Context Shortfalls in the US physician workforce are anticipated as the population ages and medical students' interest in careers in internal medicine (IM) has declined (particularly general IM, the primary specialty serving older adults). The factors influencing current students' career choices regarding IM are unclear. Objectives To describe medical students' career decision making regarding IM and to identify modifiable factors related to this decision making. Design, Setting, and Participants Web-based cross-sectional survey of 1177 fourth-year medical students (82% response rate) at 11 US medical schools in spring 2007. Main Outcome Measures Demographics, debt, educational experiences, and number who chose or considered IM careers were measured. Factor analysis was performed to assess influences on career chosen. Logistic regression analysis was conducted to assess independent association of variables with IM career choice. Results Of 1177 respondents, 274 (23.2%) planned careers in IM, including 24 (2.0%) in general IM. Only 228 (19.4%) responded that their core IM clerkship made a career in general IM seem more attractive, whereas 574 (48.8%) responded that it made a career in subspecialty IM more attractive. Three factors influenced career choice regarding IM: educational experiences in IM, the nature of patient care in IM, and lifestyle. Students were more likely to pursue careers in IM if they were male (odds ratio [OR] 1.75; 95% confidence interval [CI], 1.20-2.56), were attending a private school (OR, 1.88; 95% CI, 1.26-2.83), were favorably impressed with their educational experience in IM (OR, 4.57; 95% CI, 3.01-6.93), reported favorable feelings about caring for IM patients (OR, 8.72; 95% CI, 6.03-12.62), or reported a favorable impression of internists' lifestyle (OR, 2.00; 95% CI, 1.39-2.87). Conclusions Medical students valued the teaching during IM clerkships but expressed serious reservations about IM as a career. Students who reported more favorable impressions of the patients cared for by internists, the IM practice environment, and internists' lifestyle were more likely to pursue a career in IM.

OBJECTIVE:To describe the utilization of various methods of language interpretation by Spanish-speaking patients in an academic medical clinic and to determine patients' and physicians' satisfaction with these methods. METHODS:Survey administered to medical residents and Spanish-speaking patients asking about their experience and satisfaction with various methods of language interpretation.MAIN RESULTS: Both patients and residents had the highest level of satisfaction for professional interpreters (92.4% vs 96.1% reporting somewhat or very satisfactory, p ‫؍‬ .17). In contrast, patients were significantly more satisfied than residents with using family members and friends (85.1% vs 60.8%, p Ͻ .01). Physicians and patients agreed that accuracy, accessibility, and respect for confidentiality were highly important characteristics of interpreters ( Ͼ 90% of both groups reporting somewhat or very important). However, patients were more concerned than residents about the ability of the interpreter to assist them after the physician visit (94% vs 45.1%, p Ͻ 0.01). CONCLUSIONS:Using family members and friends as interpreters for Spanish-speaking patients should be more seriously considered; however, in order to optimize patient satisfaction, differences between patients and providers should be taken into account when using interpretation in medical settings.

Bedside teachers encountered primarily systems- and time-related barriers and overcame resident apprehensions by creating a learner-oriented environment. Strategies used by experienced bedside teachers can be used for faculty development aimed at promoting bedside rounds.