Family practice bashing as perceived by students at a university medical center

Medical schools are being asked to produce more family physicians, but it is not always clear how this can be accomplished. Previous research has focused on students' characteristics and attitudes that predict specialty choice but has paid less attention to feedback they receive in the academic medical center environment.

In early 1993, a self-administered questionnaire was mailed to 160 students from all classes of the University of California, San Francisco Medical School who had previously shown interest in family practice. Data are shown for the 138 respondents.

Most students from all years had received positive feedback about their interest in family practice, usually from family physicians. By the fourth year, 95% of students had received negative feedback, usually from physicians in other specialties. Many students gave poignant examples of pejorative comments about family practice by faculty and house staff. Negative feedback seemed strongest at the time students were making decisions about residency. By the fourth year, only 39% of these previously interested students chose family practice.

Serious efforts to encourage students to enter family practice must address the problem of negative feedback from other specialties. To promote positive feedback, contact with family physicians should be increased, especially in the third and fourth years.