Teaching medical students in community-based practices: a national survey of generalist physicians

This study was undertaken to determine the extent of medical student teaching by community-based generalists, differences between teachers and nonteachers, and physicians' perceptions and attitudes about teaching.

Two questionnaires were mailed to a random sample of 4974 generalist physicians in community-based practice in the United States including family physicians, general internists, and general pediatricians. The first survey instrument was a postcard with two questions; the second was a 4-page questionnaire sent to postcard responders. These mailings were supplemented by a telephone survey of nonresponders.

Forty-two percent responded to the postcard, and, of those, 47% responded to the questionnaire. Adjusted by the results of a telephone survey of postcard nonresponders, 30% of family physicians and general pediatricians and 20% of general internists taught medical students in their offices. The average teaching physician worked with three students per year for approximately 10 days each. Family physicians and general internists who had community-based educational experiences while in medical school were more likely to be teachers. Teachers were somewhat younger than nonteachers (year of medical school graduation 1977 vs 1973), but there were few other differences. Controlling for specialty, teachers did not differ from nonteachers in patient-care volume or payer mix of the practice. Teachers noted a 30-minute (median) lengthening of their workday when a student was present, and 30% saw fewer patients per day when a student was in the practice. Only 9% of the teachers reported being paid for their teaching. More than 90% of both nonteachers and teachers believed that students should receive part of their education in community-based practices.

Depending on specialty, 20% to 30% of community-based generalists teach medical students. Although teachers perceive that teaching lengthens their work day and may decrease productivity, the great majority of both teachers and nonteachers believe that community-based education is important.