1. A Longitudinal Study of Medical Student Primary Care Intent

2. A Longitudinal Study of Medical Student Primary Care Intent
C. K. Shannon, MD, PhD
Department of Family Medicine, West Virginia University

3. 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

4. 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

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

6. Demand for PC

7. 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)

8. Methods
Data for WV medical students from 3 schools (5 campuses), graduation years 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

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

10. Variables - Demographic
?Rural hometown
?WV hometown
Gender
Campus

11. 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

12. 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

13. 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

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

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

16. Trend in Reported PC Intent

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

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