Additionally, organizations that focus on health care for rural communities, such as the National Rural Health Association, the small and rural hospitals section of the American Hospital Association, the State Offices of Rural Health, and the federally funded Rural Assistance Center (http://www.raconline.org) could serve as information conduits to help providers acquire the core competencies. Organizations with a quality focus, such as the Institute for Safe Medication Practices, the Institute for Healthcare Improvement, the Agency for Healthcare Research and Quality, and others, could target efforts to rural audiences. As discussed in Chapter 3, QIOs might provide greater technical assistance to rural providers in acquiring quality improvement knowledge and techniques. Lastly, it is important to recognize that educational supports can be provided through distance learning programs. Internet-based educational opportunities for health professionals have expanded greatly in recent years, as has the technology for interactive distance learning. The committee does not view distance education programs as a substitute for community-based experiential training programs, but does think distance education should be explored as a way to help health professionals retain and build upon the core competencies initially acquired through the latter programs (although it should be noted that some state licensure programs limit the use of distance education in satisfying continuing medical education requirements [AMA, 2002]). The committee recognizes that there are advantages and disadvantages to distance learning, but does encourage states and other regulatory bodies to periodically re-evaluate this option as distance education programs and technologies evolve.
The model for achieving greater numbers of rural clinicians is often conceptualized in terms of a pipeline, with each point along the pipeline playing an essential part in achieving the ultimate goal of increasing the size of the rural workforce and its capacity to provide high-quality health care (see Figure 4-1). The points shown in Figure 4-1 can be aggregated into three broad areas: (1) attracting rural students to health careers, (2) providing formal education programs, and (3) recruiting and retraining trained health professionals in rural areas. The IOM committee believes there are opportunities to make improvements in each of these links that will enhance the supply of health professionals in rural areas and to improve their competency in the five core areas discussed above.