Table 5.

Recommendations for Curricular Interventions to Increase the Proportion of Medical Students Choosing Primary Care, Based on the Findings of the Present Literature Review and on Previous Recommendations Published in 1995

Recommendations by Bland, Meurer and Maldonado (see Appendix 2 for details)9	Recommendations based on the findings of the present literature review	Examples from the present review
7. Establish required longitudinal primary care experiences. 9. Establish a course on the health care needs of society and the physician’s role.	Establish longitudinal primary care programs, combining diverse learning experiences.	Successful programs include the following components: - Preclinical preceptorship: repeated sessions in a primary care physician’s office - Lectures or seminars on population-based health - Clinical clerkships in family medicine or general practice - Community-based research or public health project work - Electives for interested students
5. Use recruitment and selection processes that are most likely to attract students who will choose primary care careers. 3. Change admission policies to favour students who are interested in primary care and to give weight to student characteristics likely to predict future primary care career choices. 4. Change the composition of admission committees (…)	Discuss and reflect on selection strategies and admission criteria. Consider including evidenced-based personal criteria in addition to academic performance.	Personal characteristics known to increase the likelihood of students choosing primary care careers include: - Pre-existing interest in primary care and community-based health care - Type of community where students have been raised
8. Establish required third-year family practice clerkships.	Establish high-quality clinical clerkships in general practice or family practice. Whenever possible, include the clerkship in a longitudinal program (see above). Be aware of the possible negative impact of low-quality clerkships.	Elements defining high-quality clerkships include: - Active, hands-on experiences (as opposed to “sitting in the corner watching”) - A good relationship with the preceptor and the practice team (“feeling welcome”) - The opportunity to see a variety of patients and to be able to follow them over time - Structured teaching and good-quality feedback from preceptors
10. Establish a career counseling program, including formal education on key characteristics of specialties.	Offer unbiased career counseling and support, helping students make their own choice. Be aware that too much political support for primary care may have negative effects if students feel that primary care is imposed on them.	Primary care career support can be offered through formal or informal means: - Primary care faculty advisors or mentors - Family medicine or primary care student interest groups
1. Develop academically credible departments of family practice, general internal medicine, and general pediatrics. 2. Systematically attend to changing medical schools’ culture to value primary care. 12. Request the federal government, state governments, and health care organizations to allocate significant dollars (…)	Consider the broader context before implementing major curricular changes, including the political and cultural context, postgraduate education and financial incentives.	Successful primary care programs and special medical schools include a strong institutional mission for promoting primary care.
11. Encourage medical schools to take an inquiry approach to education (…)	Use good-quality research to evaluate programs, and share the outcomes with others.	See recommendations for research in Table 4.