Ch. Griffith et al., Specialty choices of students who actually have choices: The influence of excellent clinical teachers, ACAD MED, 75(3), 2000, pp. 278-282
Purpose. To determine the influence of the quality of attending physicians
and residents on the specialty choices of excellent medical students, who a
ctually have a broad choice of specialties.
Method. In 1993-94 and 1994-95, 169 third-year students at the University o
f Kentucky College of Medicine were randomly assigned to two one-month rota
tions on general medicine inpatient wards. At the end of each rotation, the
students confidentially evaluated the attending physician and the supervis
ing resident (different for each rotation) with whom they had worked. Data
were collected for 62 attending physicians and. 89 residents. The authors a
nalyzed the influences of the "best" and "worst" clinical instructors (thos
e rated in the top and the bottom 20% by all students with whom they had wo
rked over the two years) on "excellent" medical students (the 52 students w
hose USMLE I scores were in the top 30% of their class).
Results. Using regression approaches from the general linear model, the aut
hors found that independent predictors of internal medicine residency choic
e for excellent medical students were exposure to highly rated internal med
icine attendings (p = .02) and residents (p = .03). Nine of 29 (30%) of the
excellent students who worked with a "best" medicine clinical instructor c
hose an internal medicine residency, while none of the 23 excellent medical
students who did nor work with a "best" medicine clinical instructor did s
o. The authors found no correlation in students' ratings of their pairs of
attendings and residents, suggesting that rater bias did not explain the re
sults.
Conclusion. Better medical students who work with the best internal medicin
e attending physicians and residents in their internal medicine clerkship a
re more likely to choose an internal medicine residency.