Acad Med 1994 Oct;69(10):825-31, Medical school admission and generalist physicians: a study of the class of 1985. Madison DL Department of Social Medicine, University of North Carolina, Chapel Hill School of Medicine, 27599-7240.
A high service index (reflective of a demonstrated orientation toward community service prior to medical school matriculation) predicted strongly the choice of a generalist medical career. Less strong predictors of a generalist practice included the selection of a generous number of non-science-content courses as an undergraduate, lower socioeconomic family origin, and a record of leadership in one or more extracurricular activities during college. If an admission committee informs itself of "what finally happens" to those it admits, its decisions can contribute to achieving whatever policy its medical school adopts with respect to the mix of physicians it wishes to produce.
PURPOSE. To examine the medical school applications of physicians who are now
established in their careers to see whether any of the applicants' data might
have had predictive value for the admission process of a medical school wishing
to increase its production of generalist physicians. METHOD. Three members of
the Committee on Admissions of the University of North Carolina at Chapel Hill
School of Medicine followed the same procedure they use when reviewing current
medical school applicants in reading the applications of 148 graduates of the
class of 1985. The readers recorded data from all parts of the American Medical
College Application Service form--face sheet, personal statement, and the record
of course work--and used alumni records and published physician locators to
determine these class members' whereabouts and the specialties (and
subspecialties) they were practicing 13 or 14 years after applying to medical
school. RESULTS. Thirty-four percent of the class had elected generalist medical
careers (the practice of family medicine, general internal medicine, or general
pediatrics). A high service index (reflective of a demonstrated orientation
toward community service prior to medical school matriculation) predicted
strongly the choice of a generalist medical career. Conversely, the absence of
any clear evidence of a service orientation predicted still more strongly a
non-generalist career. Less strong predictors of a generalist practice included
the selection of a generous number of non-science-content courses as an
undergraduate, lower socioeconomic family origin, and a record of leadership in
one or more extracurricular activities during college. CONCLUSION. If an
admission committee informs itself of "what finally happens" to those it admits,
its decisions can contribute to achieving whatever policy its medical school
adopts with respect to the mix of physicians it wishes to produce.
Acad Med 1998 Nov;73(11):1207-10, Associations between primary care-oriented practices in medical school admission and the practice intentions of matriculants. Basco WT Jr, Buchbinder SB, Duggan AK, Wilson MH. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA bascob@musc.edu
In multivariable analyses, premedical recruitment efforts and public school ownership (all p < .01) were associated with greater interest of matriculants in both generalism and rural practice.
PURPOSE: To assess associations of primary-care-oriented medical school admission practices with matriculants practice intentions. METHOD: The authors performed cross-sectional, secondary analyses of databases from the Association of American Medical Colleges (AAMC). The independent variables were four medical school admission practices. The control variable was school ownership (public vs private). The dependent variables were the proportions of matriculants at each school interested in generalism, rural practice, and locating in a socioeconomically deprived area. RESULTS: One hundred and twenty medical schools (95%) completed the AAMC's Survey of Generalist Physician Initiatives in either 1993 or 1994; 94% of matriculants replied to the AAMC's 1994 Matriculating Student Questionnaire. Twenty-five percent of the schools had admission committee chairs who were generalists, half had over 25% generalists on their admission committees, 64% gave admission preference to students likely to become generalists, and 33% reported premedical recruitment efforts that targeted applicants likely to become generalists. In multivariable analyses, premedical recruitment efforts and public school ownership (all p < .01) were associated with greater interest of matriculants in both generalism and rural practice. CONCLUSIONS: Public medical schools and schools with premedical recruitment activities targeting future generalists admitted greater proportions of students interested in primary care and rural practice.
Kassebaum DG, Szenas PL
Specialty intentions of 1995
U.S. medical school graduates and patterns of generalist career choice and
decision making.
Acad Med 1995 Dec;70(12):1152-7, Comment in:
Acad Med. 1996 May;71(5):413-4. Division of Educational Research and
Assessment, Association of American Medical Colleges, Washington, D.C., USA. The
authors report on the specialty intentions that graduating students declared on
the 1995 AAMC Medical School Graduation Questionnaire (GQ) and compare the
pattern of career choices in 1995 with that in 1992. Family practice was the
leading choice of graduates in 1995, followed by internal medicine
subspecialties and general internal medicine. These choices represented
significant gains over those made in these specialties in 1992 and were at the
expense of declines in the interest of 1995 graduates for internal medicine
specialties, radiology, anesthesiology, obstetrics-gynecology subspecialties,
and some other fields. In 1992, 14.6% of graduating students declared plans to
pursue careers in one of the generalist specialties; in 1995, 27.6% declared
such plans. In 1992, no school graduated 50% or more students with generalist
intentions, and only one school reached 40%; in 1995, five schools graduated
more than 50%, and another 15 graduated more than 40% who favored generalist
careers. Medical schools with significant GQ response rates (110 out of 125)
were aggregated by level of generalist production (top 25%, middle 50%, and
bottom 25%) according to the percentages of their 1995 graduates selecting
careers in the individual generalist specialties of family practice, general
internal medicine, and general pediatrics, and in these generalist specialties
in toto. Within these groups, the linking of GQ responses to declarations given
by the same students on the Matriculating Student Questionnaire (MSQ) made it
possible to determine the extent to which graduates' specialty choices
represented early interests that were retained or interests acquired later
during medical school.(ABSTRACT TRUNCATED AT 250 WORDS)
Linzer M, Slavin T, Mutha S, Takayama JI, Branda L, VanEyck S, McMurray JE, Rabinowitz HK. Admission, recruitment, and retention: finding and keeping the generalist-oriented student. SGIM Task Force on Career Choice in Primary Care and Internal Medicine. J Gen Intern Med 1994 Apr;9(4 Suppl 1):S14-23, Department of Medicine, University of Wisconsin School of Medicine, Madison. As the country strives to produce larger numbers of generalist physicians, considerable controversy has arisen over whether or not generalist applicants can be identified, recruited, and influenced to keep a generalist-oriented commitment throughout medical training.
The authors present new and existing data to show that: 1) preadmission (BA/MD or post-baccalaureate) programs can help to identify generalist-oriented students; 2) characteristics determined at admission to medical school are predictive of future generalist career choice; 3) current inpatient-oriented training programs strongly push students away from a primary care career; 4) women are more likely than men to choose generalist careers, primarily because of those careers' interpersonal orientation; and 5) residency training programs are able to select applicants likely to become generalists.
Therefore, to produce more generalists, attempts should be made to encourage generalist-oriented students to enter medical schools and to revise curricula to focus on outpatient settings in which students can establish effective and satisfying relationships with patients. These strategies are most likely to be successful if enacted within the context of governmental and medical school-based changes that allow for more reimbursement and respect for the generalist disciplines.
Urbina C, Hickey M, McHarney-Brown C, Duban S, Kaufman A. Innovative generalist programs: academic health care centers respond to the shortage of generalist physicians. J Gen Intern Med 1994 Apr;9(4 Suppl 1):S81-9, Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque 87131.
Successful recruitment of generalism-oriented applicants requires identification and tracking of rural, minority, and other special groups of students at the high school and college levels.
Academic health care centers increasingly are exploring innovative ways to increase the supply of generalist physicians. The authors review successful innovations at representative academic health centers in the areas of recruitment and admissions, undergraduate medical education, residency training, and practice support. Lessons learned focus on those areas that have demonstrated improvements in the number and quality of physicians trained in family practice, general pediatrics, and general internal medicine. Successful recruitment of generalism-oriented applicants requires identification and tracking of rural, minority, and other special groups of students at the high school and college levels. Academic health care centers that provide early, sustained, community-based, ambulatory experiences for medical students and residents encourage trainees to maintain and choose generalist careers. Finally, academic health care centers that link with community providers and with state government encourage the retention of generalist physicians through continuing education and teaching networks.
Rabinowitz HK. The role
of the medical school admission process in the production of generalist
physicians. Acad Med 1999 Jan;74(1
Suppl):S39-44,
Department of Family Medicine, Jefferson Medical College of Thomas Jefferson
University, Philadelphia, PA 19107, USA.
Medical education research has identified a number of medical student characteristics that are related to graduates' entering generalist careers. These include initial specialty preference, geographic background, gender, age, ethnicity, economic and lifestyle factors, attitudes and personal values, service orientation, and premedical academic performance.
These include initial specialty preference, geographic background, gender, age, ethnicity, economic and lifestyle factors, attitudes and personal values, service orientation, and premedical academic performance. Identifying and giving weight to these factors in the medical school admission process is likely to increase the number of graduates who choose generalist specialties. This paper discusses these medical student characteristics and presents strategies that medical schools could use in the selection process to enhance the matriculation of students who are most likely to become generalists. In this way, medical schools will be able to recruit and select students who are most likely to become excellent physicians, and also produce a more appropriate balance of all specialists to meet the needs of the population.
Juster F, Levine JK. Recruiting and selecting generalist-oriented students at New York Medical College. Acad Med 1999 Jan;74(1 Suppl):S45-8, New York Medical College, Valhalla 10595, USA.
NYMC developed strategies to attract applicants interested in primary care and to select primary care applicants for matriculation. These strategies included use of recruiting newsletters to describe the primary care curriculum, on-campus open houses for undergraduates, visits to regional undergraduate schools by generalist faculty, changes in the admission committee to include more generalists, and changes in the interview format to stress nonacademic qualities in applicants… NYMC achieved its objectives
This paper describes the strategies developed for student recruitment and selection at New York Medical College (NYMC), a private medical school with a consortium of 22 teaching hospitals, to meet its goal of 50% of graduating medical students entering generalist careers. With funding from The Robert Wood Johnson Foundation Generalist Physician Initiative, NYMC developed strategies to attract applicants interested in primary care and to select primary care applicants for matriculation. These strategies included use of recruiting newsletters to describe the primary care curriculum, on-campus open houses for undergraduates, visits to regional undergraduate schools by generalist faculty, changes in the admission committee to include more generalists, and changes in the interview format to stress nonacademic qualities in applicants. The authors present data from the Association of American Medical Colleges (AAMC) Pre-Medical Student Questionnaire and from the AAMC Medical School Matriculation Questionnaire that indicate NYMC achieved its objectives. They warn, however, that it is unclear whether these changes occurred solely as a result of NYMC's strategies, as a result of market forces driving career choices, or as a result of some combination of these factors.
Martini CJ, Veloski JJ, Barzansky B, Xu G, Fields SK. Medical school and student characteristics that influence choosing a generalist career. JAMA 1994 Sep 7;272(9):661-8, Division of Undergraduate Medical Education, American Medical Association, Chicago, Ill.
The most influential factors under the control of the medical school are the criteria used for admitting students and the design of the curriculum, with particular emphasis on faculty role models. Personal social values was the individual characteristic that most strongly influenced graduates' career choice.
OBJECTIVE--To identify predictors in medical schools that can be manipulated to affect the proportion of graduates entering generalist practice. DESIGN AND PARTICIPANTS--Cross-sectional and retrospective studies of medical schools and practicing generalist physicians; surveys of MD-granting and DO-granting medical schools; site visits to nine schools with a high proportion of graduates becoming generalist physicians; surveys of national samples of MD and DO generalist physicians. INDEPENDENT VARIABLES--Characteristics of medical schools, including structural characteristics, financing, mission, admissions policies, student demographics, curriculum, faculty, and the production of generalist physicians; information on personal characteristics, background, perceptions, and attitudes of practicing generalist physicians. DEPENDENT VARIABLE--Estimated proportion of graduates of the classes of 1989, 1990, and 1991 in family practice, general internal medicine, and general pediatrics. RESULTS--Institutional mission, certain admissions policies, characteristics of entering students, and the presence of a primary care-oriented curriculum explained statistically significant variation in the number of physicians choosing generalist careers, even after the structural characteristics of public or private status, age of the school, and class size were controlled for statistically. CONCLUSIONS--Public and institutional policies, where implemented, have had a positive effect on students' choice of generalist careers. The most influential factors under the control of the medical school are the criteria used for admitting students and the design of the curriculum, with particular emphasis on faculty role models. Personal social values was the individual characteristic that most strongly influenced graduates' career choice.
Colwill JM, Perkoff GT, Blake RL Jr, Paden C, Beachler M. Modifying the culture of medical education: the first three years of the RWJ Generalist Physician Initiative. Acad Med 1997 Sep;72(9):745-53, Department of Family and Community Medicine, University of Missouri-Columbia (UMC), USA.
changes in admission criteria to favor applicants oriented to generalism
The Generalist Physician Initiative (GPI) was created by The Robert Wood Johnson Foundation to help medical schools increase the number of predoctoral and residency graduates entering generalist careers. The underlying assumption of the GPI is that more medical graduates will become generalists if schools select candidates whose personal characteristics are compatible with generalist careers and if schools provide for them an educational environment that values generalist careers in the same manner it has valued specialist careers. In essence, the GPI is helping schools modify the culture in which medical education occurs so that they may increase their production of generalists. Fourteen grants for six years of support were made to 16 U.S. medical schools in 1994. These schools are developing institution-wide efforts that span the continuum from the recruitment and selection of students through their medical school and residency education to their entry into practice, and include support of the practice. Most schools have developed external partners (e.g., state legislatures, managed care organizations, area health education centers) to assist in achieving their goals. The project is now (1997) at its halfway mark. This article describes the conceptual bases for the program (e.g., changes in admission criteria to favor applicants oriented to generalism), identifies common approaches to intervention chosen by the participating schools (e.g., establishing longitudinal, generalist-oriented clinical experiences throughout the four years of medical school), and explores issues being faced by the schools as they implement change (e.g., difficulties in decentralizing clinical education to include community physicians as teachers and role models).
Admissions for generalists and rural physicians