C2A - 02: RURAL SURGEONS’ PERSPECTIVES ON NECESSITY OF POST-RESIDENCY TRAINING LARGELY DO NOT DIFFER ACROSS GENERATIONS AND TIME IN PRACTICE
Dorothy Hughes, MHSA¹, Mackenzie Cook, MD², Shanley B Deal, MD³, Tyler G Hughes, MD, FACS¹, Michael Sarap, MD, FACS⁴, Karen Brasel, MD, FACS², Adnan Alseidi, MD, FACS³; ¹University of Kansas School of Medicine, ²Oregon Health Sciences University, ³Virginia Mason Medical Center, ⁴Southeastern Med Hospital

Background: The scope of surgical services in rural areas differs from that provided in urban areas. Rural areas are also facing a shortage of surgeons, with up to 65% more general surgeons practicing in urban areas than rural. We hypothesize perspectives on the training necessary for future rural surgeons differ between surgeons in practice for less than 20 years and those in practice for more than 20 years due to inherent differences between these generations.

Methods: To inform educators about skills necessary in rural surgical practice, we conducted a mixed methods study in collaboration with the American College of Surgeons (ACS) Rural Advisory Council. The first phase was an online survey containing open- and closed-ended elements including a request to participate in the second phase, semi-structured qualitative interviews. Purposive sampling was used to achieve diversity in age, gender, and geographic location in the qualitative sample. Interviews were digitally recorded, then transcribed. Variables used in regression included: town size, defined as small (≤50,000 people), medium (>50,000 and ≤100,000), and large (>100,000); and region, defined according to US Census sub-regions. Quantitative data were analyzed using univariate and bivariate testing and linear regression in Stata SE14. Qualitative data were coded and analyzed using NVivo 11 Pro.

Results: The online survey yielded 237 respondents, and 16 interviews were conducted. The interviews each averaged 41 minutes, for 11 hours of total recorded time. Bivariate testing found no relationship between generation (<20 versus ≥20 years in practice) and perception of the value of post-residency training for future rural surgeons. In multivariate regression and qualitative data analyses, however, generation became relevant when practice context (interaction of town size and region) was considered. When controlling for practice context, younger surgeons were slightly less likely to report post-residency training was necessary (p = 0.012). Qualitative analysis added valuable descriptive data about the details of practice contexts and day-to-day realities of rural practice.

Conclusion: Across generations, rural surgeons largely show no difference in perception of the skills needed to practice rural surgery. However, generational perceptions of training needed to practice do differ when specific practice contexts are considered.