THE EFFECTS OF MEDICAL-SCHOOL CURRICULA, FACULTY ROLE MODELS, AND BIOMEDICAL-RESEARCH SUPPORT ON CHOICE OF GENERALIST PHYSICIAN CAREERS - AREVIEW AND ANALITY ASSESSMENT OF THE LITERATURE

The authors evaluated and reviewed the literature on the effects of me dical school curricula, faculty role models, and federal biomedical re search support on the specialty choices of U.S. medical students. All 275 articles on these subjects published from 1984 through 1993 were c onsidered. An instrument was developed to assess the quality of the ar ticles. A total of 85 articles met study criteria and were reviewed. T he mean score achieved was 42.7% of the total possible points. Major e ducational reforms emphasizing primary care have resulted in significa nt increases in the percentages of graduates choosing generalist caree rs. Except for required clinical training in family practice, individu al curriculum components have generally not been successful. Students and physicians often stated that faculty role models influenced specia lty choices, and there is some evidence that faculty composition is re lated to students' career choices, There was a consistent inverse corr elation between the amount of federal biomedical research support rece ived and the percentage of a school's graduates choosing generalist ca reers. It is unknown whether this relationship is causative and, if so , how research funds affect specialty choices. The best strategies to enlarge the proportion of medical students choosing generalist careers include institutional reform to emphasize generalist training, increa sing the size of generalist faculty, and requiring clinical training i n family practice. The relationship of federal biomedical research sup port to the specialty choices of medical students needs to be studied further. Research on specialty choice could be improved by including a larger number of schools and students, studying trends over several y ears, and using validated measures and outcomes, control groups, and m ultivariate analyses. A reliable source of extramural funding and a pe er review process for ranking proposals are needed to increase the qua ntity and quality of medical education research.