Does community-based experience alter career preference? New evidence froma prospective longitudinal cohort study of undergraduate medical students

Context Previous studies have shown that most medical students want a hospi tal-based career, but the protagonists of community-based teaching predict that increased community exposure within undergraduate curricula will alter subsequent career preferences. Objectives To evaluate the impact on career preference and other attitudes of a year with substantial community exposure, compared with a year of hosp ital-based learning. Design Questionnaire to student cohort before and after two consecutive lev els of the course, one with, and the other prior to, substantial community placement. Setting Sheffield Medical School. Subjects Total of 260 students in the third and fourth year of the MBChB de gree. Results There were significant differences in career preference and attitud e to primary care after the year with a community placement, with more stud ents expressing a preference for a community-based career. This was particu larly true for women, and less true for non-European students. Conversely, the hospital-based students, especially men, showed a significant change to ward hospital-based careers. Conclusion The findings support the hypothetical advantages of shifting med ical education to primary care settings, both in encouraging a career in ge neral practice and in the retention of appropriate professional attitudes.