A Longitudinal Study of Medical Student Primary Care Intent

A Longitudinal Study of Medical Student Primary Care Intent C. K. Shannon, MD, PhD Department of Family Medicine, West Virginia University shannonk@rcbhsc.wvu.edu

Presentation Objectives For questionnaire and demographic data of West Virginia (WV) medical students - identify trends in reported primary care (PC) intent across the time of the medical school and rural curricula - identify assessed variables associated with reported (PC) intent at points along the curricula - identify assessed variables associated with change in reported PC intent

Trends in Primary Care Selection Downward trend for percent medical students selecting PC, especially family medicine, careers by U.S. medical school graduates over the past several years Study of such trends is useful for identifying ways to help reverse them Increase in PC physicians important for U.S. health care system; demand for PC is increasing

Skinner & Newton. Correlates of successful match. [p] Revisit match pattern

Demand for PC

Longitudinal Rural Curriculum West Virginia Rural Health Education Partnership (WVRHEP) administers a state-wide rural curriculum required of healthcare discipline students at state-supported schools ultimate goal is to enhance recruitment into rural WV conducts evaluation projects; since 2001, one project involves on-line baseline and post-rotation questionnaires for students (presently, database for >3500 students in eight disciplines)

Methods Data for WV medical students from 3 schools (5 campuses), graduation years 2003-2009 and no record of clinical rotations (n=1120) Baseline (second year), first (third year) and second (fourth year) post-rotation questionnaire data Proportions of reported PC (“family practice, general medicine, general pediatrics”) intent; 5 categories total Multiple logistic regression model used for analyzing for associations of assessed variables with: 1) reported PC intent, and 2) change in reported PC intent

Methods Categories of variables assessed by questionnaires - demographic - curricular - social/service orientation - perceptual - career goals

Variables - Demographic ?Rural hometown ?WV hometown Gender Campus

Variables - Curricular Overall quality of rotation Quality of interdisciplinary sessions Educational value of community service project Change in interest in rural health Value of various clinical and community experiences

Variables – Social/service Orientation (for medical profession) Opportunity to exercise social responsibility High status and prestige Possibility of high income Importance of meeting unique needs of the poor Anticipated accessibility of practice to indigent

Variables - Perceptual Importance that profession uses exciting technology Professional demands interfere with other interests Legal liabilities and cost of malpractice insurance cost problems Importance of an active community role

Variables – Career Goals Preferred specialty (5 categories) Anticipated size of practice town Likelihood of WV practice

Results Response rates for WV medical students - baseline questionnaire (BQ) – 85% - first post-rotation questionnaire – 70% - second post-rotation questionnaire – 68%

Trend in Reported PC Intent

First post-rotation PC intent Table 1. Variables associated with WV medical student reported primary care intent during a longitudinal rural curriculum P Baseline PC intent   Campus <0.01 Preference for smaller town practice Greater likelihood of living in WV Greater emphasis on social responsibility 0.04 Less emphasis on income First post-rotation PC intent Female gender Less baseline emphasis on income Second post-rotation PC intent Less baseline emphasis on prestige 0.05

Individual Change in PC Intent BQ to First Post-Rotation 58 students (19%) changed toward PC intent and 40 (21%) away from primary care intent First Post-Rotation to Second Post-Rotation 23 students (16%) changed toward primary care intent and 45 (20%) changed away from it BQ to Second Post-Rotation 43 changes (21%) toward primary care intent and 38 changes (29%) away from it

Baseline to first post-rotation Variable P Table 2. Variables associated with change in reported primary care intent Baseline to first post-rotation Variable P Preference for living in WV (toward PC) 0.02 Female gender (toward PC) <0.01 Greater importance of active community involvement (toward PC) 0.05 Greater importance of technology in medicine (away from PC)   Baseline to second post-rotation Preference for smaller town practice (toward PC) 0.04

Discussion – Trend in Reported PC Intent for WV Medical Students Percentage WV medical students anticipating PC careers varied mildly across the curriculum; tended relatively stable, but ‘n’ and respondents vary Previous reports

Discussion – Trends in Associations with Reported PC Intent With matriculation: - association of PC intent with campus did not persist gender; preference for smaller town practice emerged “social/service” markers varied; overall, tended to be significant

Discussion – Associations with Change in Reported PC Intent For change in reported PC intent for WV medical students, associations: - change toward PC for those who value smaller town/ WV practice ? change toward PC for female gender, for importance of community involvement change away from PC with greater emphasis on importance of technology in medicine

Discussion Study limitations: - preliminary study - based on reported data - study design - student response rate - uncertain validity of generalizations - influences of various factors, including those of academic center experiences and of mentors, could not be assessed here

Discussion Factors that influence choice of primary care/family medicine specialties