title: Student specialty plans, clinical decision making, and health care reform.
abstract: OBJECTIVE
  Health care reform aims to increase evidence-based, cost-conscious, and patient-centered care. Family medicine is seen as central to these aims in part due to evidence of lower cost and comparable quality care compared with other specialties. We sought evidence that senior medical students planning family medicine residency differ from peers entering other fields in decision-making patterns relevant to these health care reform aims.
  
  
  METHODS
  We conducted a national, anonymous, internet-based survey of senior medical students. Students chose one of two equivalent management options for a set of patient vignettes based on preventive care, medication selection, or initial chronic disease management scenarios, representing in turn evidence-based care, cost-conscious care, and patient-centered care. We examined differences in student recommendations, comparing those planning to enter family medicine with all others using bivariate and weighted, multilevel, multivariable analyses.
  
  
  RESULTS
  Among 4,656 surveys received from seniors at 84 participating medical schools, students entering family medicine were significantly more likely to recommend patient management options that were more cost conscious and more patient centered. We did not find a significant difference between the student groups in recommendations for evidence-based care vignettes.
  
  
  CONCLUSIONS
  This study provides preliminary evidence suggesting that students planning to enter family medicine may already have clinical decision-making patterns that support health care reform goals to a greater extent than their peers. If confirmed by additional studies, this could have implications for medical school admission and training processes.
authors.affiliation: Department of Family and Community Medicine, University of New Mexico.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Williams
authors.forename: Crystal
authors.initials: C
authors.lastname: Romney
authors.forename: Miria
authors.initials: M
authors.lastname: Kano
authors.forename: Randy
authors.initials: R
authors.lastname: Wright
authors.forename: Betty
authors.initials: B
authors.lastname: Skipper
authors.forename: Christina
authors.initials: C
authors.lastname: Getrich
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Susman
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Zyzanski
mesh_terms: D000328:Adult; D002321:Career Choice; D003365:Costs and Cost Analysis; D003657:Decision Making; D005194:Family Practice / Q000193:education*; D005260:Female; D018166:Health Care Reform / Q000191:economics*; D006801:Humans; D008297:Male; D018802:Patient-Centered Care / Q000191:economics* / Q000458:organization & administration; D011314:Preventive Health Services / Q000191:economics; D012959:Socioeconomic Factors; D013038:Specialization; D013337:Students, Medical / Q000523:psychology*