Medical Student Participation in Family Medicine Department Extracurricular Experiences and Choosing to Become a Family Physician

摘要

Background and Objectives: Many factors influence a medical student’s decision to choose a family medicine career. The impact of participation in extracurricular programs sponsored by family medicine departments is currently unclear. Medical student participation in four University of Washington Department of Family Medicine-sponsored programs (Community Health Advancement Program, Family Medicine Interest Group, Rural Underserved Opportunity Program, and the Underserved Pathway) could be associated with becoming a family physician.Methods: Demographic data, results from a matriculation career interest survey, records indicating participation in the four extracurricular programs, and Match lists showing the specialty of each graduate were linked. Based on responses to the matriculation survey, graduates were categorized into four levels of initial family medicine interest. Chi-square tests compared both demographic data with initial family medicine interest levels and initial family medicine interest levels with program participation. For residency-matched graduates, odds ratios of matching to family medicine versus other specialties for specific family medicine programs and number of programs were calculated, controlling for demographic variables and initial family medicine interest levels.Results: Older age, female graduates, a rural upbringing, and high level of initial family medicine interest were independently and significantly associated with choosing family medicine. Participation in the Family Medicine Interest Group (OR 2.45) and the Underserved Pathway (OR 4.37) and two or more family medicine programs (OR 2.01–2.22) was significantly associated with entering family medicine.Conclusions: Certain demographic factors and high initial interest in family medicine is associated with entering the specialty. Some, but not all, family medicine department-sponsored extracurricular programs were associated with choosing family medicine.(Fam Med 2015;47(10):763-9.)The paucity of family physicians in the United States is well documented and has significant impacts on the health of individuals residing in this country.1 At the same time, medical student career decision-making is multifactorial and includes students’ individual attributes, their exposure to different experiences in medical school, and external societal factors that are difficult to measure, such as lifestyle and specialty reimbursement.2,3 Once admitted to medical school, however, all students will have a variety of experiences that influence the specialty they choose; some are within the formal curriculum, and some are outside of it. And, although public medical schools produce more family physicians compared to private medical schools, a recent study suggests that medical school attributes and culture toward primary care account for less than 10% of the variability in graduate primary care career choice.4Required formal curricula such as primary care or family medicine clerkships are a consistent predictor associated with primary care specialty choice.3 Further, various interventions designed to address aspects of the formal curriculum are associated with increasing the number of students choosing family medicine. The most successful of these curricular interventions are comprehensive programs designed to encourage students to enter rural or urban underserved careers implemented in both public and private medical schools.5,6In addition to the formal curriculum and general culture, medical schools and family medicine departments offer a variety of extracurricular experiences; these may also impact specialty choice.7Some of these extracurricular experiences may be designed to explicitly expose students to family medicine as a career, such as Family Medicine Interest Groups. Other offerings may include preclinical summer experiences to expose students to family medicine or various types of service learning opportunities, both local and global.8,9 Family medicine d