The effect of medical education on primary care orientation: Results of two national surveys of students' and residents' perspectives

Purpose. To examine changes among a nationally representative sample of stu dents and residents in their orientations toward primary care as reflected in their attitudes toward the psychosocial and technical aspects of medicin e and their perceptions of the academic environment fur primary care. Method. Confidential telephone interviews of stratified national probabilit y samples of first- and fourth-year medical students and residents were con ducted in 1994 and 1997. The 1997 survey included 219 students and 241 resi dents who had also been interviewed in 1994. Participants were asked about their attitudes toward addressing psychosocial issues in medicine and their perceptions of faculty and peer attitudes toward primary care. Responses w ere compared over time and across groups. Results. Between the first and fourth years of medical school, there was a decline over time in students' reported orientations to socioemotional aspe cts of patient care (61.6% versus 42.7%, p = .001) and their perceptions th at working with psychosocial issues of patients made primary care more attr active (56.3% versus 43.5%, p = .01). This pattern continued for 1997 resid ents (PGY-3), who were even less likely to say that addressing psychosocial issues made primary care more attractive (26.9%). For fourth-year students in 1994 who became PGY-3 residents in 1997, there was an increased percept ion that non-primary-care house officers and specialty faculty had positive attitudes toward primary care (20.8% versus 33.0%, p = .005; 28.3% versus 45.7%, p < .0001; respectively). Conclusions. Between 1994 and 1997 students and residents perceived a posit ive shift in the attitudes of peers and faculty toward primary care. During the course of their education and training, however, the students experien ced an erosion of their orientations to primary care as they progressed thr ough medical school into residency.