Dissertation Abstract

Predictors of Primary Care Residency Choice and Perceptions of Medical Practice of Virginia Commonwealth University School of Medicine Graduates

Purpose. To describe characteristics of Virginia Commonwealth University (VCU) medical student graduates (1998–2002) that chose a primary care residency and explore factors in the Bland-Meurer model that were predictive of primary care residency choice. Additional variables related to the students' perceptions of the medical practice environment were included in the analysis. Also, factors predictive of the three fields within primary care, internal medicine, family medicine, and pediatrics were explored.

Methods. A nonexperimental correlational study using a secondary data source was conducted. Association of the American Medical Colleges Graduate Student Questionnaire data was merged with data from VCU. Independent variables were demographic and aptitude information, clinical clerkship ratings, debt amounts, career choices, perceptions of the medical practice environment, and information related to volunteer community health and research activity participation while in medical school. Principle component analyses reduced questions related to the medical practice environment into two meaningful components. Logistic regression analyses generated predictive models for primary care, internal medicine, family practice, and pediatrics.

Results. Fifty-one percent of the 555 medical students in this sample chose primary care residencies. Variables predictive of a primary care residency choice were gender (female), lower ratings of the psychiatry and surgery clerkships, higher ratings of the internal medicine clerkship, choosing not to participate in a research project in medical school, disagreement with “negative effects of healthcare system”, agreement with “access to medical care is a problem”, and planning to practice in a medically underserved area. Results differed for each of the three fields within primary care.

Conclusions. Findings suggest clinical clerkship experiences and perceptions of the medical practice environment are associated with primary care residency choice. In addition, this study provides further evidence that physicians within primary care are not a homogenous group in terms of residency choice. Finally, variables included in this study related to each stage of the student section of the Bland-Meurer model appear to be useful in assessing primary care residency choice.

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