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

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Abstract
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.

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