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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Perspective of a Medical Student on Proposed Residency Changes
The Image of Family Medicine in Medical Schools
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Paul D. Kartchner, Tucson, Arizona Fourth-year medical student, University of Arizona
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As a current medical student and soon-to-be resident in family medicine, I would like to offer my perspective in regards to the Project's recommendations on residency curriculum reform. (Task Force Report 2, Report of the Task Force on Medical Education, Appendix B, Three and Four- year Residency Curricula.) As alluded to by the previous poster, those chosing to enter family medicine find themselves confronted by a significant amount of bias by other academic departments. Unfortunately, this lack of professional prestige (as well as limited fellowship opportunities) limit the number of qualified applicants entering the field. In part because of this inherent bias, the concept of a four-year residency is welcomed by myself and a number of my colleagues as a means to enhance both quality of training and prestige. The benefits of increased prestige by increasing training length would provide opportunities for development of academic disciplines exclusive to family medicine. Although the primary value of family medicine is not its content but rather its comprehensiveness, there are some aspects of medicine that best fit under the domain of family medicine (rural medicine being one of them). An increased training emphasis on such fields would foster growth in these areas and thereby increase prestige to the specialty (and, coincidentally, make it more attractive to medical students). Competing interests: None declared |
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Louis B Jacques, Baltimore MD USA Physician
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Family Medicine is in tension between its goals of universal health care/expansion of the FM workforce and the desire for more respect from other physicians and trainees. Although a discussion of status may be somewhat uncomfortable or even "counterculture" in some FM circles, I think it's worth putting on the table. Based on my 5 years as an associate dean and 5 additional years as predoc and residency faculty in FM departments (I now work for the federal government) I was continually dismayed to see FM recruiting efforts reach to the bottom of the US and IMG applicant pools. The pressure to fill the overabundance of GME slots leads to lowering the bar. I'll be the first to say that USMLE scores aren't the full measure of a student, but I will assert that a combination of marginal to poor performance on clerkships, weak to toxic interpersonal skills and poor exam scores are a lethal combination. When students and faculty see us recruit these students, the logical conclusion is that anybody can practice FM. So if we recruit these trainees, what does that say about our own qualifications? Some percentage of the US grads going into FM are students who went unmatched in their preferred specialty. In my experience this can be up to 10-20% of the FP matchers. So the actual level of FM interest in US seniors is overrepresented by the Match Day numbers. Some might argue on idealogical grounds that we do not want students who are so mindful of professional prestige. FM has historically attracted those who preferred a different drummer. Yet we as faculty bemoan the lack of respect from colleagues and the public. In the long run it may be healthier for the specialty to shrink GME and raise standards, and defer the universal access/FM expansion for a more opportune time. Competing interests: None declared |
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