Primary Care Residency Choice and Participation in an Extracurricular Longitudinal Medical School Program to Promote Practice With Medically Underserved Populations

Kost, Amanda MD; Benedict, Joseph MPH; Andrilla, C. Holly A. MS; Osborn, Justin MD; Dobie, Sharon A. MD, MCP

doi: 10.1097/ACM.0000000000000075
Research Reports

Purpose: In 2006, the University of Washington School of Medicine (UWSOM) launched the Underserved Pathway (UP), an extracurricular longitudinal experience supporting student interest in caring for underserved populations. This study examined the association between UP participation and residency choice.

Method: The study population was 663 UWSOM graduates who matched to a residency from 2008 to 2011; 69 were UP participants. Outcomes included matching to primary care residencies (family medicine, internal medicine, pediatrics, or medicine–pediatrics). The authors calculated graduate rates and odds of UP participants versus nonparticipants matching to primary care residencies overall and to residencies in individual primary care specialties. This analysis included all graduates and 513 graduates who had dual interest in primary care and underserved care at matriculation. Of 336 graduates matching to primary care, the authors calculated rates of entering the individual specialties with respect to UP participation.

Results: UP participants matched at significantly higher rates than nonparticipants to primary care (72.5% versus 48.1%, adjusted odds ratio [OR] 2.2) and family medicine residencies (33.3% versus 15.0%, adjusted OR 2.9). Of graduates with dual matriculation interest in primary care and underserved care, 73.4% of participants versus 53.5% of nonparticipants matched to primary care (adjusted OR 1.9), and 31.2% of participants versus 18.0% of nonparticipants matched to family medicine (adjusted OR 2.1). Of primary care matched graduates, 46.0% of participants versus 31.1% of nonparticipants entered family medicine.

Conclusions: Supporting student interest in underserved careers is associated with higher rates of graduates entering primary care residencies, specifically family medicine.

Dr. Kost is assistant professor, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington.

Mr. Benedict is a fourth-year student, University of Washington School of Medicine, Seattle, Washington.

Ms. Andrilla is biostatistician and research scientist, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington.

Dr. Osborn is assistant professor, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington.

Dr. Dobie is professor, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington.

Funding/Support: Joe Benedict, MPH, received a Washington Academy of Family Physicians Foundation Family Medicine Research Externship Grant to support his work with data acquisition. Amanda Kost, MD, received a UW Department of Family Medicine Research Grant to support data analysis.

Other disclosures: None reported.

Ethical approval: The University of Washington Human Subjects Division approved this study.

Previous presentations: Society for Teachers of Family Medicine Medical Student Education Annual Meeting. Primary care career fidelity and a longitudinal experience to support student interest in the underserved. PEER Works in Progress; February 2012; Long Beach, California. Society for Teachers of Family Medicine Annual Meeting. The underserved pathway: Lessons and outcomes. Lecture–discussion. April 2012; Seattle, Washington.

Correspondence should be addressed to Dr. Kost, Health Sciences Center (E-304), Box 356390, Seattle, WA 98195; telephone: (206) 543-9425; fax: (206) 543-3821; e-mail: akost@uw.edu.

© 2014 by the Association of American Medical Colleges