Career preferences of first- and second-year medical students: the WAMI experience.

Students admitted directly to the Seattle campus of the University of Washington School of Medicine are predominately from metropolitan areas. Students completing their first year at affiliated programs at Washington State University, University of Alaska, Montana State University, and the University of Idaho are predominately from nonmetropolitan areas. The authors compared these two groups of students with respect to preferred specialties and practice location; in addition, these preferences were examined on the basis of the size of students' home communities. Factor analysis of the preferences indicated by three entering classes at the end of their second year identified interpretable clusters of specialties and location types. Few differences were found in preferences for specialties, either between the groups or based on size of home community. Differences in attitudes toward location of practice indicated that students favor commmunities similar to those in which they were raised. The preferences indicated by second-year students were found to be significantly related to those expressed by the same students as they entered medical school, suggesting stability of student attitudes toward career choices. These results indicate that increased admissions from nonmetropolitan areas may affect the distribution of physicians by region but not by specialty.