Medical School Characteristics, Policies, and Practices That Support Primary Care Specialty Choice: A Scoping Review of 5 Decades of Research

Abstract

Background and Objectives: The United States, like many other nations, faces a chronic shortage of primary care physicians. The purpose of this scoping review was to synthesize literature describing evidence-based institutional practices and interventions that support medical students’ choices of primary care specialties, published in the United States, Canada, Australia, and New Zealand. Methods: We surveyed peer-reviewed, published research. An experienced medical librarian conducted searches of multiple databases. Articles were selected for inclusion based on explicit criteria. We charted articles by topic, methodology, year of publication, journal, country of origin, and presence or absence of funding. We then scored included articles for quality. Finally, we defined and described six common stages of development of institutional interventions. Results: We reviewed 8,083 articles and identified 199 articles meeting inclusion criteria and 41 related articles. As a group, studies were of low quality, but improved over time. Most were quantitative studies conducted in the United States. Many studies utilized one of four common methodologic approaches: retrospective surveys, studies of programs or curricula, large-scale multi-institution comparisons, and single-institution exemplars. Most studies developed groundwork or examined effectiveness or impact, with few studies of planning or piloting. Few studies examined state or regional workforce outcomes. Conclusions: Research examining medical school interventions and institutional practices to support primary care specialty choice would benefit from stronger theoretical grounding, greater investment in planning and piloting, consistent use of language, more qualitative methods, and innovative approaches. Robust funding mechanisms are needed to advance these goals.

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.…”

Preliminary Workforce Outcomes of an Urban Longitudinal Integrated Clerkship

“…Curricular innovations show promise for increasing student engagement with urban underserved populations as manifested by their stated interest in working with these populations in the future. [4][5][6][7][8] Our literature review uncovered few studies reporting longterm outcomes of educational innovations designed to address workforce outcomes for urban underserved populations, [9][10][11] none of which examined the impact of longitudinal integrated clerkships (LICs) to serve this need.…”