Letters to the Editor
Dwyer Brooks and colleagues have noted an important role for a longitudinal clerkship experience that addresses a core mission within their medical school for selected students (30–40 per year, or approximately 20%) who self-identify as being interested in primary care and/or rural medicine. While the vast majority of those students subsequently choose family medicine and/or primary care, some of this is undoubtedly due to the students' self-declared interest but also to the ability of the program to maintain that interest. Whether this type of clerkship could have a similar impact at different medical schools with different missions is unknown but worth discussion.
As the momentum builds for medical education reform, longitudinal integrated clerkships (LICs) as a model for clinical education will be part of the discussion,1 and career choice is but one aspect of LICs to consider. It remains important for the medical education community to recognize that what we know currently about LICs is predominantly based on (often) preliminary studies of select students working with select faculty; whether this approach can work for entire classes of medical students, or would have a broader effect on career choice, is unknown. More importantly, if there is not concomitant reform in the practice environment—a far more difficult process but one that contributes strongly to student career choice2 and drives changes in careers for practitioners3—we are likely to continue to lose ground for primary care careers, no matter what model of medical student clinical education we use.
Paul A. Hemmer, MD, MPH
Professor and vice chairman for educational programs, Uniformed Services University of the Health Sciences, Bethesda, Maryland; firstname.lastname@example.org.
2 Hauer KE, Durning SJ, Kernan WN, et al. Factors associated with medical students' career choices regarding internal medicine. JAMA. 2008;300:1154–1164.
3 Sox HC. Leaving (internal) medicine. Ann Intern Med. 2006;144:57–58.