When do medical students identify career-influencing physician role models?

PURPOSE: To identify when medical students gain physician role models relative to when they make their specialty choices. METHOD: The 1998 graduating class of one medical school was surveyed about when and where they had made contact with their role models and whether they had made contact before or after making their specialty choices. Students also provided data about their demographics, curriculum pathways (problem-based or traditional), and specialty choices at matriculation and graduation. RESULTS: Of the 89 graduating seniors who responded (62%), 21 had role models they had known prior to matriculation, 51 had encountered their role models in medical school, and 51 had met their role models before making their specialty choices. Of the 51 students who had encountered their role models in medical school, 33 (65%) had done so before making their specialty choices. The mean time from matriculation to meeting a role model was 24.9 +/- 11.6 months, and students on the problem-based learning pathway had met their role models earlier than had students on the traditional pathway. CONCLUSIONS: Most medical students have physician role models at graduation, and many of these students identify their physician role models at a point when the interactions can influence their specialty choices.

The ability of a medical school admission process to predict clinical performance and patients' satisfaction.

PURPOSE: The authors evaluated the ability of a two-step admission process to predict clinical performance and patients' satisfaction on a third-year objective structured clinical examination (OSCE). METHOD: Subjects were three matriculating classes (1993, 1994, 1995) at one medical school. Data for the classes were analyzed separately. Independent variables were the Academic Profile (AP), an initial ranking of applicants based on grade-point ratio and MCAT scores, and the Selection Profile (SeP), an average of three interview scores. Interviews were offered based on AP rank, and admission was offered based on SeP rank. Dependent variables were total score on the faculty-graded portion of the OSCE and patients' satisfaction scores completed by the OSCE standardized patients. The authors evaluated the correlations between AP and OSCE performance and between SeP and OSCE performance. The authors also compared the OSCE performances of students whose ranks changed after interviews (SeP rank < AP rank or SeP rank > AP rank). The level of significance was adjusted for the number of comparisons (Bonferroni method). RESULTS: Complete data were available for 91% of eligible students (n = 222). No class showed a significant correlation between either AP or SeP rankings and OSCE performance (p > .01). Likewise, there was no difference in OSCE performance for students whose ranks changed after the interview. CONCLUSIONS: The admission ranking and interview process at this medical school did not predict clinical performance or patients' satisfaction on this OSCE.

Relationship between primary care practices in medical school admission and the matriculation of underrepresented-minority and female applicants.

PURPOSE: To determine whether primary care-oriented (generalist) admission practices at U.S. medical schools address physician workforce diversity issues by resulting in the admission of more members of underrepresented-minority populations or more women. METHOD: The authors performed cross-sectional, secondary analyses of databases from the Association of American Medical Colleges (AAMC). The independent variables were four generalist admission practices: generalist admission committee chair, greater representation of generalists on admission committee, offering preferential admission to likely generalists, and having a premedical recruitment activity targeting likely generalists. The control variable was public/private school ownership. The dependent variables were the mean ages of the matriculating classes and the proportions of students at each school who were African American, (total) underrepresented minorities, women, and married. RESULTS: Ninety-five percent of medical schools completed the AAMC's Survey of Generalist Physician Initiatives in either 1993 and 1994; 94% of matriculants replied to the AAMC's 1994 Matriculating Student Questionnaire. In multivariable analyses, no admission practice was associated with percentages of African Americans, total underrepresented minorities, or women. CONCLUSIONS: Schools with primary care-oriented admission practices did not admit greater percentages of underrepresented-minority students or women. Additional efforts may be required to attract and admit minority and female applicants.

Associations between primary care-oriented practices in medical school admission and the practice intentions of matriculants.

PURPOSE: To assess associations of primary-care-oriented medical school admission practices with matriculants practice intentions. METHOD: The authors performed cross-sectional, secondary analyses of databases from the Association of American Medical Colleges (AAMC). The independent variables were four medical school admission practices. The control variable was school ownership (public vs private). The dependent variables were the proportions of matriculants at each school interested in generalism, rural practice, and locating in a socioeconomically deprived area. RESULTS: One hundred and twenty medical schools (95%) completed the AAMC's Survey of Generalist Physician Initiatives in either 1993 or 1994; 94% of matriculants replied to the AAMC's 1994 Matriculating Student Questionnaire. Twenty-five percent of the schools had admission committee chairs who were generalists, half had over 25% generalists on their admission committees, 64% gave admission preference to students likely to become generalists, and 33% reported premedical recruitment efforts that targeted applicants likely to become generalists. In multivariable analyses, premedical recruitment efforts and public school ownership (all p < .01) were associated with greater interest of matriculants in both generalism and rural practice. CONCLUSIONS: Public medical schools and schools with premedical recruitment activities targeting future generalists admitted greater proportions of students interested in primary care and rural practice.

Who needs an immunization in a pediatric subspecialty clinic?

BACKGROUND: The Standards for Pediatric Immunization Practices recommends that subspecialty clinics screen children's immunization status and ensure the receipt of needed immunizations. OBJECTIVES: To determine the proportion of children presenting to a pediatric subspecialty clinic in whom immunization status can be assessed, and which of those assessed are due an immunization (eligible to receive an immunization on the day of clinic visit). DESIGN: Standardized survey of 196 patients or accompanying children presenting to a pediatric cardiology clinic. Need for immunizations was determined by the Advisory Committee on Immunization Practices recommendations. RESULTS: The reason for visit included 58% return (enrolled in the clinic), 25% initial, and 17% accompanying another patient. Usual immunization provider included 51% health department, 42% primary care physician, and 7% military. We could assess the immunization status of 79 (40%) of 196, and 19 (24%) of these 79 were due an immunization. Logistic regression analysis revealed that children enrolled in the clinic were more likely to be due for immunization than those presenting for initial visits (38% vs 8%; adjusted odds ratio, 7.42; 95% confidence interval, 1.43 to 38.55). CONCLUSIONS: We could not assess the immunization status of most children presenting to this pediatric clinic. Patients enrolled in the clinic were at increased risk for being due immunization. Having a primary care physician as a provider of immunizations did not ensure the receipt of immunizations. Pediatric subspecialists should assess the immunization status of their patients and make sure that they receive needed immunizations.