Early immersion and primary care careers: evidence from a preclerkship rotation

Arati Dahal; Toby Keys

doi:10.1093/acamed/wvag104

Early immersion and primary care careers: evidence from a preclerkship rotation | ResearchHub

Abstract Purpose The United States is facing a primary care workforce crisis that is affecting the overall health of the population. The University of Washington School of Medicine’s Rural Underserved Opportunities Program (RUOP) is a 4-week primary care preclerkship rotation. This study examined whether early and immersive exposure to primary care is independently associated with a career choice in primary care overall and family medicine as a distinct specialty. Method This retrospective cohort study included 2234 students who matriculated at the University of Washington School of Medicine between 2003 and 2015. Program records were linked to American Medical College Application Service data, a matriculation career-preference survey, and the American Medical Association Physician Masterfile. The outcomes were practice in primary care (family medicine, internal medicine, and pediatrics) and family medicine; the exposure was RUOP participation. Covariates included age; sex; parental educational level; rural upbringing; Washington, Wyoming, Alaska, Montana, or Idaho origin; and 17 baseline specialty or practice setting interests. Multivariable logistic regression generated adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results Of the 2234 graduates, 1104 (49.4%) completed RUOP. Among RUOP participants, 533 (48.2%) were practicing primary care compared with 328 of the 1130 non-RUOP graduates (29.3%). In multivariate regression, RUOP participation was associated with higher odds of practicing primary care (OR, 1.39; 95% CI, 1.10–1.76; P = .01) and family medicine practice (OR, 1.54; 95% CI, 1.11–2.14; P = .01). Conclusions RUOP was associated with higher odds of practicing both primary care and family medicine. Although confounding factors cannot be entirely excluded, these findings suggest that short, preclerkship primary care immersions may support students’ trajectories toward primary care careers. Medical schools aiming to strengthen the primary care pathway should consider incorporating similar experiences into their curricula.

External reference records

Implementing high-quality primary care: a report from the National Academies of Sciences, Engineering, and Medicine

10.1001/jama.2021.7430 · 2021

Quantifying the health benefits of primary care physician supply in the United States

10.2190/3431-g6t7-37m8-p224 · 2007

Association of primary care physician supply with population mortality in the United States, 2005-2015

10.1001/jamainternmed.2018.7624 · 2019

The triple aim: care, health, and cost

10.1377/hlthaff.27.3.759 · 2008

The effect of primary care physician supply and income inequality on mortality among blacks and whites in US metropolitan areas

10.2105/ajph.91.8.1246 · 2001

Primary care, income inequality, and stroke mortality in the United States: a longitudinal analysis, 1985-1995

10.1161/01.str.0000082380.80444.a9 · 2003

Primary care, race, and mortality in US states

10.1016/j.socscimed.2004.11.056 · 2005

Cervical cancer rates and the supply of primary care physicians in Florida

2003

Primary care physician supply and colorectal cancer

2001

Improving access to primary care for underserved populations: a review of findings from five case studies and recommendations

2023

Unresolved referenced work

Kept as external metadata until matched

Setting the target: comparing family medicine among us allopathic target schools

10.22454/fammed.2024.510377 · 2024

Unresolved referenced work

Kept as external metadata until matched

Impact of interventions to increase the proportion of medical students choosing a primary care career: a systematic review

10.1007/s11606-015-3372-9 · 2015

The WWAMI Targeted Rural Underserved Track (TRUST) program: an innovative response to rural physician workforce shortages

10.1097/acm.0000000000000807 · 2016

Impact of a targeted rural and underserved track on medical student match into family medicine and other needed workforce specialties

10.22454/fammed.2021.351484 · 2021

Longitudinal continuity learning experiences and primary care career interest: outcomes from an innovative medical school curriculum

10.1007/s11606-018-4600-x · 2018

Primary care residency choice and participation in an extracurricular longitudinal medical school program to promote practice with medically underserved populations

10.1097/acm.0000000000000075 · 2014

Efforts to graduate more primary care physicians and physicians who will practice in rural areas: examining outcomes from the University of Minnesota-Duluth and the rural physician associate program

10.1097/acm.0b013e3181d2b537 · 2010

The effect of rural underserved opportunities program participation on medical graduates’ decision to work in rural areas

10.1097/acm.0000000000005162 · 2023

Impact of the primary care curriculum and its teaching formats on medical students’ perception of primary care: a cross-sectional study

10.1186/s12875-016-0532-x · 2016

Practice observation visit for interprofessional training in primary care

10.1016/j.xjep.2022.100558 · 2022

Interprofessional primary care course impact on knowledge, attitudes, and careers

10.22454/fammed.2022.167204 · 2022

Early community-based family practice elective positively influences medical students’ career considerations—a pre-post-comparison

10.1186/1471-2296-14-24 · 2013

Impact of a first-year primary care experience on residency choice

10.1111/j.1525-1497.2001.10117.x · 2001

Interprofessional primary care course curriculum and evaluation

10.22454/fammed.2018.998057 · 2018

Interim evaluation of the Rural Health Scholars Program

10.1207/s15328015tlm1301_7 · 2001

Summer in the country: changes in medical students’ perceptions following an innovative rural community experience

10.1097/acm.0b013e318299fb5d · 2013

Early generalist placements are associated with family medicine career choice: a systematic review and meta-analysis

10.1111/medu.14578 · 2021

Pathways to primary care: charting trajectories from medical school graduation through specialty training

10.1377/hlthaff.2024.00893 · 2025

Where have the generalists gone? They became specialists, then subspecialists

10.1016/j.amjmed.2017.01.026 · 2017

Contributions of US medical schools to primary care (2003-2014): determining and predicting who really goes into primary care

10.22454/fammed.2020.785068 · 2020

Public health community externship

10.15766/mep_2374-8265.10260 · 2015

Positive yet problematic: lived experiences of racial and ethnic minority medical students during rural and urban underserved clinical rotations

10.1111/jrh.12745 · 2023

Perspective transformation

10.1177/074171367802800202 · 1978

Primacy effect or recency effect? A long term memory test of Super Bowl commercials

10.1002/cb.291 · 2010

Are first impressions lasting impressions? An exploration of the generality of the primacy effect in memory for repetitions

10.3758/bf03206321 · 2004

Unresolved referenced work

2019

Beyond the classroom: the transformative experience of short rural immersion programs for health professional students: a narrative review

10.1111/medu.15612 · 2025

Unresolved referenced work

2006

Additional external references

How often do medical students change career preferences over the course of medical school?

10.1186/s12909-023-04598-2 · doi-reference

Effect of medical student debt on mental health, academic performance and specialty choice: a systematic review

10.1136/bmjopen-2019-029980 · doi-reference

Educational debt in the context of career planning: a qualitative exploration of medical student perceptions

10.1080/10401334.2016.1178116 · doi-reference

Longitudinal integrated clerkships for medical students: an innovation adopted by medical schools in Australia, Canada, South Africa, and the United States

10.1097/acm.0b013e3181a85776 · doi-reference

Teaching undergraduate students in rural general practice: an evaluation of a new rural campus in England

10.22605/rrh3694 · doi-reference

The hidden curricula of medical education: a scoping review

10.1097/acm.0000000000002004 · doi-reference

Adopt-A-Student: early mentoring in family medicine

10.3109/01421599509008288 · doi-reference

Early immersion and primary care careers: evidence from a preclerkship rotation

Referenced works

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External reference records

Additional external references