONCLUSION: Postgraduate medical education at Dalhousie is somewhat unusual in that all first-year trainees are required to spend time in a small community as part of their training; hence, students who choose programs at Dalhousie often do so because of their interest in experience in a variety of communities, including those outside metropolitan areas. Still, it was surprising that graduates of some non-primary-care specialty programs, in addition to the graduates of the primary care programs, tended to choose rural practice locations. The site of postgraduate training appears to be one of the important factors in the selection of practice locations.