A community pre-registration year: the continuation of a community-oriented medical school curriculum

A voluntary community-based preregistration year (internship) was created for graduates of a community-oriented medical school in Beersheva, Israel. Graduates were placed in community clinics which had been upgraded to meet the needs of the programme through provision of on-site laboratory facilities and specialist consultation, and placement of social workers and health education personnel in the clinics. The graduates participated in a weekly postgraduate education programme directed to their specific needs. There was a high degree of satisfaction with the programme among the trainees, the clinic team members and the patients. Relatively few of the trainees indicated a desire to pursue careers entirely devoted to primary care, despite their positive evaluation of the pre-registration experience. Though this might have been explained by problems encountered in the programme, such as the lack of adequate on-site supervision and lack of support from the health service providers, external factors such as a general move of graduates towards more lucrative subspecialties and the relative lack of status of family practice were probably the more significant reasons. Increasing focus on the internship year, in addition to the undergraduate and residency periods, is needed to help direct medical education to ambulatory settings.