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Acad Med. 2018 Jan;93(1):90-97. doi: 10.1097/ACM.0000000000001816.

A National Longitudinal Survey of Medical Students' Intentions to Practice Among the Underserved.

Author information

1
T.F. O'Connell is a second-year internal medicine resident, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois. S.A. Ham is senior statistician, Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois. T.G. Hart is a third-year general surgery resident, Pritzker School of Medicine, University of Chicago, Chicago, Illinois. F.A. Curlin is Josiah C. Trent Professor of Medical Humanities, Trent Center for Bioethics, Humanities & History of Medicine, School of Medicine, Duke University, Durham, North Carolina. J.D. Yoon is assistant professor of medicine, MacLean Center for Clinical Medical Ethics, Department of Medicine, University of Chicago, Chicago, Illinois.

Abstract

PURPOSE:

To explore students' intentions to practice in medically underserved areas.

METHOD:

In January 2011, 960 third-year medical students from 24 MD-granting U.S. medical schools were invited to participate in a survey on their intention to practice in a medically underserved area. A follow-up survey was sent to participants in September 2011. Covariates included student demographics, medical school characteristics, environmental exposures, work experiences, sense of calling, and religious characteristics.

RESULTS:

Adjusted response rates were 564/919 (61.4%, first survey) and 474/564 (84.0%, follow-up survey). Among fourth-year medical students, an estimated 34.3% had an intention to practice among the underserved. In multivariate logistic regression modeling, predictors for intentions to practice among the underserved included growing up in an underserved setting (odds ratio [OR] range: 2.96-4.81), very strong sense of calling (OR range: 1.86-3.89), and high medical school social mission score (in fourth year: OR = 2.34 [95% confidence interval (CI), 1.31-4.21]). International experience was associated with favorable change of mind in the fourth year (OR = 2.86 [95% CI, 1.13-7.24]). High intrinsic religiosity was associated with intentions to practice primary care in underserved settings (in fourth year: OR = 2.29 [95% CI = 1.13-4.64]).

CONCLUSIONS:

Growing up in medically underserved settings, work experience in religiously affiliated organizations, very strong sense of calling, and high medical school social mission score were associated with intentions to practice in underserved areas. Lack of formative educational experiences may dissuade students from considering underserved practice.

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