Cultivating interest in family medicine: family medicine interest group reaches undergraduate medical students.
ABSTRACT Fewer medical students are choosing careers in family medicine across Canada. One way to cultivate student interest is through creation of family medicine interest groups. Students, residents, community-based family physicians, and academic faculty can all contribute to the success of such groups.
A family medicine interest group provides information about the challenging and rewarding career of family medicine through medical students' exposure to family physicians and residents.
A group of faculty and undergraduate students combined forces to form the Family Medicine Club. Development of this group and results of evaluation of its effectiveness to date are discussed.
One mechanism to increase interest in primary care as a career is to initiate and foster a family medicine interest group that links students with family physicians.
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ABSTRACT: This study examined longitudinal relationships between attitudes and career choice in family practice from admission to medical school through the end of internship. The sample included medical students graduating in 1990 and 1991. Surveys completed at the beginning of each year of medical school, at graduation, and at the end of PGY1 included measures of attitudes toward family practice and stated career choice at the time of each survey. Regression examined the relationship between attitudes and choice; repeated ANOVA measures examined changes over time. Positive attitude scores toward family practice increased over the first 2 years, then declined; women's scores were higher. The proportion of students stating a preference for family practice also increased initially but declined overall; women chose family practice more frequently. Relationships between attitudes and choice were weak over time and neither attitude scores nor change in scores predicted specialty choice. Although attitudes toward family practice remained positive throughout the 5-year study, student interest in family practice declined during the clinical years. Women maintained stronger interests in family practice than men; the reasons for this are not clear. Attitudes were poor predictors of choice. Care is needed in interpreting cross-sectional studies reporting significant relationships. We need to develop more sensitive attitude measures to improve the predictive validity of attitude measurement scales.Family medicine 09/1994; 26(8):504-8. · 1.20 Impact Factor
- Canadian Medical Association Journal 06/2002; 166(11):1419-20. · 6.47 Impact Factor
- Canadian Medical Association Journal 06/2002; 166(11):1449. · 6.47 Impact Factor
Cultivating interest in family medicine
Family medicine interest group reaches undergraduate medical students
Nora D. McKee RN MD CCFP
Meredith A. McKague MSC MD CCFP
Vivian R. Ramsden RN PHD
Raenelle E. Poole
PROBLEM ADDRESSED Fewer medical students are choosing careers in family medicine across Canada. One
way to cultivate student interest is through creation of family medicine interest groups. Students, residents,
community-based family physicians, and academic faculty can all contribute to the success of such groups.
OBJECTIVE OF PROGRAM A family medicine interest group provides information about the challenging and
rewarding career of family medicine through medical students‘ exposure to family physicians and residents.
PROGRAM DESCRIPTION A group of faculty and undergraduate students combined forces to form the Family
Medicine Club. Development of this group and results of evaluation of its effectiveness to date are discussed.
CONCLUSION One mechanism to increase interest in primary care as a career is to initiate and foster a family
medicine interest group that links students with family physicians.
PROBLÈME ÉTUDIÉ De moins en moins d‘étudiants en médecine choisissent comme carrière la médecine
familiale au Canada. Au nombre des moyens pour susciter l‘intérêt des étudiants figure la création d‘un groupe
d‘intérêts en médecine familiale. Les étudiants, les résidents, les médecins de famille dans la communauté et les
professeurs universitaires peuvent tous contribuer à la réussite de tels groupes.
OBJECTIF DU PROGRAMME Un groupe d‘intérêts en médecine familiale renseigne les étudiants en médecine à
propos des défis et des satisfactions d‘une carrière en médecine familiale en les réunissant avec des médecins de
famille et des résidents.
DESCRIPTION DU PROGRAMME Des enseignants et des étudiants au niveau prédoctoral ont combiné leurs
forces pour former le Club de la médecine familiale. La mise sur pied du groupe et les résultats de son évaluation
jusqu‘à présent font l‘objet de cet article.
CONCLUSION L‘une des mesures pour accroître l‘intérêt à l‘endroit des soins de première ligne est d‘établir et de
soutenir un groupe d‘intérêts en médecine familiale qui crée des liens entre les étudiants et les médecins de
Can Fam Physician 2007;53:661-665
been peer reviewed.
pairs. article a fait d‘une révision par des
Dr McKee is an Assistant Professor and Unit Head (Saskatoon site) in the Department of Academic Family Medicine
at the University of Saskatchewan and is the faculty facilitator of the Family Medicine Club. Dr McKague is an
Assistant Professor and the Undergraduate Program Coordinator in the Department of Academic Family Medicine at
the University of Saskatchewan. Dr Ramsden is an Assistant Professor and Director of the Research Division in the
Department of Academic Family Medicine at the University of Saskatchewan. Ms Poole is the 2005-2006 University
of Saskatchewan Family Medicine Club President and a member of the College of Medicine‘s graduating class of
Over the last decade, fewer and fewer North American medical students have chosen to train in family medicine.1-6
In Canada, this trend might increase pressure on the existing supply of family physicians and on the health care
Many factors are contributing to declining enrolment in family medicine: admission processes might select students
who are more likely to choose specialties; students often have greater exposure to specialist teachers and role
models; exposure to primary care clinical experiences is often less than optimal; economic factors steer some
students toward specialties; and students‘ perceptions of the challenges and rewards of family medicine might be
negatively affected by medical school culture.7-19 Among students who enter medicine with an initial interest in family
medicine, this interest often diminishes during their training.12-14 Messages from peers, family, and society about
family physicians‘ role could also contribute to the decline in the number of students making this career
Some factors are known to incline students toward family medicine. In addition to a variety of demographic variables
and personal attributes of students themselves,10-12 such factors as contact with positive role models, the diverse
nature of family medicine clinical practice, and the perception of family medicine as conducive to a balanced lifestyle
can influence students to choose family medicine as a career.11,12,15-17
Training programs are seeking creative ways to cultivate student interest in family medicine. Several Canadian
programs have introduced interest groups to inform students about the range of opportunities and rewards offered
by careers in family medicine as well as to offer them positive role models. Canadian medical schools have recently
been encouraged to either initiate such groups or strengthen existing groups through the recently funded Family
Medicine Interest Groups project of Health Canada and the College of Family Physicians of Canada (CFPC).20,21 While
information about activities of these groups is now being shared among group coordinators, there has been little yet
published in the literature about effective ways to establish such groups.22,23 Research evaluating the effects of such
interest groups on career choice is limited and might be irrelevant in the Canadian context.24,25
Objectives of the program
The Family Medicine Club at the University of Saskatchewan was formed in 2001 to provide undergraduate medical
students with information about the challenging and rewarding career of family medicine. This paper discusses the
experience and evaluation of the program thus far.
To begin the process of forming a club, the undergraduate medical office was contacted and students interested in
participating as leaders were asked to contact the facilitator. Several medical students were eager to take a
Organizers arranged a noon-hour family physician speakers‘ series where pizza lunch was served. Informal questions
and discussion followed each presentation. Student leaders chose topics after obtaining input from their classmates
on areas of interest. They selected dates in advance and promoted sessions by posters, e-mail messages, and word
of mouth. The faculty facilitator assisted student leaders with contacting and scheduling presenters. On average, 3
sessions have been held yearly. Premedical students have shown interest and have also attended some sessions.
Topics and presenters have varied. Examples include a rural physician with advanced skills in surgery; an urban
physician with an interest in sports medicine; the provincial Chapter President of the CFPC; residents from the local
family medicine program and the third-year emergency program; and a physician practising in a remote northern
Originally, funding was provided by a grant from the Saskatchewan Chapter of the CFPC, which was matched by the
local academic department. Increased funding obtained in 2005 through the national College allowed the club to
expand its programming. An executive committee has been formed with student representatives from each academic
year. A constitution has been drafted and a bank account established. Links with the local Saskatchewan CFPC
Chapter office have been formalized. All undergraduate students were formally invited to be members of the club
with no fee required, and a membership list was compiled. Club membership now comprises approximately 30% of
the student body.
New initiatives. The luncheon speaker series continues and new initiatives are being introduced. Students
representing the club have undertaken advocacy roles in curriculum issues. Family physicians and residents have
been invited to become part of a mentorship program. Future goals include rejuvenating the website and creating a
Another substantial addition has been the introduction of a Clinical Skills Workshop. The first evening workshop,
facilitated by residents and faculty, was held in the Academic Family Medicine Unit (Saskatoon). Twenty-four second-
and third-year students rotated through 4 stations designed to develop clinical skills. Stations were based on a clinical
scenario ―Thursday Night On Call‖ and included suturing, casting, injections, and women‘s health examinations.
Evaluation. A workshop evaluation asked students to rate their perceived performance before and after the
workshop, on a 5-point scale. Higher ratings suggested increased confidence in their procedural skills. Comparison of
scores before and after the workshop showed an average increase of at least 1 point on the confidence scale for all
but 1 skill. For example, 38% reported having ―no experience‖ with intramuscular injections before the workshop,
but 50% ranked that procedure as ―could carry out independently‖ after the workshop. Most students (84%) rated
the evening with a score of 9 or 10 (with 10 being the best possible score). Qualitative comments at the end of the
survey were positive: ―I loved the small groups; the laid-back atmosphere allowed me to ask ‗dumb‘ questions, and I
could concentrate on what I wanted to learn from the procedure.‖ ―Hands-on, informal setting, family med doctors
and residents, rare experience.‖
The overall effectiveness of the Family Medicine Club was also evaluated. The graduating class of 2006 was
surveyed, as these students had been exposed to the club throughout their undergraduate training. This survey
received Behavioural Research Ethics Board approval. Surveys were mailed directly to students by the undergraduate
medical office, and on return data were collated by the Research Division to protect respondents‘ anonymity. To
increase response, the survey was mailed a second time after 1 month; final response rate was 30% (18/60).
Frequencies of responses were tabulated.
Attendance at club events was 78% (14/18) among respondents. Those who had not attended events (3/18) stated
that they had already decided on a career in family medicine. Most respondents attended more than 1 event. When
asked how effective the club was in educating students about family medicine, all students who had attended events
described the sessions as increasing their understanding of family medicine (Figure 1). To further evaluate
programming, students reflected on which speakers were most helpful. All sessions were evaluated positively; the
resident presentations were most popular.
When asked, ―Did these events influence your decision about family medicine as a career choice?‖ 29% (4/14) said
yes, 50% (7/14) said no, and 21% (3/14) replied ―don‘t know.‖
Those who replied in the affirmative expanded their answers with such comments as ―Information provided by
residents regarding the program was very valuable. It was also important to me to be in an environment supportive
to family med as a career choice‖; ―Got clear answers concerning practice trends and difference between urban and
rural practice remuneration‖; ―The information provided assuaged some of my doubts regarding family medicine‖;
―Reinforced my decision to become a family doctor.‖
Those who thought the club had not influenced their decisions commented, ―At the events, what I learned about
family med was the stuff I already know, thus it didn‘t add anything to my career choice decision-making process‖; ―I
was already decided on family med‖; ―My decision on specialty area was made based on personal observations and
discussions with friends: ie, their practices and my interest [in] or aptitude for the subject.‖
Students and family physicians across Canada are actively working to develop and promote family medicine interest
groups. Is this a worthwhile use of energy and resources? This interest group‘s 4-year history and recent evaluation
suggest that it is a valuable endeavour.
An interest group introduces students to a variety of community-based, academic, and trainee family physicians who
can serve as positive role models. It provides students with the opportunity to ask questions about scope of practice,
flexibility of training opportunities, and lifestyle balance—issues known to influence career choices. The evaluation
demonstrated that students valued opportunities to interact with community-based physicians and family medicine
The club‘s influence appears to go beyond simply increasing students‘ knowledge about the discipline. Evaluation
suggested that the club might affect some students already interested in family medicine, reinforcing their career
decisions by providing a supportive, family medicine–friendly environment. Student members recently decided to
continue calling the interest group a ―club,‖ perhaps reflecting the sense of belonging it provides.
One limitation of the evaluation was the low response rate. The 30% response rate approximates the percentage of
the student body who are members of the club and is close to the usual percentage of students choosing family
medicine in the first-round CaRMS match at this university. Because most respondents reported attending more than
1 club activity, it is likely that those who completed the survey were primarily students engaged in the club who had
some interest in family medicine. This evaluation does not capture the experiences of students who are choosing
other specialties. Further research is needed to better understand whether club activities increase the visibility of
family medicine within the medical school, change the medical school culture, or have any influence on attitudes or
knowledge about family medicine among the student body as a whole. Because many complex factors influence
medical students‘ career choices, it is difficult to evaluate the specific effects of family medicine interest groups on
The club has faced some challenges. Student and faculty time is limited, and this has affected frequency of events.
Identifying student leaders has not been difficult, but maintaining continuity in leadership has been a challenge as
students move on in their training and as demands of their clinical work limit their involvement.
Organizers, through formal evaluation and their own reflections, have identified several factors that have been
essential to the success of the club. These factors include:
• collaborating with enthusiastic student leaders who promote events and aid in selecting appropriate dates
to avoid clashes with examinations or other events, as well as in choosing topics that reflect student
• maintaining continuity in faculty support given changes in senior student leaders;
• providing refreshments because the food attracts participants who then remain to hear the presentation;
• structuring events to facilitate informal dialogue that creates a relaxed, supportive environment; and
• engaging with local family medicine residents and physicians who participate in club activities and act as
positive role models.
In 2001 family medicine interest groups existed at a variety of medical schools in Canada and the United States. Each
college of medicine in Canada now is supported by the new national program to create its own group. National
meetings and a website have allowed effective sharing of information and ideas between groups. Some newer
groups focus primarily on speakers‘ series. Others undertake workshops and advocacy activities similar to those in
Saskatchewan, while a few groups offer expanded mentoring activities. In Saskatchewan the early establishment and
ongoing stability of the club allowed for a quick expansion of activities and a lifespan that allowed evaluation. The
experience of more established groups can help other schools successfully establish fledgling groups.
There are many reasons for the declining enrolment in Canadian family medicine training programs. Family medicine
interest groups offer one mechanism for increasing students‘ awareness of the range of opportunities within family
medicine. Groups might also support early undergraduate students who are considering family medicine as a career.
The program is maintained by financial and organizational support as well as by student leadership in content,
structure, and scheduling of events.
This description of the Saskatchewan experience might help other programs to coordinate their own interest groups
and encourage practising physicians to become involved in recruiting.
The authors thank student leaders for their contributions to the establishment and ongoing support of the Family
Medicine Club and Dr Leane Bettin, family medicine resident, for her assistance with the literature review. We also
thank the College of Family Physicians of Canada (national office and Saskatchewan Chapter), Health Canada, and
the Department of Academic Family Medicine at the University of Saskatchewan for financial support of the Family
Correspondence to: Dr Nora McKee, University of Saskatchewan, Department of Academic Family Medicine, 3311
Fairlight Dr, Saskatoon, SK S7M 3Y5; telephone 306 655-4200; fax 306 655-4894; e-mail firstname.lastname@example.org
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family medicine versus specialty medicine. CMAJ 2004;170(13):1920-4.
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literature. Acad Med 1995;70(7):620-40.
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EDITOR’S KEY POINTS
• Over the last decade, fewer and fewer North American medical students have chosen to train in family medicine.
• Several Canadian programs have introduced interest groups as a way to inform students about the range of
opportunities and rewards offered by a career in family medicine and to expose them to positive role models.
• Reflection on this interest group‘s 4-year history (at the University of Saskatchewan) and recent evaluation suggest
that offering such a group is a valuable endeavour.
POINTS DE REPÈRE DU RÉDACTEUR
• Au cours de la dernière décennie, de moins en moins d‘étudiants en médecine nord-américains ont choisi une
formation en médecine familiale.
• Quelques programmes canadiens ont instauré des groupes d‘intérêts pour renseigner les étudiants sur l‘éventail des
possibilités et des satisfactions offertes par une carrière en médecine familiale et leur présenter des modèles positifs
• Une rétrospective sur les 4 années d‘existence de ce groupe d‘intérêts (à l‘University of Saskatchewan) et une
récente évaluation font valoir qu‘il vaut la peine de créer de tels groupes.