Impact of a Population-Based Medical Curriculum on Specialty Choice

Brief communication 261 IMPACT OF A POPULATION-BASED MEDICAL CURRICULUM ON SPECIALTY CHOICE Many states are characterized by a maldistributed physician workforce. Rural states are particularly vulnerable to this phenomenon and are continually striving to come up with new plans, programs, and methodologies to provide medical care to their medically underserved populations. Georgia is no exception. In the 1970s, the Georgia legislature became increasingly concerned about the lack of primary care physicians in the state. With a group of concerned citizens serving as catalyst, the legislature voted to support the formation of a new medical school in Macon, Georgia, whose mission would be to "educate physicians to meet the health care needs of rural and other underserved areas of Georgia." This was the beginning of Mercer University School of Medicine (MUSM). Established in 1982, MUSM has the distinction of being one of the nation's most prolific producers of primary care physicians (MUSM defines primary care as family practice, internal medicine, pediatrics, general surgery, OB/GYN, psychiatry, and emergency medicine). Among MUSM's many successes, on several occasions it has been the recipient of the Gold Award from the American Academy of Family Practitioners (AAFP). This distinction is given to a medical school with a three-year average of more than 30 percent of graduates selecting family medicine as their specialty . In 1995, MUSM was the only school in the country to receive this award. A total of 77 percent of all MUSM's graduates practice in Georgia, with 52 percent practicing in health professional shortage areas. MUSM's success is due to its recognition of the AAFP's definition of primary care in the curriculum. Primary care is considered "the provision of a broad range of personal medical care (preventive, diagnostic, palliative, therapeutic, curative, counseling and rehabilitative) in a manner that is accessible, comprehensive and coordinated by a licensed M.D./D.O. physician over time."* In recent years, there has been a growing literature base contributing information on factors associated with a student's choice of medical specialty. These factors include early and longitudinal primary care experiences,1 educational orientation and medical school environment,1"4 augmenting student contact with mentors in the field,5 positive primary care role models,4"7 * AAFP Policies on Health Issues: Primary Care, American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. Journal of Health Care for the Poor and Underserved · Vol. 12, No. 3 · 2001 262 Medical Students' Opinion on Specialty Choice__________________ required rural rotations,7 and clerkship experiences (especially family medicine ) of four or more weeks duration.6"9 Some research also has correlated factors associated with selection of a non-primary care specialty. According to Osborn5 and Fincher, Lewis, and Jackson,10 factors such as income, lifestyle, opportunities to work with new technologies, and opportunities to do procedures were found to be more important to the selection of non-primary care specialties. Schieberl et al.11 further found that senior rotations have the strongest influence on physicians who selected a non-primary care field. The literature to date has primarily contributed findings associated with traditional medical school curriculum (clerkships, etc.) and their influence on specialty selection. However, MUSM's curriculum contains three programs many would classify as nontraditional. These programs are the Clinical Skills Program, the Community Office Practice Program (COPP), and the Community Science Program. Clinical Skills Program. MUSM's Clinical Skills Program is an on-campus "dry lab" program, which begins the first week of medical school. It is designed to develop and refine human interaction skills and physical exam behaviors, which contribute to the education of a sensitive and effective clinician . Learning objectives include taking a medical history, performing physical examinations, providing patient education, documenting and reporting the history and physical, developing a good patient/physician relationship, and understanding basic office lab and therapeutic procedures. The "wet lab" for the Clinical Skills Program is COPP. COPP. COPP is an off-campus program designed to introduce students to community-oriented primary care in an ambulatory setting. COPP uses primary care physicians as preceptors and is designed to integrate the curriculums of clinical skills, basic science, and community science over the course of 18...