Looney SW; Blondell RD; Gagel JR; Pentecost MW J Ky Med Assoc,
96(5):189-93 1998 May
University of Louisville Department of Family and Community Medicine, USA.
Abstract
The hypotheses that data, available at the time when a medical school admission decision is made, can be used to predict generalist specialty choice and rural practice location were tested. Applicant data, available to admissions committee members at the
University of Louisville in 1986 and 1987 about the classes of 1990 and 1991 respectively, were correlated with specialty choice and practice location in a retrospective cohort study. Data collected from 1994 to 1996 about the 1990 and 1991 graduates were used to develop a mathematical model to predict specialty choice and practice location using stepwise logistic regression. These models were more accurate in predicting which applicants would not select a generalist career (negative predictive value = 80.7%) than those who would (positive predictive value = 42.7%) and in predicting those who would not practice in a rural location (negative predictive value = 91.9%) than those who would (positive predictive value = 37.8%). We conclude that applicant data, available at the time admission decisions are made, are of limited value for identifying those who will eventually become generalist physicians or practice in a rural area. However, the data are useful for identifying those who will not.
Comments
Generalist selections are possible as noted by Madison, see Service Orientation
The success of rural background selection is well documented Rural Background
MESH Headings
Career Choice ; Cohort Studies ; Family Practice *MA/SN ; Human ; Kentucky ; Logistic Models ; Medically Underserved Area ; Professional Practice
Location *SN ; Retrospective Studies ; Specialties, Medical ; Students, Medical
*/SN ; Support, Non-U.S. Gov't Regarding Admissions to Increase the Numbers Choosing Rural
Practice and Primary Care
According to Rick Blondell at U of Louisville, the Kentucky schools do some fairly unique divisions of the candidates. They do training for interviewers to help them identify generalists vs specialists and rural vs urban in the MCAT, GPA, personal statement, and 2 interviews.
They then divide into two pools:
Generalist and Specialist
In follow ups they are 90% specific, 90% sensitive. They feel that their annual training is important and Rick is amazed at how often the two interviewers agree with their separate determinations.
The Generalist pool is examined and the attempt is made to accept as many rural generalists as possible. Students with a PEPP exposure (special high school-college advisory program for rural kids) get a special look. Unfortunately they soon run out of MCAT 8 or above candidates in this group. Everyone with a chance to hack it gets in. This pool is by far the most reliable for eventual rural and generalist practice but there is some attrition to other categories (specialists, urban) by graduation.
In the years since 1971, PEPP has documented increases and a stable pool of rural background applications even during declines in admissions nationwide.
Points to ponder
1. Few go from Non-rural to rural or from specialist to generalist and none go from specialist urban to rural - the pipeline to rural practice leaks one way, out.
2. This may mean that barriers to rural practice exist in rural communities in either the education systems in local communities or local colleges, or in health professions exposures and orientation.
3. The spouse factor may be the key reason to lose the rural generalists, especially with college, medical school, and residency in predominantly urban locations.
4. Currently, since there are still rural needs and declines in those choosing rural, the only option is to orient curricula and training location to attempt to plug some of the leaks and potentially move a few from the right column to the left (rural, generalist).
5. Long term states should move toward a more integrated approach.
6. The two Kentucky schools may actually compete for a small pool of rural applicants. Jefferson’s program and others where there is only one program in the state may do better because they get the best selection of rural candidates.
7. Unintended bonuses of rural admission programs: Nebraska’s RHOP early admission program has also improved the quality of math and science teaching in Chadron and Wayne State, as the RHOP students have competed with each other, with others interested in medical school and other professions. One teacher went from giving 1-2 barely deserved A’s in microbiology to 14 well-deserved A’s this last semester after 7 years of RHOP participation. Participation at the Chadron State Rural Health Career Day has dramatically increased during the same time period, as has enrollment in the sciences.RHOP Links
Of course this has not been transmitted to those in authority. This week the President of the University System sent a letter noting the problems with course duplication and dwindling state education resources. His note heralded the continued centralization of education resources. Seems like we should be working the other way in at least some areas. Perhaps rural communities would have less problems attracting needed young professionals of all types if we were not so blind to the direction our systems (or lack of systems) are programming our youth.