The Relationship Between a Statewide Preceptorship Program and Family Medicine Residency Selection

摘要

id="p1">Objective: The purpose of this study was to investigate the extent to which participation in the California Academy of Family Physicians Foundation Family Medicine (FM) Preceptorship Program, as well as medical school, degree earned, gender, and match year predicted FM residency match. id="p-2">Methods: Allopathic and osteopathic students who applied to the preceptorship program from 1996 to 2002 were followed until residency match. Chi-square (χ2) analysis was used to compare preceptorship participants, nonparticipants (students who applied but did not complete the preceptorship), and nonapplicants (students who did not apply to the preceptorship) for FM match rates and to compare participants to nonparticipants for primary care match rates. FM match data for California schools from 1999 to 2005 were used to perform a logistic regression predicting FM match. id="p-3">Results: Twenty-four percent of participants matched into FM residency programs whereas only 13% of nonparticipants and 13% of nonapplicants selected FM (χ2 = 24.97; P .001). There was not a statistically significant difference between the proportion of participants and nonparticipants who matched into primary care (χ2 = 0.12; P = .73). Odds ratio results of logistic regression for participants compared with nonapplicants matching into FM was 2.7 (95% CI, 2.0–3.6; P .001). id="p-4">Conclusion: Preceptorship program participants were more likely than both nonparticipants and nonapplicants to select a FM residency. id="p-5">Family physicians are important sources for primary care, yet the percentage of US allopathic and osteopathic graduates selecting a residency in family medicine (FM) has declined each year from 1998 to 2007.id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1id="xref-ref-2-1" class="xref-bibr" href="#ref-2">,2 In addition, more internal medicine and pediatric residents are selecting subspecialty residencies.id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1id="xref-ref-3-1" class="xref-bibr" href="#ref-3">,3 According to the US Department of Health and Human Services Health Resources and Services Administration and the US Government Accountability Office, the supply of primary care physicians in general, and FM physicians in particular, may be inadequate to meet future needs.id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4id="xref-ref-5-1" class="xref-bibr" href="#ref-5">,5 id="p-6">Programs designed to increase medical students’ interest in primary care may help address this concern. One strategy to boost primary care selection among medical students is based on the premise that early primary care exposure improves the likelihood that students will choose a primary care specialty. To ensure consistent provision of this early exposure, the state of California mandated in 1999 that all allopathic and osteopathic students participate in a 4-week FM clinical core clerkship to be eligible for a physician's and surgeon's license.id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6 Before this mandate, in 1993, the California Academy of Family Physicians Foundation (CAFP-F) established a statewide 4-week preceptorship program for California allopathic and osteopathic students between their first and second years of medical school; the goal of this preceptorship was to increase exposure to a FM career. Other states, including Washington, Tennessee, Texas, Ohio, Minnesota, and Iowa, also offered primary care-related externship/fellowship/preceptorship programs through their medical schools.id="xref-ref-7-1" class="xref-bibr" href="#ref-7">7–12 Although each had a similar goal of influencing student specialty career choice, there was considerable variation in program design, duration, and financing. id="p-7">Preceptorships offer students the experience of shadowing a preceptor, providing opportunities to learn aspects of medicine not available in traditional didactic and school-based environments. To both encourage participation and recognize the time commitment, most preceptorship programs, including the one through CAFP-F, provide stipends to students.id="xref-ref-7-2" class="xref-bibr" href="#ref-7">7id="xref-ref-9-1" class="xref-bibr" href="#ref-9">,9id="xref-ref-11-1" class="xref-bibr" href="#ref-11">,11id="xref-ref-13-1" class="xref-bibr" href="#ref-13">,13 Among the programs examined, the preceptorship duration varied from 3 weeks to 9 months, with a mode of 4 weeks.id="xref-ref-7-3" class="xref-bibr" href="#ref-7">7–13 Most preceptorship programs noted above required a competitive application process; however, participation in the University of Iowa's program was compulsory and the Universit