FREQUENCY AND EFFECT OF NEGATIVE COMMENTS (BADMOUTHING) ON MEDICAL-STUDENTS CAREER CHOICES

Background. Some call it ''medical bigotry,'' and others describe it a s the ''hidden curriculum,'' but, by any name, the superficial and dem eaning comments that students hear about particular career choices are thought to play a major role in discouraging the selection of primary care careers. This paper explores the frequency and effect of ''badmo uthing'' on career choice with the hypothesis that it is more frequent ly heard about primary care disciplines but has relatively little infl uence on actual career choice. Method. In 1993, 129 (79%) of the 163 U niversity of Washington School of Medicine graduates responded to a tw o-page questionnaire about badmouthing. This information was used to r efine the questionnaire. In 1994, 1,447 graduating students from nine medical schools were surveyed with the revised questionnaire. The scho ols were chosen to represent schools that had high, medium, and low pr oportions of students going into primary care careers. Results. A tota l of 1,114 questionnaires were returned, for a response rate of 77%. B admouthing was heard frequently (76% of the responding students) and o ften occurred as early as the first and second years of medical school . The students heard badmouthing about their career choices most frequ ently when they selected surgery (91%) and family medicine (87%) and l east frequently when they chose pediatrics (57%), p<.001. The students reported that the influence on career choice was low in general, but 186 students (17% of all respondents) did report altering their choice s based on badmouthing. Conclusion. Primary care fields and non-primar y care fields were equally affected by career changes due to badmouthi ng. This study indicates that badmouthing, while pervasive across all disciplines and an unattractive aspect of the educational experience, cannot alone account for the low proportion of graduates choosing prim ary care careers.