Richard Pretorius, MD, MPH Karen Devlin SUNY AT BUFFALO

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Presentation transcript:

Factors Influencing Medical Students to Enter A Family Medicine Residency at Their Own Institution Richard Pretorius, MD, MPH Karen Devlin SUNY AT BUFFALO STFM 34th Annual Predoctoral Education Conference Portland, Oregon January 26, 2008

PROBLEM: 10-year decline by 53% in US seniors entering family medicine 53% from 2340 to 1107 (1997 to 2007)

BACKGROUND Recruitment faces new challenges. Fam med residents who train at the same institution where they attended medical school are familiar the strengths & weaknesses of both programs. RESEARCH QUESTION: What factors influence medical students to enter a family medicine residency at their own institution?

METHOD Structured interviews 19 open ended questions N=8 fam med residents Med school & residency were identical: SUNY at Buffalo

METHOD Residency program 32 full time physician faculty 3 sites in Buffalo urban county hospital (ECMC) + urban clinic 5 residents/year urban not-for-profit hospital (BGH) + 2 urban clinics 6 residents/year suburban not-for-profit hospital (MFG) + suburban clinic 4 residents/year 8/42 (19%) family medicine residents at SUNY at Buffalo also graduated from medical school at SUNY at Buffalo. All 8 residents were interviewed 100% response rate

RESULTS Location of high school and college of 8 residents in study group: high school college local 4 New York State 2 1 out-of-state 3

RESULTS The medical school (SUNY at Buffalo) was chosen because of: location (4) acceptance (4) reputation (2) scholarship (1) focus on primary care (1) inexpensive (1)

RESULTS The residency (SUNY at Buffalo) was chosen because of: program (6) holistic medicine extracurricular and research opportunities integrated clinical experience good reputation familiar medical system continuity of school faculty (6) location (5) Program: familiar medical system, holistic medicine, continuity, extracurricular, research, integrated clinical experience, good training

RESULTS Advantages of UB medical school: curriculum (5) student groups (2) research (2) hospitals (1) patient diversity (1) reputation (1) state university (1) faculty (1) cost (1) Disadvantages of UB medical school none (2) curriculum (2) no academic hospital (2) not prepared for boards (1) limited study time (1) too many lectures (1) Curriculum—SP, new curriculum, integrated clin exp, strong curriculum

RESULTS Disadvantages of UB fam med residency specific rotations (4) competition with other residents to see pts (3) quality of residents (2) fam med bashing (2) dispersed campus (1) large size (1) none (1) Advantages of UB fam med residency faculty (6) program (4) research (3) diverse learning opportunities (3) patients (2) hospitals (2) residents (1) established pgm (1) location (1) academic pgm (1) supports resident's family (1)

RESULTS When decision was made to specialize in family medicine? In medical school (4): Begun in 2nd yr med school, solidified after fam med clerkship End of 3rd year Prior to med school, finalized in 3rd year 4th year Before medical school (3): “Always what I wanted to do” Confirmed with Peace Corp experience Note: one resident did not provide answer.

RESULTS Other specialties seriously considered: psychiatry (seriously), peds & med/peds (not seriously) psychiatry, fam med/psych, med/psych ER, ortho psychiatry surgery, ER, IM (gastroenterology) peds none

RESULTS Factors that most influenced the resident’s decision to go into family medicine: faculty (2) residents (2) prevention (2) familiarity (1) liked every clerkship (1) continuity of care (1) challenge (1) primary care (1) patients (1) underserved populations (1) clerkship (1) lifestyle (1)

RESULTS Important factors for helping medical students decide to enter family medicine: exposure to family physicians (3) clerkship (3) explain what family physicians do (2) ability to earn a good income (1) international rotations (1) mentors (1) procedures (1) opportunity to do pediatrics and obstetrics (1) emphasizing positives (1)

DISCUSSION A variety of factors influenced a resident’s decision to enter family medicine (12) as well for the resident’s medical school classmates (9). Exposure to positive role models, good clerkship experiences and explanations as to family medicine’s unique characteristics were among the most popular reasons cited. Medical students decide to enter family medicine for a variety of personal reasons. A multimodality approach to recruitment will likely give the best results. Family medicine is a broad specialty.