THE EFFECT OF AN AMBULATORY INTERNAL-MEDICINE ROTATION ON STUDENTS CAREER CHOICES

Purpose. To assess the effect of an ambulatory care experience on medi cal students' perceptions of internal medicine and their choices of ca reers (as measured by residency selections). Method. In 1990-91, the 1 96 third-year-students enrolled in the 12-week internal medicine clerk ship at the University of Texas Medical School at San Antonio were ran domized to a curriculum that included a three-week ambulatory care com ponent or to a traditional, exclusively inpatient curriculum. The ambu latory curriculum included the evaluation of walk-in-patients, exposur e to community internists, and a lecture series. The students' percept ions of internal medicine were surveyed before and after the clerkship . Their career choices were determined by their residency selections a t graduation. Data analysis employed chi-square tests, t-tests, and lo gistic regression. Results. Of the 196 students, 184 (76 in the ambula tory and 108 in the traditional curricula) provided complete data. The ambulatory care students were somewhat more likely to enter an intern al medicine residency (odds ratio = 1.49; 95% CI, 0.72 to 3.09) than w ere the traditional students. The ambulatory care students' perception s of internal medicine did not change significantly from before to aft er the clerkship. Conclusion. The ambulatory curriculum had a modest b ut favorable effect on the students' selections of careers in internal medicine, but was not associated with changes in their perceptions of internal medicine.