Rural Medicine

Faculty Director: Bill Alto, M.D., M.P.H.


The Swedish Family Medicine Residency Program Cherry Hill has a long history of training physicians to practice in underserved communities, including rural practice. We have trained physicians for rural practices, particularly working in American Indian, Alaskan Native, and Spanish speaking communities. Family Medicine practice in a rural area requires more experience in hospital and office procedures, acute care, as well as proficiency in culturally-competent, patient-oriented primary care. In order to improve access to these underserved populations we offer an Area of Concentration to specifically prepare physicians for the challenges and rewards of rural practice.



The Rural Medicine Track is designed to provide motivated residents opportunities in:

  1. Immersion experience in a rural Indian Health Service (IHS) practice.
  2. Increased exposure in trauma and emergency medicine.
  3. Increased proficiency in acute hospital care.
  4. Additional sports/musculoskeletal medicine training.
  5. Learning more about the specific cultural, socio-economic, political and practical issues around delivering health care in a rural setting.
  6. Learn about assessing the needs of a rural community and enacting change in a practice or community based setting.


Application Requirements

Residents will be selected based on their past demonstrated interest in rural medicine and the likelihood that they will use the skills acquired in their future practice. Residents must complete a short essay explaining their interest in rural medicine and meet the following requirements in order to be considered:

  1. Must be in good standing.
  2. Must be on track to graduate with adequate outpatient clinic visits and obstetrical continuity deliveries.
  3. Must be recommended by their faculty advisor as a resident who could manage the extra workload without negatively affecting their core family medicine training.



In order to successfully complete the AOC-RM residents must:

  1. Complete an immersion rural rotation at an approved IHS in their 3rd year.
  2. Complete and graduate certified in ATLS in addition to the required certifications of ACLS, PALS, NRP and ALSO.
  3. Complete required ER rotation at Harborview Medical Center on the Trauma Team.
  4. Complete additional training in musculoskeletal medicine.
  5. Complete ICU rotation.
  6. Complete an elective in a surgical field.
  7. Prepare and present a final project in rural medicine.


Rural Rotation

Participants will complete at least one rural rotation at an approved IHS facility after becoming fully licensed in Washington state in there 3rd year. The site will be based on the resident's academic interests (Rural OB vs. emergency medicine) and their interests in future practice opportunities. The faculty director of the AOC-RM is responsible for final approval of the rotation site. On return from the rural rotation, residents will report to the Residency in didactics on one aspect of the rural experience. This can be case-based discussion, a presentation of a medical topic particular to rural medicine, or a presentation of the social/cultural aspect of practicing medicine at the rotation site.



In addition to the currently required certifications, participants will complete the certification in ATLS during there 3rd year using their CME resources.


Emergency Medicine

In the 2nd year ER rotation, participants will rotate through Harborview Medical Center on the trauma team. Objectives are to place central lines and chest tubes, respond with the trauma team, and manage fractures and lacerations.


Musculoskeletal Medicine

In order to expand on the current musculoskeletal training the AOC-RM requires either an additional elective in orthopedics/sports medicine, a minimum of one season of athletic team coverage, or one season of ski first aid.


ICU Elective

In either the 2nd or 3rd year of residency, participants will complete an elective in the Swedish ICU with the hospitalist and Pulmonary Medicine / Intensivist Team.


Surgical Elective

In addition to the required OB, general surgery and orthopedic rotations, the AOC-RM requires an additional surgical elective of the resident's choice. The intention is to enhance procedural and OR skills in order to be a competent primary physician in outpatient procedures and a competent assistant to OR-based surgeries.


Final Project

The final project for the AOC-RM may be combined with a community medicine project or the away rotation presentation. It may be on any subject regarding the delivery of heath care in a rural community including needs assessments, public health interventions, independent study in procedure techniques, or political advocacy projects for rural communities. Final projects will be presented during didactics as part of the residents normally required presentations. A written outline or PowerPoint slides will be submitted to the faculty director.


Other Suggestions

The above represent the minimum requirements for preparation for rural practice. Family Medicine practice in a rural community is a diverse field that is influenced strongly by the community’s needs and the physician’s interests. In addition to the above curriculum, the following suggestions for further training are recommended:

  1. Attend a conference in wilderness medicine.
  2. Complete advanced training in an outpatient procedure such as colposcopy, flexible sigmoidoscopy, colonoscopy, vasectomy, Obstetrical Ultrasound, or Derm-surgery/Plastics.
  3. Participate in rural medicine advocacy through the Washington Academy of Family Medicine or other medical organization.
  4. Complete an anesthesia elective.
  5. Maximized OB experience in residency training by attending all continuity deliveries and scrubbing in as an assistant on your clinic’s continuity-panel cesarean sections.
  6. Cover extra shifts at Children's ER if available.