Impact of a first-year primary care experience on residency choice

Abstract

We designed a retrospective cohort study of first-year medical students to assess the impact of a community-based primary care course, Introduction to Primary Care (IPC), on residency choice. In the group that took IPC (n = 282), 48.2% entered generalist residencies (internal medicine, pediatrics, family medicine, or medicine/pediatrics), compared to 38.2% in the group that wanted IPC (n = 398) and 39.6% in the group that did not want IPC (n = 245). Controlling for gender, students who took IPC had a 40% higher odds of selecting a generalist residency than those who wanted to take IPC (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.04 to 1.95). There was no difference between those who wanted IPC and those who did not (OR, 1.08; CI, 0.78 to 1.52). The community-based primary care experience was positively associated with students' selection of generalist residencies.KEY WORDS: career choice; community-based training.

Characteristics of medical students who would like to be a generalist physician and contribute to remote area medicine

“…These results were supported by previous reports which showed the importance of a primary care experience for medical students to increase and maintain their motivation for remote area medicine (16,17). Therefore, repeated community -based clinical practices since the early exposure education may be important to increase and maintain the motivation for medicine there.…”

Impact of Interventions to Increase the Proportion of Medical Students Choosing a Primary Care Career: A Systematic Review

“…Only two studies reduced selection bias by randomly choosing program participants among interested students. One found a significant association between program participation and residency choice, 49 whereas the other suggested that the effect of preexisting interest was a stronger predictor of specialty choice. 56 One study found an additive effect of a preclinical curriculum and a clinical longitudinal preceptorship on students' choice of primary care specialty.…”

“…Of 21 different programs (described in 26 papers), 15 were primary care courses added to the conventional curriculum. [49][50][51][52][53][55][56][57][58][59][63][64][65][66][68][69][70][71][72] The remaining six programs were special curricula or medical schools focusing on primary care and/or rural health. 47,48,54,[60][61][62] , Contrary to the studies on clerkships, the most frequently studied outcomes of longitudinal programs were career choices after graduation (n=15).…”

“…With one exception, 72 all high quality studies were from the United States, and most of them had a positive impact (Table 3). Components of these programs included longitudinal preclinical preceptorships, 47,49,50 family medicine faculty advisors, 52 clinical rotations at rural or regional sites, 47,48,50,52,54 workshops or seminars on primary care, [48][49][50] and community-based projects. 50 Most of them also recruited students according to predictors of career choice previously described in the literature, including the students' childhood community and interest in primary care.…”

The Impact of the Internal Medicine Sub-internship on Medical Student Career Choice

“…A complex set of factors influences medical students' career decisions including gender, race, indebtedness, temperament, and relationship styles [3][4][5][6] . Although specialty preference upon medical school matriculation predicts ultimate career choice, 7 many medical school experiences, especially during clinical rotations, are also influential [8][9][10] . For example, first-year preceptorships with internal medicine faculty and identification of a primary care role model during medical school are associated with a primary care career choice 11,12 .…”