February 26, 2019 03:50 pm Sheri Porter – The AAFP knows -- and statistics show -- that fewer than 13 percent of U.S. medical school graduates match to family medicine residency programs each year. The AAFP and others invested in increasing the ranks of family physicians nationwide are working on various fronts to drive those numbers upward.
As part of those efforts, in 2015 the AAFP invited 11,998 U.S. seniors -- all graduating AAFP student members that year -- to complete a survey designed to probe the perceptions and attitudes of medical students as they are making those critical decisions about specialty choice.
"Although student members of the AAFP are more likely to be interested in family medicine, the majority ultimately choose other specialties," wrote the authors.
A total of 1,814 students completed the survey. Of the 1,530 students who reported the specialty they ranked in the 2015 National Resident Matching Program Main Residency Match, 600 planned to enter family medicine and 930 chose other medical specialties.
Specifically, the survey asked students who were preparing to enter a variety of medical specialties about their impressions of respect and support for family medicine at their institutions, and the impact of those perceptions on their specialty choice.
The survey also posed questions about the effect of mentors and role models on specialty choice, as well as student involvement in family medicine interest groups (FMIGs) and AAFP student programs.
According to study authors, additional questions were asked of graduating students who planned to enter family medicine residencies; those queries focused on perceptions of support of the specialty by both family medicine and non-family medicine mentors and faculty.
Results of the survey were published in the February issue of Family Medicine in an article titled "Graduating Medical Student Perspectives on Factors Influencing Specialty Choice: An AAFP National Survey."
Readers should note that the AAFP and seven other national family medicine organizations are working together on the America Needs More Family Doctors: 25 x 2030 Student Choice Collaborative. The goal is to ensure that by the year 2030, 25 percent of combined U.S. allopathic and osteopathic medical school graduates choose family medicine as their specialty.
In their discussion, authors noted the importance of mentorship. "These data indicate that having faculty and mentors who are supportive of family medicine significantly influences students to choose family medicine," they wrote. Indeed, they said that support of family medicine mentors was "practically necessary" for family medicine specialty choice.
"More than 90 percent of students who reported family medicine as their first specialty choice also reported that they were supported by strong mentors in family medicine," said the authors. These same students also were more likely to say they had strong support from faculty and mentors outside family medicine.
"Perceived support for family medicine of the greater medical community has a strong influence on students," said the authors. Additionally, they noted that students who chose family medicine were more likely to believe that the future of the specialty was bright.
Authors were surprised at one finding that suggested students who chose family medicine were more likely to disagree with a statement saying family medicine was "a respected specialty at their medical schools."
Researchers hypothesized that students who had already chosen the specialty could have become more sensitive to actions and situations that they perceived as disrespectful of family medicine, or that students who were outspoken about their family medicine choice could have experienced "more microaggressions related to that choice."
Survey results also showed that students reported higher levels of interest in family medicine when they were more involved in an FMIG, attained a free AAFP student membership or participated in the AAFP's annual National Conference of Family Medicine Residents and Medical Students.
"Taken together, the results suggest that AAFP student support is important for maintaining and increasing student choice of family medicine but should not be the only strategy employed to do so," wrote the authors.
Corresponding author Amanda Kost, M.D., serves as an associate professor in the department of family medicine at the University of Washington in Seattle and practices full-spectrum family medicine at the Harborview Family Medicine Clinic there.
In an interview with AAFP News, Kost said the survey provided the AAFP with a "snapshot" of student attitudes about family medicine and a solid indication that Academy and medical school investments in student programs such as FMIGs and the AAFP's National Conference are a wise use of resources.
Regarding the importance of mentors in guiding medical students to family medicine, Kost said authors were not surprised that both family medicine and non-family medicine mentors played important roles.
She clarified that a student's circle of influential mentors is wider than just preceptors.
"It's all the folks students interact with -- FMIG faculty and local family physicians who participate in FMIG events, family medicine career advisors, preclinical instructors, family medicine researchers and family physicians like myself who also teach educational courses that support family medicine," said Kost.
Residents and peers also serve as important mentors because they allow students to see themselves in the future, she added.
Notably, Kost explained what she has come to believe is the biggest predictor for students choosing family medicine -- simply coming into medical school with high interest in the specialty. "Right when they hit that med school door, they already know they want to be in family medicine.
"If tomorrow, everyone admitted to medical school already considered family medicine their top specialty choice, we'd be in much better shape," she said.
Lastly, Kost provided a call to action for family medicine educators and family physicians in practice -- a short checklist of attitudes and activities that help bring students on board.
Related AAFP News Coverage
Leader Voices Blog: Finding the Right Mentor Is Worth the Quest