An elective primary care track in the preclinical years

Early exposure to primary care is hypothesized as a means of reducing attrition in primary care specialty preference over the course of medical school. This study evaluated an elective preclinical primary care track that featured generalist instructors as role models and a community office-based experience in the second year of medical school.

A total of 386 students from the University of Southern California graduating classes of 1991-1993 (both primary care track participants and nonparticipants) completed questionnaires on attitudes about primary care before and after the primary care track experiences. These pre- and post-second year data were linked with data for the same students from the Association of American Medical Colleges matriculation questionnaire and data on their specialty choices at graduation.

The primary care track, instituted during a period of declining interest in primary care among incoming students at our medical school, was not found to be associated with pre- and post-second year declines in participants' specialty preferences or attitudes toward primary care. Enrollment in the track and preclinical interest in primary care specialties were related to exogenous student characteristics (especially females). Enrollment was strongly predictive of primary care specialty choice at graduation but were not found to be related to students' anticipated debt levels for their medical education.

Use of a primary care track in the preclinical years may help stem the decline in interest in primary care known to occur over the course of medical school. Coupled with a primary care specialty choice, participation in the track is clearly related to choice of a primary care specialty at graduation.