Rural Family Medicine training streams should be community-based integrated programs with full academic support; that the four principles of Family Medicine provide the framework for the development of specific curricula; that a minimum of six months of postgraduate education should occur in rural settings. - CFPC Working Group May 1999

Competency in the knowledge, skills and attitudes for rural family practice should be the goal for rural Family Medicine residency training, and educational content should be based on the clinical realities of rural practitioners building on the template of problems and procedures . - CFPC Working Group May 1999

Core postgraduate rural/regional community based rotations are desirable within all programs ...these should be no less than eight weeks in duration and occur in rural or regional centres, and all residents should have access to significant rural electives/selectives in Family Medicine and other disciplines - CFPC Working Group May 1999

Rural Family Medicine training streams should be developed as appropriate postgraduate training for rural family practice - CFPC Working Group May 1999 - Recommendation #3 at page 22

The number of rural Family Medicine training stream positions should reflect rural health care needs of communities for rural doctors. For most parts of the country, this will require a significant increase in the rural stream Family Medicine residency positions. - CFPC Working Group May 1999

[Due to attrition the percent] of rural stream residency positions needs to be larger than the percent of rural family physicians [to total practising family physicians]. - CFPC Working Group May 1999

Successful development of core postgraduate education for rural family practice and special advanced skills training is required to meet the health care needs of rural Canadians. Producing more physicians with the knowledge, skills and attitude for rural family practice will require involvement, collaboration, co-operation, and support of governments, medical schools, medical organizations and rural doctors - CFPC Working Group May 1999.

Manpower planning in Canada will continue to be seriously compromised unless the medical needs of the Canadian people can be met by Canadian physicians through appropriate social, economic, organizational, and educational incentives to prepare and retain physicians in our non-urban communities. -1988 CMA Meetings on the Training of GP/FPs to Provide Anesthesia Services

There has been, and will continue to be, a need for family practitioners with training in anesthesia to provide anesthesia services to non-urban communities, particularly in isolated areas. -1988 CMA Meetings on the Training of GP/FPs to Provide Anesthesia Services

[We commit to the goal of] "ensuring appropriate training of adequate numbers of rural doctors and other health professionals and promoting the reorientation of the universities to provide such training." -Durban declaration World Rural Health Congress 1997

[We commit to the goal of] "Ensuring continued educational support of health professionals in rural areas." -Durban declaration World Rural Health Congress 1997

[We commit to the goal of] "Sustaining and enhancing the provision of rural health care by the provision of incentives and appropriate conditions for rural doctors and other health professionals." -Durban declaration World Rural Health Congress 1997

[We commit to the goal of] "The provision of adequate resources and facilities for rural health care." -Durban declaration World Rural Health Congress 1997

[We commit to the goal of] "Developing multi-disciplinary teams with a community orientated approach." -Durban declaration World Rural Health Congress 1997

Many Rural and Northern area facilities have always been or have become centres of excellence. That is to say that the care given there, within their scope of practice, has been exemplary and the outcomes as good or better than in large high tech centres. -From education to sustainability, Dec 1998

Successfully developing and implementing a rural curriculum requires the development and input of rural faculty, combined with central faculty and management support. -From education to sustainability, Dec 1998

For aspiring rural physicians, there must be a separate rural stream, with a rural core component of no less than four months of rural family medicine plus two months training in each of emergency medicine, obstetrics and ICU/anaesthesia. The B.C. experience of total rural immersion provides one successful model. -From education to sustainability, Dec 1998

Ultimately, accessible, quality medical care is dependent on an adequate number of appropriately trained and distributed physicians or "critical mass" working within an integrated, supported health care system. -From education to sustainability, Dec 1998

Any funding formula adopted for an alternate payment plan must reflect the unique nature of work provided by rural practitioners. -From education to sustainability, Dec 1998

“Most Physicians are inadequately prepared during residency for rural practice" -Graham Scott QC, 1995

“Medical school and residency training programs are not providing the necessary pool to avoid a rural crisis" -Graham Scott QC, 1995

“The unique nature of rural practice should be officially acknowledged and appropriately supported within the academic community. There should be an FP designation based on the special skills required for rural practice." -Graham Scott QC, 1995

“Rural physicians have difficulty accessing the AHSC's for the substantial technical and moral support that they require from them." -Graham Scott QC, 1995

“A cross pollination of expertise between rural practitioners and the AHSC's is not only in the public's interest, but it is in their mutual interest." -Graham Scott QC, 1995

Data is a campfire around which organizations huddle for heat and light. The irony is in the fact that neither the heat nor the light yield a solution. The solution emerges out of the huddling (i.e., through the organizational interaction in a discussion forum). -Ontario Ministry of Health and Long-Term Care, anonymous.

“...the health human resource planning activities of the Ministry (of Health) have tended to be reactive, responding to topical issues and concerns. They have tended not to take a long term focus and they have generally lacked a comprehensive perspective..." -Price Waterhouse Health Human Resources Planning Project 1990

“...there appear to have been few significant attempts to manipulate remuneration levels in order to achieve health human resource planning objectives." -Price Waterhouse Health Human Resources Planning Project 1990

The [Rural Family Medicine Training] stream's clinical rotations in Family Medicine and specialty disciplines should occur, to the greatest extent, in rural and regional practice and hospital settings. - RPAP Co-ordinating Committee Working Group on Rural Medical Education Sept 1999

University specialty departments have a social responsibility to rural communities to provide appropriate training and referral backup to rural practitioners and their accreditation should include an assessment of their commitment to educating physicians for rural practice - RPAP Co-ordinating Committee Working Group on Rural Medical Education Sept 1999

Not that urbanites do not have difficulties, but residents in rural areas, small towns and remote locations face many more obstacles and those obstacles tend to be much more formidable. -Rural Health Research in CIHR 1999

Although there is a lingering idyllic notion about the countryside... in reality, many rural communities in Canada are facing demographic, ecological, economic and social challenges due to geographic and social isolation, depletion of natural resources, boom-and-bust cycles in primary industries, chronic high unemployment, out-migration of the young,... -Rural Health Research in CIHR 1999

...even when rural is mentioned, it is commonly used as a convenient comparison category to illustrate urban-rural differences. Rural is rarely the focus of attention, yet findings and recommendations from urban-based research are often considered universally applicable or are extrapolated to rural settings. -Rural Health Research in CIHR 1999

It is essential that rural health issues be understood in more than anecdotal terms and that rural inhabitants be treated as more than statistical categories. -Rural Health Research in CIHR 1999

Policies and programs designed to meet rural health needs must be grounded in solid information and sound research analysis. Rural clinicians practise in different and sometimes challenging environments and often have to be innovative and adaptive in what they do... Research can be very helpful... But such research has to be based in rural reality. -Rural Health Research in CIHR 1999

It is not just the size of the rural population that is important from the perspective of health research. Equally important is the fact that rural Canada has many serious and protracted health problems that need to be better understood and resolved with the help of research. -Rural Health Research in CIHR 1999

Because the health problems confronting rural Canada are serious, complex, interrelated and evolving, research should have a critical role to play in examining the nature of these problems, monitor their progress or deterioration, identifying their causes, finding solutions and evaluating the effectiveness of various interventions. -Rural Health Research in CIHR 1999

Rural health studies must not be seen as an outgrowth of urban-based research and must not be regarded as something that can conveniently be subsumed under other areas of health research. -Rural Health Research in CIHR 1999

A cross-cutting approach, in the absence of financial and organizational clout, tends to invite inaction or lip service. Instead of the status quo, rural health research needs a deliberate spur, a defined program, a definitive identity and dedicated funding to help it overcome past benign neglect. -Rural Health Research in CIHR 1999

Health professionals education represents one of the South's major successes….. despite increases in the overall supply ….. serious problems of distribution of professionals to geographic, subspecialty, and public service areas of need continue, except for those situations in which carefully coordinated strategies have been directed to specific problems Southern Regional Education Board 1983

When loan forgiveness programs have been instituted without any other strategies, the results have been dismal. But when they have been combined with other efforts, such as careful selection of candidates who are motivated to work in the areas of need, specially designed teaching experiences, and counseling and placement services, they have been quite successful. Southern Regional Education Board 1983

“Rural doctors identify a series of key attractions of rural practice. First is the greater variety of practice that often includes obstetrics, surgery, anaesthetics and emergency medicine together with hospital access and care of the acutely ill." -WONCA Policy on Training for Rural Practice 1995

“Social satisfactions of rural practice identified by rural doctors include community standing and respect, coupled with a sense of belonging to a stable community, and enjoyment of outdoor living with many recreational opportunities." -WONCA Policy on Training for Rural Practice 1995

“An important attitudinal problem is that of 'learned helplessness'. The highest that many new medical graduates aspire to in dealing with medical problems is being able to assess to which specialist to refer the patient. Consequently, it is a frightening prospect for them to contemplate rural practice." -WONCA Policy on Training for Rural Practice 1995

“The relative professional isolation, which provides many challenges and rewards for rural doctors, is seen as a negative factor for many students and new graduates. Often this aspect is over-emphasised within the context of urban-based training rather than the development of individual knowledge and skills required" -WONCA Policy on Training for Rural Practice 1995

Rural family physicians generally provide a wider range of services than do their metropolitan counterparts. Consequently, there is a need for specific residency training programs for rural practice, which prepare new medical graduates for a career in the country. -WONCA Policy on Training for Rural Practice 1995

After a rural background the next strongest factor associated with entering rural practice is undergraduate and postgraduate clinical experience in a rural setting. -WONCA Policy on Training for Rural Practice 1995

In addition to standard training for family practice, rural practice vocational training requires specific emphasis on: hands-on learning of procedural skills; the spectrum of illnesses in rural and remote communities; the sociology and psychology of rural and remote communities; and professional and personal aspects of living and working in small rural communities. -WONCA Policy on Training for Rural Practice 1995

“Ultimately, recruitment to rural practice will only increase when students and new medical students see rural practice as a positive career option." -WONCA Policy on Training for Rural Practice 1995

“Rural exposure for all undergraduate medical students should be maximised." -WONCA Policy on Training for Rural Practice 1995

“Training positions for advanced rural practice skills in emergency medicine, anesthesia, surgery, procedural obstetrics and others need to be developed and appropriately funded." -WONCA Policy on Training for Rural Practice 1995 "There is a need for specific tailored continuing education and professional development programs to meet the needs of rural family physicians. Generally these programs should be developed by rural doctors for rural doctors." -WONCA Policy on Training for Rural Practice 1995

“Practice in remote and rural areas has many financial disadvantages. In order to recruit and retain doctors in remote and rural practice these financial issues need to be addressed." -WONCA Policy on Training for Rural Practice 1995

“It has been found that the production of more and more doctors does not lead to an overflow of physicians from the cities to the country." -WONCA Policy on Training for Rural Practice 1995

“In order to increase the numbers and quality of rural doctors it is necessary to implement a series of strategies aimed at establishing an integrated career pathway of education and training for rural practice." -WONCA Policy on Training for Rural Practice 1995

“Rural practitioners are much more likely to be looking after individual patients for all their medical problems on a continuing basis and to be caring for other family members." -WONCA Policy on Training for Rural Practice 1995

“Once in rural practice not only is continuing education difficult to arrange, but often proves to be of limited value to practicing rural doctors." -WONCA Policy on Training for Rural Practice 1995

Medical school admission procedures should be based on institutional mission and capacity, and national health work force targets. The open entry system is obsolete" -Edinburough declaration of the World Rural Health Conference