Changes in the patterns of specialties selected by high and low academic performers before and after 1980.
BACKGROUND
The goal of this study was to examine whether recently observed changes in the distribution of medical school graduates' choices are linked to level of academic achievement, graduation year, or both.


METHODS
The authors studied the specialty selections made by two groups of graduates of the University of Kentucky College of Medicine: 319 who were elected to Alpha Omega Alpha and 276 who ranked academically in the bottom 10% of their classes. They also divided the groups into two time frames: 1964-1979 and 1980-1991. Two-way factorial analyses of variance compared the distributions of specialty selections according to time frame and to academic group.


RESULTS
Significantly higher percentages of students in the low-achievement group selected primary care specialties (F = 14.76, p < .001), and this difference between the academic groups increased in recent years: 67% versus 41% in 1980-1991 compared with 53% versus 46% in 1964-1979.


CONCLUSIONS
The specialty options most readily available to academically low-achieving medical school graduates are narrowing. Low achievers may be funneled into primary care simply because they cannot compete for other specialties. The authors recommend that: (1) recruitment and selection into primary care specialties should be made only after each candidate has been assessed over a broad range of cognitive and noncognitive factors and (2) academically low-ranking graduates should not end up in primary care specialties simply because no other specialty options are available to them.
Jarecky
R K
RK
University of Kentucky College of Medicine, Lexington.
Donnelly
M B
MB
Rubeck
R F
RF
Schwartz
R W
RW
D000704:Analysis of Variance; D001290:Attitude; D002321:Career Choice; D004503:Education, Medical, Graduate; D004522:Educational Status; D005069:Evaluation Studies as Topic; D005163:Factor Analysis, Statistical; D006801:Humans; D007389:Internal-External Control; D007396:Internship and Residency; D007629:Kentucky; D008019:Life Style; D008511:Medicine / Q000592:standards / Q000706:statistics & numerical data*; D010560:Personnel Selection; D008486:Physician Executives / Q000523:psychology; D010818:Practice Patterns, Physicians'; D012570:School Admission Criteria; D013038:Specialization; D013997:Time Factors; D000078329:Workforce; D016526:Workload