What is the place of rural attachments in surgical training? A qualitative study of Scottish trainee experiences

OBJECTIVES: Rural surgical training attachments are an important means to improve rural-urban workforce equity. Recent evidence from the USA indicates that the educational benefits of rural surgical attachments are much broader than just developing a rural workforce pipeline. In our own context rural attachments have been offered for many years, but the quality and gains from rural training have not been studied previously. Thus, the study aim was to explore UK core surgical trainees' experiences of a remote and rural rotation and the value they placed on this experience in terms of positioning them for their next career surgical steps. METHODS: This was a qualitative study using semi-structured interviews to gather the views and experiences of core surgical trainees (CSTs) who had undertaken a placement in a Scottish rural hospital. Interview questions were developed from the wider literature. Data were analysed using an inductive, thematic approach. RESULTS: Four themes were identified from interviews with 10 trainees. First, rural surgical training is a unique and valuable learning experience, ideal for early surgical training, offering useful experiences for personal and professional growth. Second, rural training is a positive and personalised experience: a community experience both within and outside the hospital. Third, rural training is an opportunity to gain a broad understanding of healthcare delivery, and the impact of context on healthcare delivery. Fourth, there was a perceived misalignment between rural surgical training and core training requirements, and a view that rural training was not for everyone. CONCLUSION: Rural surgical attachments in Scotland are high-quality educational experiences which effectively facilitate the development of both technical and non-technical skills and deliver self-learning as well as an understanding of the wider context of surgical care delivery. These placements integrate well into many surgical careers and their uniqueness could be better recognised in the training system.