title: Educational and individual factors associated with positive change in and reaffirmation of medical students' intention to practice in underserved areas.
abstract: OBJECTIVE
  The projected U.S. physician shortage will disproportionately affect underserved areas. This study examined the impact of medical school educational experiences on positive changes in and reaffirmation of students' intention to practice in underserved areas (practice intention).
  
  
  METHODS
  Medical students (n = 7,361) from 113 U.S. MD-granting medical schools who graduated in 2009-2010 and responded to both the Association of American Medical Colleges' 2006 Matriculating Student Questionnaire and 2010 Graduation Questionnaire were included. Multilevel logistic regression analyses were conducted to determine factors associated with change in and reaffirmation of practice intention.
  
  
  RESULTS
  After controlling for individual characteristics, community health field experience (adjusted odds ratio [OR]: 1.36; 95% CI: 1.18, 1.57), learning another language (OR: 1.41; 95% CI: 1.22, 1.63), cultural competence/awareness experience (OR: 1.38; 95% CI: 1.21, 1.58), becoming more aware of perspectives of individuals from different backgrounds (OR: 1.24; 95% CI: 1.04, 1.48), and attending schools with higher social mission scores (OR: 1.66; 95% CI: 1.28, 2.16) were all significantly associated with positive changes in practice intention from matriculation to graduation. Field experience in community health (OR: 1.24; 95% CI: 0.99, 1.53), learning another language (OR: 1.29; 95% CI: 1.01, 1.65), and attending schools with higher social mission scores (OR: 1.62; 95% CI: 1.09, 2.43) were all significantly associated with reaffirmation of practice intention at graduation.
  
  
  CONCLUSIONS
  Multifaceted factors are associated with practice intention. This study suggests medical schools can play active roles in alleviating the physician shortage in underserved areas through targeted curricular interventions and recruitment.
authors.affiliation: Dr. Boscardin is associate professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. Dr. Grbic is senior research analyst, Association of American Medical Colleges, Washington, DC. Dr. Grumbach is professor, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California. Dr. O'Sullivan is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.
authors.forename: Christy K
authors.initials: CK
authors.lastname: Boscardin
authors.forename: Douglas
authors.initials: D
authors.lastname: Grbic
authors.forename: Kevin
authors.initials: K
authors.lastname: Grumbach
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Sullivan
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002321:Career Choice; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004504:Education, Medical, Undergraduate / Q000458:organization & administration; D005260:Female; D006801:Humans; D007206:Individuality; D033182:Intention; D016015:Logistic Models; D008297:Male; D008507:Medically Underserved Area; D015999:Multivariate Analysis; D016017:Odds Ratio; D011365:Professional Practice Location; D012577:Schools, Medical / Q000458:organization & administration; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult