Promoting institutional change to encourage primary care: experiences at New York Medical College and East Carolina University School of Medicine.

New York Medical College and East Carolina University School of Medicine significantly changed their curricula and organizational structures in response to The Robert Wood Johnson Foundation's Generalist Physician Initiative (GPI). Seven common elements essential to successful institutional change were retrospectively identified at these two markedly different schools. They are (1) using national priorities to promote need for change, (2) establishing internal and external financial support, (3) developing a planning process and organizational structure to effect change, (4) devising an ongoing evaluation strategy, (5) sustaining positive attitudes toward primary care, (6) integrating community-based physicians, and (7) sustaining interest in the GPI. Within this framework, the authors present the GPI objectives at both schools, discuss examples of methods for institutional change and describe successes, failures, and lessons learned. The authors conclude that both schools have significantly increased the number of students choosing primary care careers and note the general perception of improvement in the quality of primary care educational programs, student recruitment, departmental collaboration, and faculty development opportunities. Although these changes have not yet been fully institutionalized, the similarities of the processes described may be of value to others addressing similar issues.