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Attributes Affecting the Medical School Primary Care Experience

Jerant, Anthony MD; Srinivasan, Malathi MD; Bertakis, Klea D. MD, MPH; Azari, Rahman PhD; Pan, Richard J. MD, MPH; Kravitz, Richard L. MD, MSPH

doi: 10.1097/ACM.0b013e3181d29af7
Workforce

Purpose: Favorable primary care (PC) experiences might encourage more medical students to pursue generalist careers, yet academicians know little about which attributes influence the medical school PC experience. The authors sought to identify such attributes and weight their importance.

Method: Semistructured interviews with 16 academic generalist leaders of family medicine, general internal medicine, and general pediatrics led to the development of a Web-based survey, administered to a national sample of 126 generalist faculty. Survey respondents rated (on a nine-point Likert-like scale) the importance of each interview-generated PC medical school attribute and indicated (yes/no) whether outside experts' assessment of the attributes would be valid. The authors assessed interrater agreement.

Results: Interview thematic analysis generated 58 institutional attributes in four categories: informal curriculum (23), institutional infrastructure (6), educational/curricular infrastructure (6), and specific educational experiences (23). Of these 58, 31 (53%) had median importance ratings of >7 (highly important). For 14 of these (45%), more than two-thirds of respondents indicated external expert surveys would provide a valid assessment. Of the 23 informal curriculum attributes, 20 (87%) received highly important ratings; however, more than two-thirds of respondents believed that external expert survey ratings would be valid for only 4 (20%) of them. Strong agreement occurred among respondents across the generalist fields.

Conclusions: Academic generalist educators identified several attributes as highly important in shaping the quality of the medical school PC experience. Informal curriculum attributes appeared particularly influential, but these attributes may not be validly assessed via expert surveys, suggesting the need for other measures.

Dr. Jerant is associate professor, Department of Family and Community Medicine, University of California, Davis, School of Medicine, Sacramento, California.

Dr. Srinivasan is associate professor, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California.

Dr. Bertakis is professor, Department of Family and Community Medicine, University of California, Davis, School of Medicine, Sacramento, California.

Dr. Azari is lecturer, Department of Statistics, University of California, Davis, Davis, California.

Dr. Pan is associate professor, Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California.

Dr. Kravitz is professor, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California.

Correspondence should be addressed to Dr. Jerant, Department of Family and Community Medicine, University of California, Davis, School of Medicine, 4860 Y Street, Suite 2300, Sacramento, CA 95817; telephone: (916) 734-7081; fax: (916) 734-5641; e-mail: afjerant@ucdavis.edu.

© 2010 Association of American Medical Colleges