Journal of General Internal Medicine

, Volume 10, Issue 10, pp 542–549 | Cite as

The impact of an ambulatory rotation on medical student interest in internal medicine

  • Mark D. Schwartz
  • Mark Linzer
  • David Babboff
  • George W. Divine
  • W. Eugene Broadhead
  • the Society of General Internal Medicine Task Force on Career Choice in Internal Medicine
Original Articles

Abstract

OBJECTIVE: To determine whether students who take ambulatory rotations in internal medicine are more likely to choose internal medicine careers.

DESIGN: National survey.

SETTING AND PARTICIPANTS: The intended sample was 1,650 senior U.S. medical students from 16 medical schools, of whom 1,244 (76%) responded. Representative schools nationwide were selected using a stratified, random-sampling method.

MEASUREMENTS: The questionnaire asked about characteristics of the ambulatory rotation, perceptions of internal medicine, and factors influencing students toward or away from an internal medicine career.

RESULTS: Ambulatory rotations were taken by 543 students (43%). Of these rotations, 73% were required, 74% were during the fourth year, 77% were in general internal medicine, 73% provided continuity of care, and 19% were during the medicine clerkship. Overall, 24% of the students chose careers in general (9%) or subspecialty internal medicine (15%). Thirty percent of the students who did ambulatory rotations planned internal medicine careers, compared with 19% of the students who had no rotation [odds ratio (OR)=1.8,95% confidence interval (CI) 1.3 to 2.4, p=0.0001]. This association was of similar magnitudes for students completing required rotations (OR=1.6, 95% CI 1.2 to 2.2, p=0.002) and for students completing rotations before or in proximity to when they chose careers (OR=1.7, 95% CI 1.1 to 2.4, p=0.01). Ninety percent of the 543 students who had ambulatory rotations were satisfied with the experience. Thirty-eight percent of the highly satisfied students chose internal medicine careers, compared with 21% of the students who had low or moderate satisfaction (p=0.0001).

CONCLUSIONS: An ambulatory rotation is strongly associated with positive perceptions of, attraction to, and choice of a career in internal medicine. Research is needed to determine specific components of an effective rotation. Further development of ambulatory rotations could help attract more students to internal medicine.

Key words

medical student career choice medical education ambulatory care internal medicine 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Schwartz MD, Linzer M, Babbott B. Divine GW, Broadhead E. and the Society of General Internal Medicine Interest Group on Career Choice. Medical student interest in internal medicine. Initial report of the Society of General Internal Medicine Interest Group Survey on Factors Influencing Career Choice in Internal Medicine. Ann Intern Med. 1991;114:6–15PubMedGoogle Scholar
  2. 2.
    Rucker L, Morgan C, Ward K, Bell B. Impact of an ambulatory care clerkship on the attitudes of students from five classes (1985–1989) toward primary care. Acad Med. 1991;66:620–2.PubMedCrossRefGoogle Scholar
  3. 3.
    Davidson RA, Harris JO, Schwartz MD. A simple ambulatory-care experience and students’ residency choices and attitudes toward general internal medicine. Acad Med. 1993;68:311–2.PubMedCrossRefGoogle Scholar
  4. 4.
    Duerson MC. Crandall LA, Dwyer JW. Impact of a required family medicine clerkship on medical students’ attitudes about primary care. Acad Med. 1989;64:546–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Fincher RM. Lunn JS. Nance LD. Does an ambulatory care experience influence third-year students to select a career in internal medicine? Acad Med. 1990;65:421.PubMedCrossRefGoogle Scholar
  6. 6.
    Stimmel B. The crisis in primary care and the role of the medica school: defining the issues. JAMA. 1992;268:2060–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Brooks CH. Do area health education center programs produce primary care specialists? Results of a longitudinal study. Int J Health Serv. 1992;22:567–78.PubMedCrossRefGoogle Scholar
  8. 8.
    Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42:121–30.PubMedCrossRefGoogle Scholar
  9. 9.
    Martini CJ, Veloski JJ, Barzansky B, Xu G, Fields S. Medical school and student characteristics that influence choosing a generalist career. JAMA. 1994;272:661–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Schroeder SA. Showstack JA, Gerbert B. Residency training in internal medicine: time for a change? Ann Intern Med. 1986;104:554–61.PubMedGoogle Scholar
  11. 11.
    McMurray JE, Schwartz MD, Genero NP. Linzer M, for the Society of General Internal Medicine Task Force on Career Choice in Internal Medicine. The attractiveness of internal medicine: a qualitative analysis of the experience of female and male medical students. Ann Intern Med. 1993;119:812–8.PubMedGoogle Scholar
  12. 12.
    Federated Council for Internal Medicine. Generating more generalists: an agenda for renewal for internal medicine. Ann Intern Med. 1993;119:1125–9.Google Scholar

Copyright information

© Hanley & Befus, inc. 1995

Authors and Affiliations

  • Mark D. Schwartz
    • 1
  • Mark Linzer
    • 2
  • David Babboff
    • 3
  • George W. Divine
    • 4
  • W. Eugene Broadhead
    • 5
  • the Society of General Internal Medicine Task Force on Career Choice in Internal Medicine
  1. 1.the Division of Primary Care, Department of MedicineNew York University Medical CenterNew York
  2. 2.the Division of General Internal Medicine, Department of MedicineUniversity of Wisconsin Clinical Science CenterMadison
  3. 3.the Department of MedicineMedical Center Hospital of VermontBurlington
  4. 4.the Department of Biostatistics, Research Epidemiology, and Medical InformaticsHenry Ford Health Sciences CenterSouthfield
  5. 5.the Department of Family MedicineDanville Regional Medical CenterDanville

Personalised recommendations