The Role of Medical School Culture in Primary Care Career Choice
The Role of Medical School Culture in Primary Care Career Choice
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DOI：
10.1097/acm.0000000000000038
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发表时间：
2013-12-01
影响因子：
7.4
通讯作者：
Carle, Adam C.
中科院分区：
文献类型：
--
作者：
Erikson, Clese E.;Danish, Sana;Carle, Adam C.
目的研究个人层面和医学院层面的因素，包括学校的初级保健文化，这些因素与医学生从事初级保健的可能性有关。方法2010年春季，美国医学会劳动力研究中心邀请所有四年级医学生参加一项在线调查，调查在专业选择决策中的因素。根据毕业生成为执业初级保健医生的历史百分比，对学校进行了分层。采用多水平Logistic回归模型，确定哪些个人特征和学校特征对学生从事小学教育的可能性有显著预测作用。结果在2,604名受邀学生中，有1,661人(%)回答。在拥有感兴趣变量完整数据的1554名学生中，207名(13%)计划进入初级保健住院医生，并表示他们很有可能在完成培训后成为初级保健医生。在报告的初级保健不良程度较高的学校就读的学生不太可能从事初级保健(OR，0.6；95%CI，0.4-0.9)。就读于学生在初级保健助理员职位上的积极经历多于中位数的学校会增加从事初级保健的可能性(OR，1.6；95%CI，1.1-2.3)。总体而言，学生从事初级保健的可能性的总差异中有8%可归因于学校层面的因素。结论尽管学生个人的特征和偏好决定了专业选择，但学校普遍存在的初级保健文化也起到了作用。
Purpose To examine individual-level and medical-school-level factors, including the school's primary care culture, that are associated with medical students' likelihood of practicing primary care.Method In spring 2010, the Association of American Medical Colleges Center for Workforce Studies invited all fourth-year medical students at a stratified random sample of 20 U.S. MD-granting medical schools to participate in an online survey examining factors in specialty choice decisions. Schools were stratified according to the historical percentage of their graduates who became practicing primary care physicians. Multilevel logistic regression modeling was used to determine which individual- and school-level characteristics significantly predicted students' likelihood of practicing primary care.Results Of the 2,604 students invited, 1,661 (64%) responded. Of the 1,554 students with complete data on variables of interest, 207 (13%) planned to enter a primary care residency and stated they were very likely to become a primary care physician on completion of training. Students who attended schools with high reported levels of badmouthing primary care were less likely to practice primary care (OR, 0.6; 95% CI, 0.4-0.9). Attending a school where students had greater than the median number of positive experiences in primary care clerkships increased the likelihood of practicing primary care (OR, 1.6; 95% CI, 1.1-2.3). Overall, 8% of the total variation in a student's likelihood of practicing primary care was attributable to school-level factors.Conclusions Although individual students' characteristics and preferences drive specialty choice decisions, the prevailing primary care culture at a school also plays a role.