Building Interest in the Primary Care Specialty Through Enhanced Global Health Experience

Abstract

Background An overwhelming majority of matriculating medical students in the USA are keen to deliver quality health care to all people, including the socioeconomically disadvantaged populations in remote, resource-scarce regions nationally and worldwide. Here, we describe a protocol developed to evaluate the interest of our medical students in global health activities. We also examined the relationship between students' interest in global health and readiness to pursue a future career in the primary care specialty. Materials and methods We designed a survey in Qualtrics online software and reached all first-year and third-year medical students between 2019 and 2022 enrolled at the Alabama College of Osteopathic Medicine (ACOM). The survey utilized ordinal scale items to explore the medical students' interest in primary care residency programs, their interest in global health and international travel, and their perceptions of how a range of factors might motivate their desire to participate in global health activities. The study was approved by ACOM's Institutional Review Board (IRB). In order to compare findings from this study with data from other medical schools, we developed constructs using the national aggregate data, in percentages, from matriculants and graduates of Doctor of Osteopathic Medicine (DO) degree-granting medical schools according to gender, published by the American Association of Colleges of Osteopathic Medicine (AACOM). Statistical analysis of national aggregate data was performed using the unpaired t-test. Results Both female and male participants had lived or traveled abroad before starting medical school. Female (98%, n=249) and male (95%, n=140) participants in the first-year cohorts considered helping the underserved population as important or very important as it is related to a career in medicine. Females in the third-year cohorts (97%, n=71) also ranked this statement as important or very important compared to male cohorts (89%, n=31). A higher proportion of females (43%, n=108) compared to males (35%, n=52) in first-year cohorts agreed or strongly agreed that they would likely pursue a residency in primary care. More females (59%, n=43) than males (46%, n=16) in the third-year cohorts agreed or strongly agreed with the same statement. Analysis of the aggregate national data (2009-2022) revealed that the percentage (actual count not available) of female students who planned to practice in underserved/shortage area was higher both at the time of matriculation (M=51%, SD=4%) and before graduation (M=40%, SD=4%) compared to males (matriculation: M=40%, SD=5%; graduation: M=33%, SD=4%) presenting a significant difference (matriculation t(24)=6.7, p<0.0001; graduation t(24)=5.4, p<0.0001). Furthermore, a higher percentage of females at the time of matriculation (M=25%, SD=5%) and graduation (M=40%, SD=6%) planned to practice in the primary care specialties compared to males (matriculation: M=17%, SD=4%; graduation: M=29%, SD=6%) presenting a significant difference (matriculation: t(24)=4.6, p = 0.0001; graduation: t(24)=4.8, p<0.0001). Conclusions Interest in global health activities may be associated with interest in pursuing a future career in the primary care specialty. In this study, more female medical students expressed interest in participating in global health experiences, serving the underserved population domestically and abroad, and expressing interest in primary care than males.

Keywords: gender; global health education; higher education medical training; international and travel medicine; primary care.

Figure 1. Most survey respondents had traveled abroad

Figure 2. The relative importance of "helping the underserved" as it relates to a career in medicine (A) and "I will likely pursue a residency in primary care (i.e., family medicine, general internal medicine, or pediatrics)" (B)

Figure 3. Constructs developed by plotting selected data found in the Academic Year Graduating Seniors Survey Reports, and Academic Year Entering Student Survey Reports published by AACOM

Construct A: the percentage of entering class (solid dots) matched to the graduating class of seniors four years later (circles) who "Plan to practice in underserved/shortage areas" according to gender (female green, male yellow). Construct B: the percentage of entering class (solid dots) matched to the graduating class of seniors (circles) who "Plan to practice in primary care specialties" according to gender (female green, male yellow). The constructs were developed by plotting selected data found in the Academic Year Graduating Seniors Survey Reports, and Academic Year Entering Student Survey Reports published by AACOM in the years between 2009 and 2021. Ten points were matched between entering and graduating cohorts four years later. Entering classes (2006-09) was not available; similarly, points for graduating classes after 2021 were not included, since data was not yet available when constructs were developed.