A. Kost is associate professor, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington. D. Evans is associate professor, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington. S. Dobie is professor, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington. E. Sanders is associate professor, College of Education, University of Washington, Seattle, Washington.
Acad Med. 2018 Jul;93(7):1042-1047. doi: 10.1097/ACM.0000000000002073.
More primary care physicians are needed in underserved areas of the United States. Prior research indicates that medical student experiences in underserved settings increase the likelihood that they will practice in underserved areas; few studies have controlled for selection bias. This study aimed to estimate the effect of the University of Washington School of Medicine's (UWSOM's) longitudinal extracurricular experience, the Underserved Pathway (UP), on graduates' choice in entering a family medicine residency with underserved training opportunities.
The American Medical College Application Service application that all students submit to apply to UWSOM and a matriculation survey were used to collect demographic information for medical school graduates who subsequently entered family medicine residencies between 2010 and 2015. A given family medicine residency offered underserved training if it had a clinic or rotation at a federally qualified health center or if the admitting hospital was a critical access hospital. Multiple logistic regression was used to estimate the UP program's effect on graduates entering an underserved family medicine residency, adjusting for 26 covariates.
Participants were 158 UWSOM graduates; 39 (25%) completed the UP program. UP completion was associated with a 3.58 odds ratio increase to matching to an underserved family medicine residency, compared with non-UP graduates.
Completion of the UP was linked to a significant increase in program graduates matching to an underserved family medicine residency. Longitudinal extracurricular programs similar to the UP could be an important component in the pipeline to meeting the primary care needs of underserved populations.
美国服务不足地区需要更多的初级保健医生。先前的研究表明，医学生在服务不足环境中的经历增加了他们在服务不足地区行医的可能性；但很少有研究控制选择偏差。本研究旨在估计华盛顿大学医学院（UWSOM）的纵向课外体验，即服务不足途径（UP）对毕业生选择进入有服务不足培训机会的家庭医学住院医师的影响。
使用所有学生提交的美国医学院申请服务（AMCAS）申请和入学调查，收集 2010 年至 2015 年间进入家庭医学住院医师的医学院毕业生的人口统计学信息。如果家庭医学住院医师有联邦合格的健康中心的诊所或轮转，或者如果住院医院是关键访问医院，则提供服务不足的培训。使用多变量逻辑回归估计 UP 计划对进入服务不足的家庭医学住院医师的毕业生的影响，调整了 26 个协变量。
参与者为 158 名 UWSOM 毕业生；39 名（25%）完成了 UP 计划。与非 UP 毕业生相比，完成 UP 计划的毕业生匹配到服务不足的家庭医学住院医师的几率增加了 3.58 倍。
完成 UP 计划与毕业生匹配到服务不足的家庭医学住院医师的显著增加有关。类似于 UP 的纵向课外项目可能是满足服务不足人群的初级保健需求的重要组成部分。
