THE STATE OF THE LITERATURE ON PRIMARY-CARE SPECIALTY CHOICE - WHERE DO WE GO FROM HERE

A large body of research on medical students' choice of primary care s pecialties has been published. However, the literature is difficult to interpret because of multiple biases, design weaknesses, small number s of subjects, inconsistencies in both dependent and independent varia bles, and conflicting results. These weaknesses have been noted by aut hors who have reviewed the work in this area, but the authors have giv en little direction for ways to improve and build upon the current sta te of the literature. This paper provides a quantitative description o f the content of the specialty choice literature. As part of a larger project that included an exhaustive literature analysis, all research on primary care specialty choice published between 1987 and 1993 was c ollected and summarized according to study questions, designs, data so urces, samples, theory, and outcome variables. Portions of this inform ation were used to rate the quality of each study, yielding a score fr om zero to 100 that indicated the trustworthiness of the study's concl usions. Overall, the studies examined were found to use predominantly cross-sectional designs and to lack theoretical basis. Special curricu lar tracks, student personality, and self-reported influences were the most frequently studied determinants of primary care specialty choice s. The results confirm previous qualitative descriptions of the state of the literature on specialty choice, and lead to recommendations for approaches to improve the quality of further work in this area. The r esearch agenda that emerged from the larger project is also presented.