Medical students' specialty choice and the need for primary care. Our future

Perspective: Creating the next generation of general internists: a call for medical education reform

The United States is faced with an increasing shortage of physicians in the primary care workforce. The number of medical school graduates selecting careers in primary care internal medicine has fallen dramatically since 1985. Although political, financial, and organizational reform of the medical system is necessary, these changes will address only part of the problem. Endeavors designed to ameliorate this current crisis in primary care practice must also address the education and training of future primary care internists. Learners require specialized training in primary care internal medicine to be able to provide high-quality, patient-centered, outcome-oriented care. This article examines the impact of educational interventions in undergraduate medical education (UME) and graduate medical education (GME) on primary care internal medicine career choice and makes suggestions for future educational changes. Suggested UME changes include providing early longitudinal clinical experiences and providing the option for an integrated ambulatory third year of training. Suggested GME changes include early, sustained exposure to general internal medicine and differentiated training tracks for residents interested in primary care. Key among these changes are that medical students and residents must have adequate mentorship from primary care internists and clinical experiences in highly functioning primary care settings established as patient-centered medical homes. Academic centers have a unique opportunity to contribute to these imperatives by reengineering the practice of primary care in a way that embodies the core values of effective, patient-centered care.

The influence of longitudinal mentoring on medical student selection of primary care residencies

BACKGROUND

The number of students selecting careers in primary care has declined by 41% in the last decade, resulting in anticipated shortages.

METHODS

First-year medical students interested in primary care were paired with primary care mentors. Mentors were trained, and mentors and students participated in focus groups at the end of each academic year. Quantitative and qualitative results are presented.

RESULTS

Students who remained in the mentoring program matched to primary care programs at 87.5% in the first year and 78.9% in the second year, compared to overall discipline-specific match rates of 55.8% and 35.9% respectively. Students reported a better understanding of primary care and appreciated a relationship with a mentor.

CONCLUSIONS

A longitudinal mentoring program can effectively support student interest in primary care if it focuses on the needs of the students and is supportive of the mentors.

Changes in U.S. medical students' specialty interests over the course of medical school

BACKGROUND

Studies have examined factors affecting medical students' specialty choice, but little research exists on stability of these specialty interests.

OBJECTIVE

To describe patterns of change in specialty interests during medical school and examine associations between specialty change patterns and gender, desire for a high-prestige career, and interest in prevention.

DESIGN

Medical students (Class of 2003) at 15 representative US schools were invited to complete surveys during freshman orientation, entry to wards, and senior year.

PARTICIPANTS

This analysis used data from 942 students who completed all 3 surveys.

MEASUREMENTS

In addition to a number of other items, students were asked to choose the 1 specialty they were most interested in pursuing.

RESULTS

The most common specialty choices among freshman students were pediatrics (20%) and surgery (18%); least common choices were psychiatry and preventive medicine (1% each). General internal medicine was the initial specialty choice for 8%. Most students changed their specialty choices, regardless of initial interest. Only 30% of those initially interested in primary care (PC) remained interested at all 3 time points, compared to 68% of those initially interested in non-PC. Female versus male students were more commonly interested in PC at all 3 time points. Senior students interested in non-PC specialties were more likely to desire a high-prestige career (48%) than those interested in PC (31%).

CONCLUSIONS

Medical students may benefit from more intensive introduction to some specialties earlier in pre-medical and medical education. In addition, increasing the prestige of PC fields may shape the physician workforce.

What is medicine and what is a doctor? Medical students' perceptions and expectations of their academic and professional career

BACKGROUND

Research was conducted at the University of Cape Town in South Africa where a new medical curriculum was introduced in 2002. This curriculum is largely problem-based and primary health care (PHC) driven.

AIM

To qualitatively explore medical students' perceptions of medicine and doctors and their expectations of studying medicine and practising as a doctor.

METHODS

A questionnaire was administered to all first-year students (n = 193) that assessed their perceptions of doctors, and their expectations of studying medicine and practising as a doctor. Interviews and focus groups were conducted with purposively selected first-, second-, third- and fourth-year students.

RESULTS

Medical students at the University of Cape Town were found to have generally positive perceptions of medicine and doctors, and depicted the medical profession as one that is very significant because of its influence within society, to the point of being perceived as almost noble. Some of the more challenging and difficult aspects of a career in medicine were mentioned, but these seem to be minor compared to the positive aspects. Some students regarded the medical profession as having a biomedical and curative emphasis, although there seemed to be a strong move towards a more holistic view. However, students expected their degree to concentrate on the biomedical aspects of medicine, and therefore did not expect particular components of their degree, such as the psychosocial component.

CONCLUSIONS

Unmet expectations regarding their curriculum seem to be a very significant issue for students. It is therefore important for educators who deliver the curriculum to be aware of and to understand medical students' perceptions and expectations of medicine and doctors, in order to detect and deal with conflict between these perceptions and expectations and what may be an educational institution's 'hidden curriculum'.

Psychosocial beliefs of medical students planning to specialize in family medicine

The psychosocial orientation of fourth-year medical students planning careers in family medicine was compared to those selecting other specialties using the Physician Belief Scale. This scale has shown that practicing family physicians have a greater psychosocial orientation than those in other specialties such as internal medicine. The current study was done to see whether students choosing family medicine already have this greater orientation before they begin training as residents. 664 fourth-year medical students received surveys during their senior year and 378 (57%) returned completed surveys. Female students had a significantly greater psychosocial orientation than their male peers, but there were no significant differences between students planning residencies in family medicine and those selecting other residencies. The greater orientation of family doctors would appear to be a product of further training and experience either during residency or later during the actual practice of family medicine.