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.