Timing of PC Rotations to Influence Choice

The evidence suggests that later timing is bad for career decisions regarding family medicine.

Schools in the US such as Mercer with emphasis on family medicine do their family medicine first of all of their clinical rotations. It makes a nice transition between the first two years and the last two clinical years. At Nebraska we had our two month Rural Preceptorship in the fourth year, but grew tired of students telling us that it came too late to influence their decision. We moved it to the third year a few years ago and feel that this has helped us to some degree. We also added a 3 week experience at the end of the first medical school year as well as significant presence throughout the first two years.

You must resist a decrease in length or a delay in the curriculum with all that you can bear on the situation. You must somehow increase your influence in all years of training, especially the earlier years. Research that may help you, if available, would be when in the curriculum students make decisions on their future career. This is AAMC data from 1995 on the 294 US senior medical students interested in rural practice compared to the responses of the other 13000. The figures for family medicine are a bit different if someone can add them to the discussion.
 

Also, Tom Bruce in his book, Improving Rural Health, noted that the State of Arkansas basically had twice as much gain in the ration of physicians to population from 1975 to 1979 when compared to states throughout the south and midwest and at 18% growth, had the 5th largest growth of any state in the nation. States with comparable efforts had tremendous population growth (marked with #), significant primary care efforts (marked with *), or both. From P 168 See http://www.unmc.edu/Community/ruralmeded/model/medsch/arkansas_approach.htm 

A June 1983 report by US Dept of Health and Human Services on Diffusion and the Changing Geographic Distribution of Primary Care Physicians noted that Arkansas had the 4th largest increase in PC docs in the nation at 22% and a higher ratio of office-based pc docs when compared to the entire southern US. At the starting point, Arkansas had the most depleted supply of physicians in the nation p 164
 

Searching on James Rourke and SWORM would give you further data from a Canadian perspective. The Australians have also made major inroads into this area as well.

Robert C. Bowman, M.D, Co-Chairman
Rural Medical Educators Group of the National Rural Health Association
UNMC Department of Family Medicine Director of Rural Health Education and Research
983075 Nebraska Medical Center
Omaha, NE 68198-3075
(402) 559-8873 or fax at -8118
Email: rcbowman@atsu.edu
http://www.ruralmedicaleducation.org  or
http://www.unmc.edu/Community/ruralmeded/

Dear Mark and Carol:

I hope all is well with you, we are fine, as you know the news probably look worse from the outside.

I wanted to consult with you regarding the issue of family medicine rounds. As you know the Israeli medical program is 6 years, the first three years are preclinical and the latter are the clinical years where the clinical rounds take place in the different hospital departments.

Up till now the round in family medicine has been 6 weeks long during the fifth year, after the clinical rounds in internal medicine and pediatrics, before psychiatry and surgery. Our feeling has been that this works well and that the yield of students continuing for a residency in family medicine has also increased.

As part of the revision plan of the medical school it is now suggested to change the family medicine round to the sixth year (the final year) before all the elective rounds and after completion of all the hospital rounds.

I would appreciate it if you could inform me what is the practice in your respective medical schools and its length and what is your opinion on the changes suggested.

My concerns (from our previous experience when the family medicine round took place in the sixth year) are that the students arrive at the end of the road without a message that family medicine obtains a specific body of knowledge, when this might affect their choice in choosing a specialty in the future.

As the final meeting regarding this issue is this coming Thursday, any input would be appreciated.

Thank you in advance.

Best regards, Pesach Shvartzman


Prof. Pesach Shvartzman
Chairman, Division of Community Health
Ben-Gurion University of the Negev
POB 653
Beer-Sheva, 84105
Israel

Tel: 972-8-6477429/30
Fax: 972-8-6477636
Email: spesah@bgumail.bgu.ac.il

Stephan:
Do you have any "evidence" for the data you gave regarding:
1) "Late entry of students into family medicine clerkships does not produce
family docs", and
2) "Schools in the US that have the best rate of producing family docs tend
to have early clerkships in family medicine"...

Could others comment in "strategies" to produce more family doctors (an
interest in my institution), like the ones from Kirksville College of
Osteopathic Medicine commented by Stephan?

Thanks,
Howard

**************************
Howard Tandeter, MD
Department of Family Medicine
Ben-Gurion University,
Beer-Sheva
Israel
 

Howard:

The following article concluded that instituting third year clerkships resulted in an "immediate, significant increase" in the number of students selecting family medicine, whereas simply starting a Department of Family Medicine did not.

Campos-Outcalt D, Senf J.A longitudinal, national study of the effect of implementing a required third-year family practice clerkship or a department of family medicine on the selection of family medicine by medical students. Acad Med 1999 Sep;74(9):1016-20

Stephen

Stephen L. McKernan, ND, DO, FAAFP
Director, Family Practice Residency Program
Kirksville College of Osteopathic Medicine
800 West Jefferson Street
Kirksville, MO 63501
(660) 626-2637
Fax (660) 626-2922
smckernan@kcom.edu