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Admission, recruitment, and retention

Finding and keeping the generalist-oriented student

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As the country strives to produce larger numbers of generalist physicians, considerable controversy has arisen over whether or not generalist applicants can be identified, recruited, and influenced to keep a generalist-oriented commitment throughout medical training. The authors present new and existing data to show that: 1) preadmission (BA/MD or post-baccalaureate) programs can help to identify generalist-oriented students; 2) characteristics determinedat admission to medical school are predictive of future generalist career choice; 3) current inpatient-oriented training programs strongly push students away from a primary care career; 4) women are more likely than men to choose generalist careers, primarily because of those careers’ interpersonal orientation; and 5) residency training programs are able to select applicants likely to become generalists. Therefore, to produce more generalists, attempts should be made to encourage generalist-oriented students to enter medical schools and to revise curricula to focus on outpatient settings in which students can establish effective and satisfying relationships with patients. These strategies are most likely to be successful if enacted within the context of governmental and medical school-based changes that allow for more reimbursement and respect for the generalist disciplines.

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  1. Schroeder SA. The splendor of internal medicine: it begins with patient care. J Gen Intern Med. 1992;7:528–31.

    Article  PubMed  CAS  Google Scholar 

  2. Colwill J. Where have all the primary care applicants gone? N Engl J Med. 1992;326:387–93.

    Article  PubMed  CAS  Google Scholar 

  3. Rabinowitz HK. Recruitment, retention and follow-up of graduates of a program to increase the number of family physicians in rural and underserved areas. N Engl J Med. 1993;328:934–9.

    Article  PubMed  CAS  Google Scholar 

  4. Association of American Medical Colleges. Generalist Physician Initiatives in U.S. Medical Schools. Washington, DC: AAMC, 1993.

    Google Scholar 

  5. Funkenstein DH. Medical students, medical schools, and society during five eras. Cambridge, MA: Ballinger Publishing, 1978.

    Google Scholar 

  6. Fincher RME, Lewis LA, Rogers LQ. Classification model that predicts medical students’ choices of primary care. Acad Med. 1992;67:324–7.

    Article  PubMed  CAS  Google Scholar 

  7. Kassler WJ, Wartman SA, Silliman RA. Why medical students choose primary care careers. Acad Med. 1991;66:41–3.

    Article  PubMed  CAS  Google Scholar 

  8. Rivo ML. Internal medicine and the journey to medical generalism. Ann Intern Med. 1993;119:146–52.

    PubMed  CAS  Google Scholar 

  9. Schwartz MD, Linzer M, Babbott D, Divine GW, Broadhead E. Medical student interest in internal medicine. Ann Intern Med. 1991;114:6–15.

    PubMed  CAS  Google Scholar 

  10. Schwartz MD, Linzer M, Divine GW, Babbott D, Broadhead WE. Medical student interest in internal medicine: impact of an ambulatory rotation. Clin Res. 1991;39:622A.

    Google Scholar 

  11. Lieu TA, Schroeder SA, Altman DF. Specialty choices at one medical school: recent trends and analysis of predictive factors. Acad Med. 1989;64:622–9.

    Article  PubMed  CAS  Google Scholar 

  12. McMurray JE, Schwartz MD, Genero NP, Linzer M. The attractiveness of internal medicine. Ann Intern Med. 1993;119:812–8.

    PubMed  CAS  Google Scholar 

  13. Grant L. The gender climate of medical school. JAMWA. 1988;43:109–19.

    PubMed  CAS  Google Scholar 

  14. Baker-Miller J. Towards a new psychology of women. Boston: Beacon Press, 1976.

    Google Scholar 

  15. Bigby J, Schwartz MD, McMurray JE, Genero NP, Linzer M. Career choice in internal medicine: not for African-American students. Clin Res. 1993;41:554A.

    Google Scholar 

  16. Taggart MP, Wartman SA, Wessen AF. Influences on choice of primary care. Med Care. 1987;25:671–4.

    Article  PubMed  CAS  Google Scholar 

  17. Strelnick AH, Bateman WB, Jones C, et al. Graduate primary care training. Ann Intern Med. 1988;109:324–34.

    PubMed  CAS  Google Scholar 

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Linzer, M., Slavin, T., Mutha, S. et al. Admission, recruitment, and retention. J Gen Intern Med 9 (Suppl 1), S14–S23 (1994).

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