The impact of an ambulatory rotation on medical student interest in internal medicine. The Society of General Internal Medicine Task Force on Career Choice in Internal Medicine.
OBJECTIVE
To determine whether students who take ambulatory rotations in internal medicine are more likely to choose internal medicine careers.


METHODS
National survey.


METHODS
The intended sample was 1,650 senior U.S. medical students from 16 medical schools, of whom 1,244 (76%) responded. Representative schools nationwide were selected using a stratified, random-sampling method.


METHODS
The questionnaire asked about characteristics of the ambulatory rotation, perceptions of internal medicine, and factors influencing students toward or away from an internal medicine career.


RESULTS
Ambulatory rotations were taken by 543 students (43%). Of these rotations, 73% were required, 74% were during the fourth year, 77% were in general internal medicine, 73% provided continuity of care, and 19% were during the medicine clerkship. Overall, 24% of the students chose careers in general (9%) or subspecialty internal medicine (15%). Thirty percent of the students who did ambulatory rotations planned internal medicine careers, compared with 19% of the students who had no rotation [odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.3 to 2.4, p = 0.0001]. This association was of similar magnitudes for students completing required rotations (OR = 1.6, 95% CI 1.2 to 2.2, p = 0.002) and for students completing rotations before or in proximity to when they chose careers (OR = 1.7, 95% CI 1.1 to 2.4, p = 0.01). Ninety percent of the 543 students who had ambulatory rotations were satisfied with the experience. Thirty-eight percent of the highly satisfied students chose internal medicine careers, compared with 21% of the students who had low or moderate satisfaction (p = 0.0001).


CONCLUSIONS
An ambulatory rotation is strongly associated with positive perceptions of, attraction to, and choice of a career in internal medicine. Research is needed to determine specific components of an effective rotation. Further development of ambulatory rotations could help attract more students to internal medicine.
Schwartz
M D
MD
Department of Medicine, New York University Medical Center, NY 10002, USA.
Linzer
M
M
Babbott
D
D
Divine
G W
GW
Broadhead
W E
WE
D000328:Adult; D000553:Ambulatory Care; D002321:Career Choice; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D008297:Male; D010865:Pilot Projects; D012189:Retrospective Studies; D013337:Students, Medical; D011795:Surveys and Questionnaires