MODIFYING THE CULTURE OF MEDICAL-EDUCATION - THE FIRST 3 YEARS OF THERWJ GENERALIST PHYSICIAN INITIATIVE

The Generalist Physician Initiative (GPI) was created by The Robert Wo od Johnson Foundation to help medical schools increase the number of p redoctoral and residency graduates entering generalist careers. The un derlying assumption of the GPI is that more medical graduates will bec ome generalists if schools select candidates whose personal characteri stics are compatible with generalist careers and if schools provide fo r them an educational environment that values generalist careers in th e same manner it has valued specialist careers. In essence, the GPI is helping schools modify the culture in which medical education occurs so that they may increase their production of generalists. Fourteen gr ants for six years of support were made to 16 U.S. medical schools in 1994. These schools are developing institution-wide efforts that span the continuum from the recruitment and selection of students through t heir medical school and residency education to their entry into practi ce, and include support of the practice. Most schools have developed e xternal partners (e.g., state legislatures, managed care organizations , area health education centers) to assist in achieving their goals. T he project is now (1997) at its halfway mark. This article describes t he conceptual bases for the program (e.g., changes in admission criter ia to favor applicants oriented to generalism), identifies common appr oaches to intervention chosen by the participating schools (e.g., esta blishing longitudinal, generalist-oriented clinical experiences throug hout the four years of medical school), and explores issues being face d by the schools as they implement change (e.g., difficulties in decen tralizing clinical education to include community physicians as teache rs and role models).