• Karen E Hauer, Mark J Fagan, Walter Kernan, Matthew Mintz, and Steven J Durning.
• Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. khauer@medicine.ucsf.edu
• J Gen Intern Med. 2008 Jul 1; 23 (7): 1101-4.

BackgroundExperienced medical student educators may have insight into the reasons for declining interest in internal medicine (IM) careers, particularly general IM.ObjectiveTo identify factors that, according to IM clerkship directors, influence students' decisions for specialty training in IM.DesignCross-sectional national survey.ParticipantsOne hundred ten institutional members of Clerkship Directors in IM.MeasurementsFrequency counts and percentages were reported for descriptive features of clerkships, residency match results, and clerkship directors' perceptions of factors influencing IM career choice at participating schools. Perceptions were rated on a five-point scale (1 = very much pushes students away from IM careers; 5 = very much attracts students toward IM careers).ResultsSurvey response rate was 83/110 (76%); 80 answered IM career-choice questions. Clerkship directors identified three educational items attracting students to IM careers: quality of IM faculty (mean score 4.3, SD = 0.56) and IM rotation (4.1, SD = 0.67), and experiences with IM residents (3.9, SD = 0.94). Items felt most strongly to push students away from IM careers were current practice environment for internists (mean score 2.1, SD = 0.94), income (2.1, SD = 1.08), medical school debt (2.3, SD = 0.89), and work hours in IM (2.4, SD = 1.05). Factor analysis indicated three factors explaining students' career choices: value/prestige of IM, clerkship experience, and exposure to internists.ConclusionsIM clerkship directors believe that IM clerkship experiences attract students toward IM, whereas the income and lifestyle for practicing internists dissuade them. These results suggest that interventions to enhance the practice environment for IM could increase student interest in the field.

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