Martini C J, Veloski J J, Barzansky B, Xu G, Fields S K
Division of Undergraduate Medical Education, American Medical Association, Chicago, Ill.
JAMA. 1994 Sep 7;272(9):661-8.
To identify predictors in medical schools that can be manipulated to affect the proportion of graduates entering generalist practice.
Cross-sectional and retrospective studies of medical schools and practicing generalist physicians; surveys of MD-granting and DO-granting medical schools; site visits to nine schools with a high proportion of graduates becoming generalist physicians; surveys of national samples of MD and DO generalist physicians.
Characteristics of medical schools, including structural characteristics, financing, mission, admissions policies, student demographics, curriculum, faculty, and the production of generalist physicians; information on personal characteristics, background, perceptions, and attitudes of practicing generalist physicians.
Estimated proportion of graduates of the classes of 1989, 1990, and 1991 in family practice, general internal medicine, and general pediatrics.
Institutional mission, certain admissions policies, characteristics of entering students, and the presence of a primary care-oriented curriculum explained statistically significant variation in the number of physicians choosing generalist careers, even after the structural characteristics of public or private status, age of the school, and class size were controlled for statistically.
Public and institutional policies, where implemented, have had a positive effect on students' choice of generalist careers. The most influential factors under the control of the medical school are the criteria used for admitting students and the design of the curriculum, with particular emphasis on faculty role models. Personal social values was the individual characteristic that most strongly influenced graduates' career choice.
确定医学院校中可加以调控的因素，以影响进入全科医疗领域的毕业生比例。
对医学院校和执业全科医生进行横断面研究和回顾性研究；对授予医学博士学位和医学博士职业学位的医学院校进行调查；对毕业生中全科医生比例较高的9所院校进行实地考察；对医学博士和医学博士职业学位的全科医生全国样本进行调查。
医学院校的特征，包括结构特征、资金、使命、招生政策、学生人口统计学特征、课程设置、教师以及全科医生的培养；关于执业全科医生个人特征、背景、认知和态度的信息。
1989届、1990届和1991届毕业生从事家庭医疗、普通内科和普通儿科的估计比例。
即使在对公立或私立性质、学校年龄和班级规模等结构特征进行统计学控制之后，机构使命、某些招生政策、入学学生的特征以及以初级保健为导向的课程设置，在选择全科职业的医生数量上解释了具有统计学意义的差异。
已实施的公共政策和机构政策对学生选择全科职业产生了积极影响。医学院校能够控制的最具影响力的因素是招生标准和课程设计，尤其要强调教师榜样的作用。个人社会价值观是最强烈影响毕业生职业选择的个人特征。
