Care Careers Research Articles

Are health care careers losing their lustre?

It’s no secret that Canada’s health systems are struggling. But are stories of increasing stress, burnout, harassment, and staffing challenges taking the shine off health care careers? More than one in 10 physicians, one in six personal support workers, and nearly one-quarter of nurses say they

Ethical consideration for neurodevelopmental disorder pathway service evaluation and research

The Disabilities Act of 1990 and the Developmental Disabilities Assistance and Bill of Rights Act of 2000 of United States in act to prevent social exclusion of people with intellectual and developmental disabilities (IDDs) and to cut back on unneeded expenditures to society. However, despite the protective legislation, the rights of adults with neurodevelopmental disorders have not yet been fully realised. There are several obstacles to overcome the neurological development related health care services, including health care usage, educational and career pathways, family and social lives, self-fulfilment, and quality of life. There are significant gaps in the transition process that affect the health care systems. Lack of transition and transfer planning, neurodevelopmental disorder health care pathway services have lack of experience, education, and expertise which result the inadequate growth of the health care quality and create communication gap in between service providers and service users. The aim of this short communication is to mention and clarify the ethical concerns of neurodevelopmental service evaluation.

The perception of teachers and students about clinical reasoning in health care careers

Clinical reasoning (CR) is a training mainstay in health care careers. To describe the perception of students and teachers about the development of clinical CR in Kinesiology and Dentistry careers. Exploratory descriptive qualitative study, with 12 informants (six teachers and six students), applying a script of questions through a semi-structured interview. A thematic inductive data analysis was carried out. Two hundred thirty-five meaning units, 38 codes, seven subcategories and three categories were collected. CR was reported as a basic analysis process in health care training. Its necessary elements are knowledge, a learning environment and a facilitator teacher, among others. Motivation, analysis models, variability and exposure are reported as facilitating factors for the development of CR. Teacher paternalism, resistance to change and few learning opportunities are presented as obstacles. Active strategies such as clinical cases, simulation and clinical practice are perceived as facilitators for the development of CR. Those situations where the student does not assume a leading role such as lectures and activities in large groups, are considered as obstacles. Both students and teachers point to CR as an analysis process that is indispensable in both careers. Exposure to variable educational experiences through active educational strategies in small groups encourages CR.

The influence of intensive care unit culture and environment on nurse decision-making when managing vasoactive medications: A qualitative exploratory study.

Nurses working in intensive care units make autonomous decisions to manage high-risk vasoactive medications in critically ill patients. Noradrenaline (norepinephrine) is a vasoactive medication commonly administered to patients in intensive care units. The influence of unit culture and environment on nurse-decision-making on noradrenaline (norepinephrine) management is unknown. The study aimed to investigate nurses' perceptions of the impact of interpersonal interactions, socialisation, and the intensive care environment on decision-making when managing noradrenaline (norepinephrine). An exploratory qualitative study applied thematic analysis to focus group data. A purposive sample of nineteen nurses participated in four focus groups at two intensive care units in Melbourne, Australia, from March to June 2021. The COREQ checklist was used to guide study development and no patients or members of the public were involved in focus groups. Three themes were generated from the researcher's interaction with data, Nursing and Medications; Culture and Decision-making; and a Safe Practice Environment. Nurses reported decision-making challenges associated with learning to manage noradrenaline (norepinephrine) early in their intensive care career and discussed feelings of isolation due to staffing resources, and the configuration of the intensive care environment. Nurses developed titration and weaning strategies to support decision-making in the absence of evidence-based algorithms. Empathetic patient allocation early in nurses' intensive care careers facilitated a safer learning environment, and reduced isolation inherent in single room intensive care units. Nurses developed and used titration and weaning strategies, often learnt from other clinicians to manage practice uncertainty. Management of noradrenaline (norepinephrine) is core business for intensive care nurses worldwide. Development of titration and weaning strategies by nurses indicated unmet need for guidelines to support decision-making. Identifying contextual elements that impact nurse management of high-risk medications can guide development of environments, resources and policies that support nurse decision-making, and reduce nurse anxiety and disempowerment.

Emerging Subspecialties in Neurology: Cortical Careers in Neuropalliative Care.

Serious neurologic illnesses are associated with significant palliative care (PC) needs, including symptom management, complex decision-making, support for caregivers, and end-of-life care. While all neurologists are responsible for the provision of primary PC, there is an increasing need for trained neurologists with expertise in palliative medicine to manage refractory symptoms, mitigate conflict around goals of care, and provide specialized end-of-life care. This has led to the emergence of neuropalliative care (NPC) as a subspecialty. There are different ways to acquire PC skills, incorporate them into one's neurology practice, and develop a neuropalliative carer. We interviewed 3 leaders in the field of NPC, Dr. Robert Holloway, Dr. Jessica McFarlin, and Dr. Janis Miyasaki, who are all neurologists with different subspecialties and training pathways working in academic centers. They share their career paths, their advice for neurology trainees interested in pursuing a career in NPC, and their thoughts on the future of the field.

The Creation of Classism in Medical Education: "Time" as a Form of Social Capital in First-Generation Low-Income Students.

Purpose: Previous research has noted that first-generation, low-income (FGLI) medical students experience “everyday forms of classism” because their social backgrounds are different from the typical medical student. 1,2 The reason for this difference is often described as FGLI students not having the right social capital 3 in the elite profession of medicine. 4 This study argues that not just any social capital creates classism in medical education, but specifically time as a form of social capital creates this system. Method: Using Sallee’s ideal worker theory 3 as a theoretical framework, this critical study explored the professional identity experiences of FGLI medical students. The ideal worker theory asserts that institutional structures, and the assumptions that lie beneath them, advantage some groups over others because those who are able to meet these expectations are better prepared to become an “ideal worker.” Data collection and analysis relied on a constructivist grounded theory approach, in which interviews were collected from 19 FGLI students from across the United States. Interview data were coded by a team of researchers for moments when students talked about how their status as FGLI students relates to time. Time was used as the unit of analysis because participants frequently referenced time when specifically discussing their struggles to meet the profession’s expectations. After the initial analysis focusing on where and how time was used, data were then categorized by how having time/not having time impacts them as physicians in training. Results: The results show that FGLI students expressed time as social capital in 3 ways. First, they indicated that because their parents had not completed higher education, they needed more time to figure things out in medical school. For example, participants discussed spending copious amounts of time trying to understand how to apply to medical school, learning how to create social networks, as well as having to explain medicine and their experiences as a medical trainee to their family members. Second, participants also described needing extra time because they had outside community commitments. Many were obligated to assist others in their family or neighborhood with their education. For example, many provided ongoing support to friends and family interested in a career in health care. They also had cultural expectations in their family and home life, which compromised their study time, and also needed to care for younger and older family members. Third, participants described that because they lacked economic resources, they were not able to take time for wellness and relaxation, such as vacations. They also described having to work to support their journey to and through medical school, which impinged on study time. Finally, because they relied on public transportation, essential activities of daily living such as laundry and grocery shopping took twice as long. Discussion: This study shows that in trying to meet the profession’s expectations as an ideal worker, FGLI students needed extra time, a form of social capital that is afforded to non-FGLI students by virtue of their relatively privileged familial background, but denied to those students whose parents either lack higher education or economic resources. As such, the time needed for FGLI students to meet medical education’s expectations is one of the mechanisms that helps to create, maintain, and reify medical education as a classist system. Significance: Although medical education has been previously labeled as a classist system, 1 how this system is created and reproduced has not been explored. This study demonstrates how time is the mechanism for keeping this system in place.

Factors Associated with Office-Based, Primary-Care Practice Among U.S. Medical Graduates: A National Cohort Study.

Purpose: Primary care (PC) career choice has been declining among U.S. medical graduates and residents since the 1990s. 1,2 By 2034, an estimated shortage of 17,800–48,000 PC physicians is expected. 2 Some medical schools have developed programs to increase students’ interest in PC specialties and practice in underserved areas. 3,4 To our knowledge, the durability of early PC-specialty preference for long-term PC practice has not been reported. Method: The Association of American Medical Colleges provided linked, deidentified data for a national cohort of 48,533 U.S. MD-granting medical school matriculants from 1998–1999 through 2000–2001. Data from the Student Records System (sex, race/ethnicity, and graduation year), Matriculating Student Questionnaire (MSQ; specialty board certification plans and attitudinal variables: importance of prestige and social responsibility in choosing a medical career), Graduation Questionnaire (GQ; total debt, plans to practice in underserved areas, and student ratings [excellent vs not excellent] of PC and non-PC clerkship experiences), and American Medical Association (AMA) Physician Masterfile practice data through May 2020 were used. The outcome was office-based practice in a specialty from the AMA Physician Masterfile, categorized as follows: (1) general-PC (i.e., internal medicine, pediatrics, family practice, general practice, internal medicine/pediatrics, or internal medicine/family practice as primary specialty, with another general-PC or unspecified secondary specialty), (2) PC-subspecialty (i.e., general-PC primary and PC-subspecialty secondary specialty, or PC-subspecialty as primary specialty), and (3) non-PC specialties (i.e., non-PC primary specialty). Multivariable logistic regression models identified variables independently associated with general-PC vs each of PC-subspecialty and non-PC-specialty practice. Results: Of 46,698 graduates in 2002–2013, 30,435 (65.2%) had complete data for analysis (7,700 [25.3%] general-PC physicians, 5,327 [17.5%] PC subspecialists, and 17,408 [57.2%] non-PC specialists). Female (vs male) students, and students with plans to practice in underserved areas (vs no plans) were more likely to report general-PC (vs PC-subspecialty) practice. Underrepresented racial/ethnic minorities in medicine (URiM), Asian/Pacific Islander (Asian/PI) students (each vs White), and students planning to pursue non-PC specialties or no board certification (each vs PC board certification plans) on the MSQ were each less likely to report general-PC (vs PC-subspecialty) practice. In the second model, female students and students reporting plans to practice in underserved areas (vs no plans), endorsing higher importance of social responsibility, or rating only PC clerkships excellent (vs rating both PC and non-PC clerkships excellent) were each more likely to report general-PC (vs non-PC-specialty) practice. URiM, Asian/PI students, students planning to pursue non-PC or no board certification, and students endorsing higher importance of prestige were each less likely to report general-PC (vs non-PC-specialty) practice. Discussion: Several factors were associated with future PC practice. The greater likelihood of women and lower likelihood of URiM graduating students to choose PC specialties on the GQ has been reported. 1 We extend this work, finding lower likelihood of URiM and A/PI physicians to be in general-PC practice. Importantly, early preference for PC specialties was positively associated with general-PC practice in both models. This may reassure medical schools considering early specialty preferences for admissions or entry into early, PC-pathway programs. Although clerkship experiences might influence students to change specialty interests, 5 to our knowledge, associations between clerkship experiences and PC practice have not been examined. We observed that students reporting excellent PC-clerkship experiences were more likely to report general-PC (vs non-PC) practice. Greater importance of social responsibility in choosing medicine also was positively associated with general-PC (vs non-PC) practice. Significance: Medical school experiences that are amenable to intervention were associated with greater odds of general-PC practice. Admitting students with early interest in PC specialties or who highly value social responsibility, fostering students’ plans to practice in underserved areas, 3,4 and improving PC-clerkship experiences may help mitigate the PC-physician shortage. Acknowledgments: The authors thank Hershel Alexander, PhD, Marie Caulfield, PhD (retired), David Matthew, PhD, and Lindsay Roskovensky, at the Association of American Medical Colleges (AAMC), for their efforts to obtain and prepare the deidentified datasets from various sources and their assistance with data coding; the National Board of Medical Examiners (NBME) Office for Research Strategy for permission to use Step 1 licensing examination data; Kristy Vanderplow at MMS, Inc., for provision of the American Medical Association (AMA) Physician Masterfile data; and Maria Pérez, MA, at Washington University School of Medicine, for data management and preparation of the data for analysis.

Evolving Needs of Critical Care Trainees during the COVID-19 Pandemic: A Qualitative Study.

Critical care trainees were integral in the coronavirus disease (COVID-19) pandemic response. Several perspective pieces have provided insight into the pandemic's impact on critical care training. Surveys of program directors and critical care trainees have focused on curricular impact. There is a lack of data from the trainee perspective on curricular enhancements, career development, and emotional and well-being needs to succeed in a critical care career in the ongoing COVID-19 pandemic. Our objective was to elicit perspectives from critical care trainees on their personal and professional needs as they continue to serve in the COVID-19 pandemic. This was a hypothesis-generating qualitative study. Individuals in a U.S. critical care training program during the COVID-19 pandemic participated in either focus groups or semistructured interviews. Interviews were conducted between July 2020 and March 2021 until data saturation was achieved. Audio recordings were professionally transcribed and analyzed using qualitative content analysis. A codebook was generated by two independent coders, with a third investigator reconciling codes when there were discrepancies. Themes and subthemes were identified from these codes. Thirteen participants were interviewed. The major themes identified were as follows: 1) Curricular adaptation is necessary to address evolving changes in trainee needs; 2) COVID-19 impacted career development and highlighted that trainees need individualized help to meet their goals; 3) receiving social support at work from peers and leaders is vital for the sustained well-being of trainees; 4) fostering and maintaining a sense of meaning and humanity in one's work is important; and 5) trainees desire assistance and support to process their emotions and experiences. The needs expressed by critical care trainees are only partially captured in conceptual models of physician well-being. The need for multilevel workplace social networks and identifying meaning in one's work have been magnified in this pandemic. The themes discussing curricular gaps, career development needs, and skills to process work-related trauma are less well captured in preexisting conceptual models and point to areas where further research and intervention development are needed.

The impact of volunteering with a student-run free clinic on medical student specialty selection

BackgroundThe shortage of primary care physicians in the United States is expected to grow to 17,800–48,000 physicians by 2034. Student Run Free Clinics are an increasingly popular component of medical schools and may provide an avenue for increasing medical student interest in primary care specialties. However, there is limited research on the impact of Student Run Free Clinics on medical student specialty choice. This investigation sought to determine whether volunteering with the Interprofessional Community Clinic (ICC), the Student Run Free Clinic associated with Chicago Medical School, was associated with an increased likelihood of matching into primary care specialties. Secondarily, the authors investigated associations between volunteering and matching into family practice. Finally, the authors explored associations between volunteering and the competitiveness of specialty choice.MethodsThis retrospective review utilized data on medical school graduates from 2015 – 2021 including their matched specialties, the number of ICC shifts they volunteered for, and whether they held an ICC leadership position (executive officers). Primary care specialties were defined as internal medicine, family practice, pediatrics, or combined internal medicine/pediatrics. Residency fill rate was used as a proxy for competitiveness.ResultsThis analysis included 506 medical students (254 ICC volunteers and 252 non-volunteers). Among ICC volunteers, 47.2% matched into a primary care specialty compared to 36.5% of non-volunteers (RR 1.29, 95% CI 1.05–1.59). Each additional shift worked at the ICC was correlated with increased odds of matching into family practice by a factor of 1.042 (95% CI 1.005–1.079).ConclusionsMedical students who volunteered with the ICC were more likely to match into primary care residencies. Students who volunteered more frequently were more likely to match into family practice. Further investigation is warranted to determine whether these associations are causative and could thus be leveraged to encourage medical students to pursue primary care careers.

The Chain Mediating Effect of Network Behavior and Decision Self-Efficacy between Work Skills and Perceived Employability Based on Social Cognitive Theory.

The purpose of this study is to investigate the chain mediating effects of networking behaviors and decision self-efficacy between work skills development and perceived employability. Structural equations modeling is used to analyze data collected from 813 Chinese students. The results show the following: first, the work skills development is positively correlated with perceived employability. Second, network behavior and decision self-efficacy each have a mediating effect between work skills development and perceived employability. Finally, this study found a chain mediating effect of network behavior and decision self-efficacy between work skills development and perceived employability. Therefore, this research shows that Work-Integrated Learning (WIL) needs to focus not only on skills development and employability outcomes but also on developing a strong network-based platform for stakeholders. In addition, higher education institutions and workplaces should also provide career guidance and counseling centers to help students build confidence in career decision-making and ensure students' mental health care and healthy career development.

Veterinary medical student perceptions of companion animal primary care as a career choice over an academic year.

Despite companion animal primary care being the most common career choice for veterinarians, relatively little is known about students' perception of this career choice. In this study, the authors examined students' (233 at Time 1 and 119 at Time 2) perceptions of careers in companion animal primary care and whether perceptions changed over the course of an academic year or differed by year in veterinary school. The study was conducted by an online questionnaire sent to the student email listserv and the results analyzed by Mixed ANOVAs for each perception outcome. The study concluded that a majority of veterinary students have companion animal primary care as their preferred career choice and have a positive perception of it as a career choice. This positive perception increased over the course of an academic year, but did not differ significantly by year in school. First year students had a decrease in perception of level of training over time. This study sets a baseline for students' perceptions of companion animal primary care as a career choice at one college of veterinary medicine.

Indigenizing Medicine.

The drive to the reservation took me through busy highways and shopping centers, then slowed down on winding roads through rising hills and rocky scenes. Just an hour-long drive from the University of California San Diego campus took me to a drastically different landscape, both geographically and culturally. The Tribal Ambulatory Healthcare Experience, an elective created by our Association of Native American Medical Students, provided a formative experience for me as a Chickasaw medical student. Everyone was so kind and welcoming as I found my way to my preceptor’s office at the Indian Health Center. This is not always the experience of a medical student navigating a new clinic. My preceptor, who grew up on a nearby reservation, went out of his way to introduce me and even emailed my picture with a short biography to the staff. It seemed like everyone was family and they made me feel right at home. It was clear that the staff had great relationships with each other and their patients. When discussing the day ahead, they knew the patients’ stories and families. When patients called or came into the office, they were greeted as relatives. I began to notice a stark difference in the treatment of patients as family, rather than strangers or customers. We first saw an adolescent girl with an inflamed inguinal lymph node and ordered tests to check for sexually transmitted infections. When we disclosed that she was positive for chlamydia and that we would prescribe antibiotics, I noticed how comfortable she seemed discussing a sensitive issue—evidently due to the long-standing relationship she had with my preceptor. After taking time to answer her questions, she inquired about my medical training and mentioned her own interest in becoming a lab technician. My preceptor suggested she consider a local medical assistant program, which she was visibly excited to hear about. Throughout the day, I observed how youths and adults alike were comfortable opening up to my preceptor. Whether discussing career advice or recommending nearby hiking trails for exercise, each patient was met with care attentive to their Native identity and where they lived. I even learned there was a sweat lodge in the back of the clinic to foster holistic and communal healing. Receiving care within this relational context fostered trust in the clinic staff, many of whom were community members. Trust in a government structure like the Indian Health Service (IHS) is rightfully hard to build, but placing relationships at the center of care allowed my preceptor to do so. This is not the typical approach that has been modeled to me in medical school. I am often taught to empathize with patients, but to stay removed; to acknowledge culture, but keep it disintegrated from Western medicine. Yet, it was easy to see how relationship-centric care was making an impact on this community. This approach to care is an ideal way to promote health equity on a broad scale. Within a space of trust, we might be better able to promote open communication to guide care, health literacy for patients, adherence to treatment regiments, and continuity of care. On my drive back through those same serpentine roads, I thought of our patients that day. I thought of their comparison to reductive statistics in literature: sexually transmitted diseases, diet and exercise counseling, painful peripheral neuropathy from chronic alcohol consumption. Each visit personified how structural determinants of health drive inequity in Native communities. These are not problems unique to Indigenous peoples but a fault of our systems. They are the result of inadequate federal resources allocated to Indigenous health; food deserts and abused ecosystems; and the trauma of genocide, dispossession, and assimilation still carried in Indigenous bodies and minds. In the face of all these issues, how can I advocate for a healthier future for tribal nations? My preceptor showed me how relationship-centric care fosters medical trust and builds community. Within this space, I saw the potential to impactfully care for individuals and families. This requires longitudinal commitment to a place and people. It specifically requires training a workforce made up of community members. IHS facilities nationwide are understaffed and experience significant turnover. We must encourage Native youth to consider careers in health care, just as my preceptor and I did in conversation at clinic. And then, I think about how I will bring Indigenous values into Western medicine; how I can relate to the whole person in front of me, rather than tending toward efficiency and detachment; how I will see where our systems may have positioned them and take time to build trust; how I will see my patient’s health as tied to their culture, land, and community. Indigenizing medicine certainly has the potential to promote health equity, but also enables us to see and partake in the interconnected human experience.

Comfort With Uncertainty in Medical Students and Their Residency Choice: A Residency Research Network of Texas Study.

Little is known about how comfort with uncertainty (CwU) influences career choice in medical students. The authors of this study examined the correlation between CwU and primary care career choice. In academic years 2017-2018 and 2018-2019, the authors distributed surveys to third-year medical students from eight US medical schools, seven in Texas. The survey tool included two CwU scales and one comfort with ambiguity scale. Other questions covered career plans, family and personal background, and student debt. In the subjects' fourth year of medical school, authors obtained match data from the medical schools and the authors further communicated with the students where indicated. The primary outcome was the composite score of the three scales correlated to career choice, with a focus on primary care and family medicine. Among 642 participants, there was no difference in CwU scores between students who matched into primary care versus specialty fields (3.39 vs 3.37 average of three scales, P=.65, each individual scale NS) or family medicine (FM) vs all other fields (3.39 vs 3.37 average of three scales, P=.81). Other bivariate predictors of FM choice were more similar than different to previous studies, such as osteopathic more likely than allopathic, lower family income, planning to care for underserved populations, and had a primary care role model. Logistic regression found the two biggest predictors of FM were osteopathic training and the importance of educating patients about health promotion and disease prevention. We found no correlation between CwU and medical student career choice for primary care or FM. We discuss confounding factors that may impact results, as well as recommendations for medication education and public policy.

Views of Generation Z regarding care and care careers: a four-country study

Globally, life expectancy is increasing, as is the need for effective care responses to chronic health conditions, global emergencies and health disparities. Alongside this is a shortage of skilled caregivers. This four-country qualitative study investigates the views of ‘care’ and ‘care careers’ of Generation Z (the next generation to join the workforce). Four cross-cultural themes emerged: conceptualising care; objects and subjects of care; recognising the challenges of care; and appreciating care work. Discussed in relation to Tronto’s analysis of care, these themes illuminate Generation Z’s commitment to care and highlight the need for organisational and political action to attract young people to care careers.

Thinking About a Career in Post-Acute and Long-Term Care? Consider this Advice

Thinking About a Career in Post-Acute and Long-Term Care? Consider this Advice

Intergenerational Programs Spark Fountains of Youth, Creativity

Intergenerational Programs Spark Fountains of Youth, Creativity

Colorectal Cancer and Its Screening Among Public in the Western Region of Saudi Arabia.

Background: Colorectal cancer (CRC) is defined as a cancer that starts in the colon or the rectum. CRC is the most commonly diagnosed cancer among Saudi males and ranks third in female individuals. Awareness among the population about CRC symptoms, risk factors, and screening tests is essential for preventing further morbidity and mortality. This study aimed to assess CRC knowledge in the western region of Saudi Arabia, as well as awareness of CRC risk factors, symptoms, and screening based on various demographic data.Methods: We conducted a cross-sectional study with a representative random sample of 358 Saudi residents in the western region. A self-administered questionnaire was distributed through social media sites starting from October 2021 till December 2021. Participants' awareness of CRC risk factors, symptoms, and screening was assessed using the questionnaire. For data analysis, we used SPSS Statistics, version 24 (IBM Corp., Armonk, NY).Results: Of the 385 participants, 76.4% were females, and most participants had a university degree level of education. Study respondents reported fear of colonoscopy as the top reason why they avoided CRC screening. Most participants (63.4%) showed insufficient knowledge. Certain factors showed a significant association with the participants' knowledge about CRC, such as age (p<.001), higher education (p=.002), and having a career in health care (p=.002).Conclusion: As the study resulted in overall insufficient knowledge about CRC among respondents, certain factors showed a significant association with the knowledge level. Raising awareness and health promotion programs should target older age groups and those with below university degree level of education to ultimately prevent morbidity and mortality related to colorectal cancer.

The Influence of Role Modeling and Mentorship on Primary Care Career Choice: What Can Be Gleaned From 30 Years of Research?

Role modeling and mentoring are key aspects of identity formation in medical school and likely influence student specialty choice. No reviews have examined the ways that mentorship relationships impact primary care career choice. We conducted a systematic literature search to identify articles describing the influence of role models and mentorship on primary care interest, intention, or choice. A content analysis of the included articles determined which articles focused on mentorship versus role modeling and the definitions of each. We coded articles as groundwork, effectiveness, or impact depending on the methodology and outcomes of each study. Searches yielded 362 articles, of which 30 met inclusion criteria. Three offered definitions of role modeling, and one compared and contrasted definitions of mentoring; 17 articles laid groundwork that indicated that role modeling and mentorship are important factors in career choice and specifically in primary care. Thirteen articles reported the effectiveness and impact of role modeling and mentoring in influencing intent to enter primary care or actual career choice. Primary care and non-primary care physicians influenced student interest, intent, and choice of primary care careers; this influence could be positive or negative. Role modeling and mentorship influence primary care career choice. Very few articles defined the studied relationships. More work on the impact of mentorship and role modeling on career choice is needed.

The Impact of Family Medicine Interest Groups and Student-Run Free Clinics on Primary Care Career Choice: A Narrative Synthesis

Student-directed activities such as family medicine interest groups (FMIG) and student-run free clinics (SRFC) have been examined to discover their impact on entry into family medicine and primary care. The objective of this review was to synthesize study results to better incorporate and optimize these activities to support family medicine and primary care choice. We conducted a comprehensive literature search using PubMed, Scopus, and CINAHL to identify all English-language research articles on FMIG and SRFC. We examined how participation relates to entry into family medicine and primary care specialties. Exclusion criteria were nonresearch articles, review articles, and research conducted outside the United States, Canada, Australia, and New Zealand. We used a 16-point quality rubric to evaluate 18 (11 FMIG, seven SRFC) articles that met our criteria. Of the nine articles that examined whether FMIG participation impacted entry into family medicine, five papers noted a positive relationship, one paper noted unclear correlation, and three papers noted that FMIG did not impact entry into family medicine. Of the seven articles about SRFC, only one showed a positive relationship between SRFC activity and entry into primary care. Larger-scale and higher quality studies are necessary to determine the impact of FMIG and SRFC on entry into family medicine and primary care. However, available evidence supports that FMIG participation is positively associated with family medicine career choice. In contrast, SRFC participation is not clearly associated with primary care career choice.

Institutional Characteristics Influencing Medical Student Selection of Primary Care Careers: A Narrative Review and Synthesis.

There is an ongoing shortage of primary care physicians in the United States. Medical schools are under pressure to address this threat to the nation's health by producing more primary care graduates, including family physicians. Our objective was to identify institutional characteristics associated with more medical students choosing primary care. We conducted a systematic literature review with narrative synthesis to identify medical school characteristics associated with increased numbers or proportions of primary care graduates. We included peer-reviewed, published research from the United States, Canada, Australia, and New Zealand. The existing literature on characteristics, including institutional geography, funding and governance, mission, and research emphasis, was analyzed and synthesized into summary statements. Ensuring a strong standing of the specialty of family medicine and creating an atmosphere of acceptance of the pursuit of primary care as a career are likely to increase an institution's percentage of medical students entering primary care. Training on regional campuses or providing primary care experiences in rural settings also correlates with a larger percentage of graduates entering primary care. A research-intensive culture is inversely correlated with primary care physician production among private, but not public, institutions. The literature on institutional financial incentives is not of high enough quality to make a firm statement about influence on specialty choice. To produce more primary care providers, medical schools must create an environment where primary care is supported as a career choice. Medical schools should also consider educational models that incorporate regional campuses or rural educational settings.