Does community-based experience alter career preference? New evidence from a prospective longitudinal cohort study of undergraduate medical students.

CONTEXT: Previous studies have shown that most medical students want a hospital-based career, but the protagonists of community-based teaching predict that increased community exposure within undergraduate curricula will alter subsequent career preferences.
OBJECTIVES: To evaluate the impact on career preference and other attitudes of a year with substantial community exposure, compared with a year of hospital-based learning.
DESIGN: Questionnaire to student cohort before and after two consecutive levels of the course, one with, and the other prior to, substantial community placement.
SETTING: Sheffield Medical School.
SUBJECTS: Total of 260 students in the third and fourth year of the MBChB degree.
RESULTS: There were significant differences in career preference and attitude to primary care after the year with a community placement, with more students expressing a preference for a community-based career. This was particularly true for women, and less true for non-European students. Conversely, the hospital-based students, especially men, showed a significant change toward hospital-based careers.
CONCLUSION: The findings support the hypothetical advantages of shifting medical education to primary care settings, both in encouraging a career in general practice and in the retention of appropriate professional attitudes.