BIMODAL MEDICAL-SCHOOLS - EXCELLING IN RESEARCH AND PRIMARY-CARE

The authors studied four ''bimodal'' medical schools-those ranked in t he top 20% by the Association of American Medical Colleges both in pro duction of primary care physicians and in receiving research grants fr om the National Institutes of Health. A descriptive, anthropologic met hod was used to describe the cultures of these schools and to determin e common factors in their success. The four schools are at the Univers ity of Washington, the University of North Carolina, the University of California, San Francisco, and the University of California, San Dieg o. These common factors ranged from characteristics of the schools to characteristics of their external environments. All four are part of l arge, state-supported universities. They are relatively new schools in areas of the country that have blossomed in biotechnology, aerospace, and computer industries. The schools' missions, admission committees, and educational programs reflect their dual role: to meet the health care needs of their states and to advance basic science knowledge in m edicine. Each state has a strong Academy of Family Practice, and the m edical schools have been in the forefront of residency training in thi s specialty. Federal- and state-funded Area Health Education Centers a nd private foundations have provided seed money for educational progra ms in community and rural settings that attract medical students to pr imary care. Research-intensive medical school can encourage students t o enter primary care specialties if they have strong primary care lead ers and programs and if they support medical education programs outsid e the academic, tertiary-care center. A culture of mutual respect and commitment to community service is also essential to achieving this bi modal success.