How to Serve the Underserved: Making the Case for Rural and Remote Mental Health Training for Psychiatry Residents

Interest in Rural Training Experiences in a Canadian Psychiatry Residency Program

BACKGROUND

With the large majority of mental health professionals concentrated in urban settings, people living in rural and remote areas face significant barriers to accessing mental health care. Recognizing that early exposure is associated with future practice in rural and remote locations, we sought to obtain baseline data regarding interest in expanded rural residency training opportunities and academic teaching.

METHODS

In March 2021, all psychiatry residents at the University of Alberta (UofA) were invited to complete a 19-question survey that included both closed-ended (age, gender, year of study, rural experience, interest in rural training, etc.) and open-ended questions (challenges, barriers, academic training, and other comments). A reflexive thematic analysis using an inductive and semantic approach was completed on the comments.

RESULTS

36 residents completed the survey (response rate, 75%). Significant associations were identified between previous rural training experience and interest in rural psychiatry training and practice. Female residents and junior residents were significantly more interested in rural training experiences than their counterparts. Thematic analysis noted concerns with the financial costs of accommodation and transportation, high service burden, continuity of care and isolation from their cohort. Many were interested in academic sessions on the realities of rural practice; approaches to collaborative care; and strategies on culturally relevant care; specifically Indigenous health.

CONCLUSIONS

The University of Alberta has highlighted a focus on improving equity and accountability; and with a large rural catchment region; the residency program is well positioned to make training adjustments to diversify training. Based on our findings we have incorporated rural rotations for incoming residents and have developed further rural academic content to support our responsiveness and accountability to the rural and northern communities we are committed to serving. Future research should review the impact of rural training exposure in medical specialties on recruitment and retention as well as on healthcare outcomes.

The Regional Distribution of Psychiatric Residency Positions Funded by the Department of Veterans Affairs and Its Relationship to Rural Veteran Populations

OBJECTIVE

The authors evaluated the distribution of psychiatry residency positions funded by the Department of Veterans Affairs between 2014 and 2020 with respect to geographic location and hospital patient population rurality.

METHODS

The authors collected data on psychiatry residency positions from the Veterans Affairs' Office of Academic Affiliations Support Center and data on hospital-level patient rurality from the Veterans Health Administration Support Service Center. They examined the chronological and geospatial relationships between the number of residency positions deployed and the size of the rural patient populations served.

RESULTS

Between 2014 and 2020, the Department of Veterans Affairs has substantially increased the number of rural hospitals hosting psychiatry residency programs, as well as the number of residency positions at those hospitals. However, several geographic regions serve high numbers of rural veterans with few or no psychiatry resident positions.

CONCLUSIONS

While the VA efforts to increase psychiatry residency positions in rural areas have been partially successful, additional progress can be made increasing support for psychiatry trainees at Veterans Affairs hospitals and community-based outpatient clinics that serve large portions of the rural veteran population.