Henderson M C, Hunt D K, Williams J W
Department of Medicine, University of Texas Health Science Center, San Antonio 78284-7879, USA.
Am J Med. 1996 Dec;101(6):648-53. doi: 10.1016/S0002-9343(96)00334-8.
To determine whether medical students supervised by general internist attendings during the third-year medicine clerkship are more likely to choose primary care careers than students supervised by subspecialist attendings.
One hundred forty-four consecutive medical students rotating on the general medicine inpatient service during the 1993-1994 academic year were surveyed about their career choice and professional expectations, both at the beginning and end of the clerkship; an additional 50 students completed a post-clerkship survey only. The cohort of students was surveyed at graduation to determine stability of their career preferences.
Both pre- and post-clerkship surveys were completed by 138 of 144 students (96%); post-clerkship surveys were completed by 181/194 (93%); and graduation surveys were completed by 137/188 (73%). Fifty-eight students (32%) designated primary care (general internal medicine, general pediatrics, or family practice) as their career choice post-clerkship; of these, 45 students (78%) also indicated a primary care career choice at graduation. Characteristics associated with choosing primary care post-clerkship were: low income expectation, desire to interact closely with patients, desire to contribute to society, low class rank, female gender, and high educational debt. Having a physician parent was negatively associated with choosing primary care. After controlling for important demographic, academic and attitudinal characteristics, increasing exposure to a general internist attending was associated with choosing primary care (OR = 5.1, comparing highest to lowest amount). Among students choosing primary care, exposure to a general internist attending was associated with choosing general internal medicine in a dose-dependent fashion (OR = 4.2, comparing highest to lowest amount).
Although career choice is clearly related to personal characteristics such as socioeconomic background and humanistic qualities, a high degree of exposure to general internists during the medicine clerkship is associated with choosing primary care. Exposure of students interested in primary care to general internist attendings may also influence them to consider general internal medicine over family practice and pediatrics.
确定在医学三年级实习期间由普通内科主治医生带教的医学生比由专科主治医生带教的学生更倾向于选择初级保健职业。
对1993 - 1994学年在内科住院部轮转的144名连续医学生在实习开始和结束时进行了关于他们职业选择和专业期望的调查；另外50名学生仅完成了实习后的调查。在毕业时对这组学生进行了调查，以确定他们职业偏好的稳定性。
144名学生中有138名（96%）完成了实习前和实习后的调查；181/194名（93%）完成了实习后调查；137/188名（73%）完成了毕业调查。58名学生（32%）在实习后将初级保健（普通内科、普通儿科或家庭医学）指定为他们的职业选择；其中，45名学生（78%）在毕业时也表示选择初级保健职业。与实习后选择初级保健相关的特征包括：低收入期望、渴望与患者密切互动、渴望为社会做出贡献、低班级排名、女性性别和高教育债务。有医生父母与选择初级保健呈负相关。在控制了重要的人口统计学、学术和态度特征后，增加与普通内科主治医生的接触与选择初级保健相关（比值比 = 5.1，最高与最低接触量相比）。在选择初级保健的学生中，与普通内科主治医生的接触与以剂量依赖方式选择普通内科相关（比值比 = 4.2，最高与最低接触量相比）。
虽然职业选择显然与社会经济背景和人文素质等个人特征有关，但在医学实习期间与普通内科医生的高度接触与选择初级保健相关。让对初级保健感兴趣的学生接触普通内科主治医生也可能影响他们考虑选择普通内科而非家庭医学和儿科。
