Family medicine in highly ranked medical schools
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ABSTRACT: Favorable primary care (PC) experiences might encourage more medical students to pursue generalist careers, yet academicians know little about which attributes influence the medical school PC experience. The authors sought to identify such attributes and weight their importance. Semistructured interviews with 16 academic generalist leaders of family medicine, general internal medicine, and general pediatrics led to the development of a Web-based survey, administered to a national sample of 126 generalist faculty. Survey respondents rated (on a nine-point Likert-like scale) the importance of each interview-generated PC medical school attribute and indicated (yes/no) whether outside experts' assessment of the attributes would be valid. The authors assessed interrater agreement. Interview thematic analysis generated 58 institutional attributes in four categories: informal curriculum (23), institutional infrastructure (6), educational/curricular infrastructure (6), and specific educational experiences (23). Of these 58, 31 (53%) had median importance ratings of >7 (highly important). For 14 of these (45%), more than two-thirds of respondents indicated external expert surveys would provide a valid assessment. Of the 23 informal curriculum attributes, 20 (87%) received highly important ratings; however, more than two-thirds of respondents believed that external expert survey ratings would be valid for only 4 (20%) of them. Strong agreement occurred among respondents across the generalist fields. Academic generalist educators identified several attributes as highly important in shaping the quality of the medical school PC experience. Informal curriculum attributes appeared particularly influential, but these attributes may not be validly assessed via expert surveys, suggesting the need for other measures.
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ABSTRACT: The annual U.S. News & World Report (USN&WR) Primary Care Medical School (PCMS) ranking attracts considerable attention, but its measurement properties have not been published. The authors examined the short-term stability of the PCMS ranking and the PCMS score from which it derives, along with the short-term spread of schools' rankings. The authors employed published data and methods to reconstruct the 2009-2012 PCMS scores and rankings. They used mixed-effects models to assess the within-school, between-year reliability (short-term stability) of the PCMS score and ranking, yielding intraclass correlation coefficients (ICCs). They defined short-term spread as the median within-school range in ranking across the four-year study period. Reconstructed PCMS scores correlated highly with published scores all four years (Pearson correlations ≥ 98.9%). Most schools' mean annual PCMS scores were tightly clustered near the center of the score distribution. ICCs for the PCMS score and ranking were, respectively, 94% and 90%. The median difference between the best and worst ranking over the study period was 4 for the 18 schools with an average annual ranking of 1 to 20, and 17 for the other 89 schools (P < .001, Kruskal-Wallis test). The short-term stability of the USN&WR PCMS score and ranking were reasonably good. However, the short-term spread in PCMS rankings was large, particularly among schools with mean annual rankings below the top 20. The variability is greater than could be plausibly attributed to actual changes in training quality. These findings raise questions regarding the ranking's validity and usefulness.
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