How, when, and why do physicians choose careers in academic medicine? A literature review.

PURPOSE: Medicine has different pathways in which physicians pursue their vocation. Clinical practice, research, and academia are common paths. The authors examined the literature to identify research-based factors influencing physicians to choose a career path in academic medicine. METHOD: In the fall of 2006, the authors searched the PubMed database from 1960 to 2006 using the term career academic medicine. Review of articles resulted in the identification of nine themes relating to academic medicine career paths. The authors summarized the important and relevant articles to capture what the literature contributed as a whole to the larger question, "How, when, and why do physicians choose an academic career in medicine?" RESULTS: A synthesis of articles revealed that (1) values are essential to understanding the decision to enter a career in academic medicine, (2) factors associated with academic medicine career choice include research-oriented programs, gender, and mentors and role models, (3) an obstacle to pursuing this career path is loss of interest in academic careers during residency as residents learn about factors associated with academic careers in medicine, and (4) debt may be a barrier to choosing an academic career in medicine for some individuals in some specialties. CONCLUSIONS: Despite the study findings, the larger question (stated above) remains essentially unanswered in the literature. The authors propose a call to action by various professional groups and organizations to use rigorous and complex research efforts to seek answers to this very important question.

Professional development in geriatrics for community-based generalist faculty.

Generalist physicians provide most primary care for older people. Increasingly, undergraduate clinical education occurs in community sites. Hence, community-based generalist faculty members need continuing education in geriatrics to support clinical practice and teaching. The Geriatrics Scholars Program provided continuing medical education (CME) in geriatrics over a 3-year period to 88 participants. Sixty physicians completed 30 or more hours of education and were designated Geriatrics Scholars. On an anonymous exit survey, Scholars reported being better equipped to care for elderly patients and to teach geriatrics and improved patient care in specific aspects of geriatrics, including medication use, cognition, and functional assessment. In summary, community-based generalist faculty who participated in a substantial, 3-year program of geriatrics CME reported that their care of older people and their teaching of geriatrics were enhanced.

Study of Selected Outcomes of Medical Students Who Fail USMLE Step 1.

PURPOSE: Passage of the United States Medical Licensing Exam (USMLE) is required to obtain a medical license in the United States. Currently the majority of US medical schools require passage of USMLE Step 1 for either promotion to the third year or graduation from medical school. Virginia Commonwealth University School of Medicine (VCUSOM) requires that students take the USMLE but does not require passing of USMLE Step 1 for promotion or graduation. This policy enabled the authors to analyze performance outcomes during clinical rotations and monitor the residency match for a group of students who failed USMLE Step 1 on the first attempt. METHODS: Third year clerkship grades and residency match results were reviewed for 64 students of the graduating classes of 1999-2005 who failed Step 1 on the first attempt. An equal number of students who passed Step 1 were randomly selected from each class as a comparison group. Average clinical performance ratings, NBME subject exam scores and final third year clerkship grades for the two groups were compared. Residency match rates and specialty certification were also compared. RESULTS: The USMLE Fail Group had more Pass and fewer Honors clerkship grades than the comparison group. Subject exam scores were significantly lower in the USMLE Fail Group in all clerkships. Clinical performance ratings were significantly lower in the Fail group in three out of six clerkships: Internal Medicine, Pediatrics, and Psychiatry. However, 82% of the USMLE Fail Group later passed USMLE Step 1 and 2. Fifty-nine of the 64 students in the USMLE Fail Group matched for a residency, whereas all of the students in the Pass Group matched for a residency. CONCLUSION: Students who fail USMLE Step 1 have lower final clerkship grades due in part to lower NBME subject exam scores. The majority of these students, however, successfully pass USMLE Step 1 prior to graduation, go on to graduate medical training, and become board certified in their specialty.

The Self-Directed Learning Readiness Scale: a factor analysis study.

BACKGROUND: The practice of medicine demands that its physician practitioners are self-directed, life-long learners. The Self-Directed Learning Readiness Scale (SDLRS) intends to measure adults' readiness to engage in self-directed learning. PURPOSE: The present study assesses the underlying factor structure of the SDLRS for a sample of entering medical students. METHODS: Over a period of 6 years, 972 first year medical students at the Virginia Commonwealth University School of Medicine completed the SDLRS. To summarise the inter-relationships among variables, a principal axis factor analysis with oblique rotation was used on the 58 SDLRS items. A series of confirmatory factor analyses using LISREL 8.54 was performed to further examine the measurement model underlying the SDLRS. RESULTS: A 4-factor confirmatory model representing 4 correlated substantive factors and a reverse coding method factor fits these data well. CONCLUSIONS: Medical educators should hold limited expectations of the SDLRS to measure medical students' readiness to engage in self-directed learning. The definitions and theoretical assumptions that inform readiness for self-directed learning should be reconsidered. Alternative approaches to studying self-directed learning should be explored.

Understanding primary care residency choices: a test of selected variables in the Bland-Meurer model.

PURPOSE: This study tested the predictive validity of variables related to student characteristics of the Bland-Meurer Model of Career Decision-Making. METHOD: A study was conducted using Association of American Medical Colleges' Graduate Student Questionnaire and career data from one medical school. Logistic regression analyses generated predictive models of primary care residency choice, including family medicine, general internal medicine, and pediatrics for 555 medical school graduates over five years. RESULTS: Variables predictive of primary care residency choice were gender; student ratings of psychiatry, surgery, and internal medicine clerkships; not having participated in a research project in medical school; attitudes toward "the changing health care system on physicians" and "access to medical care"; and planned practice in a medically underserved area. Results differed for each field within each residency choice. CONCLUSIONS: The Bland-Meurer Model may be used for variable selection in multivariate predictive models of family medicine, internal medicine and pediatrics residency choice. The authors' results may help guide admissions decisions, while providing medical educators and health care policymakers with a clearer picture of residency choice and a better understanding of how to meet the demands of selected patient populations.

Predicting career decisions in primary care medicine: a theoretical analysis.

Entering the 1960s, more than half of the medical doctors in the United States were family physicians, pediatricians, or general internists. Today, about one-third of all U.S. physicians are primary care practitioners. Although opinions vary on the optimal ratio of primary care to specialty physicians, in the mid-1990s, the consensus among leaders in medicine was that more primary care physicians would be needed to ensure access to quality care. The target output of graduates was set for a minimum of 50% primary care physicians, and medical school admission committees responded. The present study examines research related to career decision making in primary care medicine. We address career decision making in primary care with the expectation that selection of a medical residency is based on multiple factors, and multivariate statistical techniques comprise the most appropriate statistical procedure for developing predictive models of medical student residency choice. Additional multivariate studies for simultaneous analysis of multiple dependent and multiple independent variables are needed to determine whether health policy planners and medical schools should continue to address the distribution of primary care physicians through medical school admissions. Further to enabling prediction, researchers must renew efforts to base investigations on theoretical models, summarizing and organizing previous research, and providing one another with means to focus future studies while building on previous work.

Electrifying a medical school course: a case study.

BACKGROUND: At Virginia Commonwealth University School of Medicine, the Dean charged the curriculum office to "electrify the curriculum." An instructional development team chose a 2nd-year course to serve as a model e-course and to provide evaluation data for a 2-year study. DESCRIPTION: The instructional development process used instructional and Web design principles. An evaluation plan included a number of data collection methods: e-mail surveys, a focus group, student diaries, and comprehensive end-of-course student assessments. The e-course allowed students to take advantage of learning opportunities that traditional face-to-face instruction normally does not. EVALUATION: Students found access to multiple images; interactivity; and meaningful, efficient navigation within the site to be useful. Web-based instruction shows promise to aid students in the transition from concept acquisition to complex "doctor thinking." It does not replace the need for human teachers. CONCLUSION: The authors conclude with instructional design suggestions to exploit the power of Web-based teaching for the enhancement of complex learning.