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Almost Internists: Analysis of Students Who Considered Internal Medicine but Chose Other Fields

Durning, Steven J. MD; Elnicki, D. Michael MD; Cruess, David F. PhD; Reddy, Shalini MD; Kernan, Walter N. MD; Harrell, Heather E. MD; Schwartz, Mark D. MD; Fagan, Mark J. MD; Battistone, Michael MD; Hauer, Karen E. MD

doi: 10.1097/ACM.0b013e3182045ee5
Specialty and Career Choice

Purpose: Medical students' career choices affect health care. To understand how to increase the number of students who choose careers in internal medicine (IM), students who seriously considered IM but chose another field (“Switchers”) and those who rejected IM (“Never Considered”) were compared with those who chose IM (“Choosers”).

Method: Fourth-year medical students from 11 U.S. institutions were surveyed about demographics, medical school educational experiences, and aspects of the specialty of IM. Univariate analysis and multivariate logistic regression models examined associations between student characteristics and classification as Switchers, Choosers, and Never Considered.

Results: A total of 1,177 students completed the survey (82% response rate). There were 274 (23%) Choosers, 398 (34%) Switchers, and 499 (43%) Never Considered. The authors' models explained over 80% of variance in these three career choice classification groups. For most responses, an increasingly favorable gradient from Never Considered to Choosers was observed. Multivariate analysis revealed six items that were associated with higher probability of choosing IM: types of patients internists see, timing of career decision, interest groups, intellectual challenge, satisfaction among internists, and the core IM clerkship.

Conclusions: Several potentially modifiable educational experiences and aspects of IM distinguished Switchers from the other two groups. The percentage of variance explained by group suggests that these findings identify important underpinnings of career decisions. These items also suggest ways that educational experiences and aspects of the specialty could be redesigned by academicians and policy makers to improve the attractiveness of IM careers.

Dr. Durning is professor of medicine and pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Elnicki is professor of medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Dr. Cruess is professor of preventive medicine and biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Reddy is associate professor of medicine and associate dean of student programs and professional development, University of Chicago Pritzker School of Medicine, Chicago, Illinois.

Dr. Kernan is professor of medicine, Yale University School of Medicine, New Haven, Connecticut.

Dr. Harrell is associate professor of medicine, University of Florida College of Medicine, Gainesville, Florida.

Dr. Schwartz is associate professor of medicine, Division of General Internal Medicine, New York University School of Medicine, New York, New York.

Dr. Fagan is professor of medicine, Alpert Medical School of Brown University, Providence, Rhode Island.

Dr. Battistone is staff physician, Veterans Affairs Salt Lake City Health Care System, and associate professor of medicine, University of Utah School of Medicine, Salt Lake City, Utah.

Dr. Hauer is professor of medicine, University of California, San Francisco, School of Medicine, San Francisco, California.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. Durning, Department of Medicine (NEP), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814-4712; e-mail: sdurning@usuhs.mil.

First published online December 16, 2010

© 2011 Association of American Medical Colleges