By Melissa N Johnson, MD; Ariana Nestler, MD; Wesley Ng, MD; George Olsen, MD; Lucille Heimerl, MA; and Jill VanWyk, MD; University of Colorado School of Medicine, Department of Family Medicine, Aurora, CO

Abstract

Family medicine remains a crucial component of the health care system, providing care to communities across the United States. Despite the increasing need for family medicine graduates, US Medical Graduate match rates have been relatively stable in recent years. To address this, our undergraduate medical education team created a curriculum of family medicine exposure for first-year medical students as an optional elective. We then surveyed our students to assess changes in attitudes toward family medicine and interest in family medicine as a specialty. While long-term data is still needed to determine the impact on match rates into family medicine, the trends in attitude change and increased interest are promising.

Background

Family medicine makes up 40% of the primary care workforce as of 2019, yet the interest in the specialty has remained stagnant. In 2024, only 12.8% of US medical graduates matched into family medicine. To develop greater understanding and increase medical student choice of family medicine as a specialty, the AAFP calls for early exposure to the broad scope of family medicine, including office procedures, pregnancy care, and other focus areas (AAFP, 2023). Factors that discourage students from choosing family medicine include a limited number of role models practicing full-scope care, few positive experiences in primary care clerkships, lack of institutional support for family medicine, and beliefs about the specialty's lack of research and prestige (Lee 2022). To address these barriers, we developed a first-year elective to expose students to the specialty of family medicine, including full-spectrum care and fellowship opportunities, and then administered pre- and post-surveys to assess attitudes and interest.

Methods

The course was designed to fit within the requirements for first-year student electives, lasting 1-hour per week for 13 weeks. Seminars alternated between topical presentations and hands-on procedural workshops led by family physicians.

The course included sessions on suturing, addiction medicine, contraception, research in family medicine, gender-affirming primary care, maternal-child health in family medicine, underserved medicine, geriatric/palliative care, and sports medicine. Family physicians with expertise or fellowship training in these areas addressed specific content and described their clinical practice. Experiential workshops included suturing, LARC placement, OB ultrasound, and joint injections. The elective was pass/fail based on attendance.

In the first year, nine students participated in the elective. The following year, 35 students expressed interest, but due to limited funding and resources, we accepted 24 students. The course was advertised at an electives fair with flyers containing planned sessions and quotes from prior year survey comments. Our team includes a medical education fellow, an administration liaison, and two faculty members with dedicated protected time for undergraduate medical education work in our Department of Family Medicine. We offered snacks for sessions, provided suture kits for all students, and gave gift cards to our OB participants for volunteering for the ultrasound session.

Results

Students were surveyed before and after the course to evaluate changes in perception of family medicine and interest in the specialty.

Our data from 2022 and 2023 showed an increased interest in the specialty. In the 2022 pre-survey, 11.1% of students were slightly interested, 66.7% were moderately interested, and 22.2% were very interested, which increased to 28.6% moderately interested, 57% very interested, and 14.3% extremely interested. In the 2023 pre-survey, 4.8% were not at all interested, 23.8% were slightly interested, 57.1% were moderately interested, and 14.3% were very interested, which increased to 37.5% slightly interested, 37.5% moderately interested, 18.8% very interested, and 6.3% extremely interested. In both instances, all attendees did not complete the post survey. The students who chose to take our course were all undifferentiated and in addition to their interest in family medicine were also interested in sports medicine, pediatrics, emergency medicine, surgery, dermatology, internal medicine, physical medicine and rehabilitation, obstetrics and gynecology, urology and psychiatry.

We found no significant change in how students perceived research within family medicine or in their perceived community need for family medicine physicians.  Students preferred hands-on sessions and the ability to ask questions about physician career paths. They requested more information on the day-to-day of a family physician, finances, work-life integration, and research in family medicine (which was not included in the second year due to presenter illness).

Students had an overall positive experience and gave the following subjective reviews:

“I think that this was an amazing elective that really opened my eyes to the field of family medicine and definitely gave me something to consider.”

“I think this class was amazing. I learned so many things that I don't think we will be learning much about in our normal curriculum.”

“I LOVED the obstetrics ultrasound session and the end-of-life care panel we had.”

“Thank you so much! I learned so much and really enjoyed all the content. You did a fantastic job, especially for the first year. I hope that the elective stays around for a while so that students are able to experience it.”

“This course was a phenomenal introduction into family medicine, and I appreciated how varied and intentional all of our sessions were.”

Discussion

A weekly elective with hands-on and presentation-style workshops providing exposure to different focus areas and faculty in family medicine has a positive impact on early interest in the specialty. Student feedback indicates that exposure to diverse career paths, practical experiences, and potential mentors led to more interest in family medicine. While additional time and review are needed to assess the long-term impact on specialty choice, our department has determined the elective to be valuable and plans to support it moving forward. The course content can be adjusted based on funding and faculty expertise at different institutions.

Conclusion

A first-year medical student elective focused on exposing students to the breadth of family medicine through hands-on workshops and faculty interactions has a promising impact on increasing interest and perceptions of the specialty. Continued investment in such early exposure initiatives may help address the persistent challenge of attracting medical students to family medicine.

References

1.  AAFP Policy Statement on Family Medicine’s Role in Undergraduate Education.
2. Lee AL, Erlich DR, Wendling AL, et al. The Relationship Between Medical School Clerkships and Primary Care Specialty Choice: A Narrative Review. Fam Med. 2022;54(7):564-571. https://doi.org/10.22454/FamMed.2022.857719.
3. Wilkinson E, Bazemore E, Jabbarpour Y. Ensuring Primary Care Access in States with an Aging Family Physician Workforce. Am Fam Physician. 2019 Jun 15;99(12):743. PMID: 31194480. https://pubmed.ncbi.nlm.nih.gov/31194480/
4. Young RA, Tinger S. Attracting Medical Students to Family Medicine: An Historical View. Fam Med. 2022;54(4):290-293.https://doi.org/10.22454/FamMed.2022.279855.
5. 2024 Match Results American Academy of Family Medicine