GENERAL INTERNISTS INFLUENCE STUDENTS TO CHOOSE PRIMARY-CARE CAREERS - THE POWER OF ROLE MODELING

PURPOSE: TO determine whether medical students supervised by general i nternist attendings during the third-year medicine clerkship are more likely to choose primary care careers than students supervised by subs pecialist attendings. METHODS: One hundred forty-four consecutive medi cal students rotating on the general medicine inpatient service during the 1993-1994 academic year were surveyed about their career choice a nd professional expectations, both at the beginning and end of the cle rkship; an additional 50 students completed a post-clerkship survey on ly. The cohort of students was surveyed at graduation to determine sta bility of their career preferences. RESULTS: Both pre- and post-clerks hip surveys were completed by 138 of 144 students (96%); post-clerkshi p surveys were completed by 181/194 (93%); and graduation surveys were completed by 137/188 (73%). Fifty-eight students (32%) designated pri mary care (general internal medicine, general pediatrics, or family pr actice) as their career choice post-clerkship; of these, 45 students ( 78%) also indicated a primary care career choice at graduation. Charac teristics associated with choosing primary care post-clerkship were: l ow income expectation, desire to interact closely with patients, desir e to contribute to society, low class rank, female gender, and high ed ucational debt. Having a physician parent was negatively associated wi th choosing primary care. After controlling for important demographic, academic and attitudinal characteristics, increasing exposure to a ge neral internist attending was associated with choosing primary care (O R = 5.1, comparing highest to lowest amount). Among students choosing primary care, exposure to a general internist attending was associated with choosing general internal medicine in a dose-dependent fashion ( OR = 4.2, comparing highest to lowest amount). CONCLUSIONS: Although c areer choice is clearly related to personal characteristics such as so cioeconomic background and humanistic qualities, a high degree of expo sure to general internists during the medicine clerkship is associated with choosing primary care. Exposure of students interested in primar y care to general internist attendings may also influence them to cons ider general internal medicine over family practice and pediatrics. (C ) 1996 by Excerpta Medica, Inc.