Institutional Characteristics Influencing Medical Student Selection of Primary Care Careers: A Narrative Review and Synthesis

Abstract

Background and Objectives: There is an ongoing shortage of primary care physicians in the United States. Medical schools are under pressure to address this threat to the nation’s health by producing more primary care graduates, including family physicians. Our objective was to identify institutional characteristics associated with more medical students choosing primary care. Methods: We conducted a systematic literature review with narrative synthesis to identify medical school characteristics associated with increased numbers or proportions of primary care graduates. We included peer-reviewed, published research from the United States, Canada, Australia, and New Zealand. The existing literature on characteristics, including institutional geography, funding and governance, mission, and research emphasis, was analyzed and synthesized into summary statements. Results: Ensuring a strong standing of the specialty of family medicine and creating an atmosphere of acceptance of the pursuit of primary care as a career are likely to increase an institution’s percentage of medical students entering primary care. Training on regional campuses or providing primary care experiences in rural settings also correlates with a larger percentage of graduates entering primary care. A research-intensive culture is inversely correlated with primary care physician production among private, but not public, institutions. The literature on institutional financial incentives is not of high enough quality to make a firm statement about influence on specialty choice. Conclusions: To produce more primary care providers, medical schools must create an environment where primary care is supported as a career choice. Medical schools should also consider educational models that incorporate regional campuses or rural educational settings.

Implementing Public Health Modules as an Approach to Improve Knowledge and Attitudes of Medical Students: A Student-Led, Multiyear Study

“…For example, it would be valuable to identify if students engaged in more public health research or advocacy, or matched into primary care specialties. Whether our intervention affected these outcomes is unknown; to our knowledge, few interventions have been demonstrated to be effective at impacting career choice 30–36 . Further studies should focus on the impact of medical education interventions on long-term behavioral change rather than focusing on attitudinal changes.…”

“…Whether our intervention affected these outcomes is unknown; to our knowledge, few interventions have been demonstrated to be effective at impacting career choice. [30][31][32][33][34][35][36] Further studies should focus on the impact of medical education interventions on long-term behavioral change rather than focusing on attitudinal changes.…”

Revitalizing General Practice: The Critical Role of Medical Schools in Addressing the Primary Care Physician Shortage

“…To provide more primary care providers, medical schools must create an environment in which primary care is supported as a career choice. Medical schools should also consider educational models that incorporate regional campuses and rural educational settings [ 13 ]. The slow pace of change in curricula at many public medical universities can be attributed to a variety of factors, including complex bureaucratic processes and lengthy approval procedures that public universities often face, as these can hinder the implementation of systemic approaches in medical education [ 7 ].…”

“…To address the personnel shortage in general practice, existing state medical schools must undertake a comprehensive modernization of their curricula [ 13 ]. This entails the incorporation of general-practice content and experience throughout the educational program, with an emphasis on community-based and primary care settings.…”

Psychometric evaluation of the Chinese version of Self-assessment scale for the community- based and emergency practice among medical students

“…Medical schools are constantly de ning the skills and knowledge required of students to ensure that graduates are adequately prepared for work. [19,20] Its focus is on developing clinical practice skills of medical students to provide for the development of the manpower needed for primary care. The provision of planned community healthcare services is an ideal way to improve the capacity and effectiveness of primary care physician services, as well as the basis for implementing universal health coverage.…”