The effects of medical school curricula, faculty role models, and biomedical research support on choice of generalist physician careers

Abstract

The authors evaluated and reviewed the literature on the effects of medical school curricula, faculty role models, and federal biomedical research support on the specialty choices of U.S. medical students. All 275 articles on these subjects published from 1984 through 1993 were considered. An instrument was developed to assess the quality of the articles. A total of 85 articles met study criteria and were reviewed. The mean score achieved was 42.7% of the total possible points. Major educational reforms emphasizing primary care have resulted in significant increases in the percentages of graduates choosing generalist careers. Except for required clinical training in family practice, individual curriculum components have generally not been successful. Students and physicians often stated that faculty role models influenced specialty choices, and there is some evidence that faculty composition is related to students' career choices. There was a consistent inverse correlation between the amount of federal biomedical research support received and the percentage of a school's graduates choosing generalist careers. It is unknown whether this relationship is causative and, if so, how research funds affect specialty choices. The best strategies to enlarge the proportion of medical students choosing generalist careers include institutional reform to emphasize generalist training, increasing the size of generalist faculty, and requiring clinical training in family practice. The relationship of federal biomedical research support to the specialty choices of medical students needs to be studied further. Research on specialty choice could be improved by including a larger number of schools and students, studying trends over several years, and using validated measures and outcomes, control groups, and multivariate analyses.(ABSTRACT TRUNCATED AT 250 WORDS)

The International Health Program: the fifteen-year experience with Yale University's Internal Medicine Residency Program.

“…7,8 However, while individual factors may be the most powerful influences, studies have indicated that certain experiences during training can complement these inherent characteristics regarding career choices. [9][10][11][12][13] In assessing the pre-existing characteristics of our study cohort, we found that participants not only had a great deal of non-academic international experience prior to residency, they chose Yale for training in part because of its international elective program. Moreover, residents stated that cross-cultural experience and a desire to serve a less privileged population were the most important, not the most frequent, reasons for participation.…”

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

“…Three other literature reviews have examined primary care specialty choice and have reached similar conclusions (Appendix 1), [11][12][13] but were also limited to North American studies. Since Bland and colleagues' comprehensive review, medical schools around the world have developed new initiatives in recognition of the need to increase students' exposure to primary care.…”

Factors Related to the Choice of Family Medicine: A Reassessment and Literature Review

“…Bland et al 9 and Meurer 10 covered most factors related to specialty choice. The review by Campos-Outcalt et al 11 was limited to just 3 areas, curricula, role models and school funding. 10 The conclusions of these 3 reviews, which included research published through 1993, serve as the starting point for this one, which critically reviews the literature published since 1993 on the choice of family medicine as a specialty.…”