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This chapter describes the faculty development efforts of the eight schools that participated in The Robert Wood Johnson Foundation's "Preparing Physicians for the Future: Program in Medical Education." The authors define "faculty development" as the "enhancement of educational knowledge and skill of faculty members so that their educational contributions can extend to advancing the educational program rather than just teaching within it." Faculty development programs varied widely among the schools. Some schools had active programs in place, others initiated programs at the start of the project. This chapter explores the faculty development topics and methods, both shared and unique, among the eight schools. It then looks at the ways the schools motivated their faculties to participate in their programs. Finally, it describes some of the outcome measures that were used to gauge the effectiveness of the faculty development programs. The authors conclude that the eight schools' approaches and levels of commitment to their faculty development programs varied. They present lessons learned from the successes and failures of the various programs.

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PURPOSE: To explore the relationship between various levels of academic achievement and the spectrum of initial specialty placements for graduates. METHOD: The authors studied the initial specialty placements of all 1984-1994 graduates of the University of Kentucky College of Medicine. Statistical analyses were used to determine the nature and strength of the relationships between initial specialty selection and students' achievement indicators and changes in that relationship over time. RESULTS: Students tended to aggregate across time into discernible levels of achievement. The relationships between academic achievement levels and initial specialty placements were highly variable. CONCLUSION: Although students with higher levels of achievement had broader choices available to them, graduates at every level of achievement entered a wide variety of specialties. Thus, the authors believe that academic achievement should not be used to the exclusion of other performance characteristics in determining how students and residencies should be matched.

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Computers are increasingly being used in clinical practice settings. Aware of the need to educate students regarding computer applications in medicine, the University of Kentucky College of Medicine is in the midst of developing a computer curriculum. To that end, many courses and clerkships have devised software packages for transmittal of course information and for evaluation of student performance. This paper outlines requisite computer skills that applicants applying to medical school should possess, broadly reviews how those computer skills will be used in medical school, and suggests means for attaining computer competency prior to making application to medical school.

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The resources of an important educational grant provided by the Robert Wood Johnson Foundation, as well as designated local college and medical center funds, provided support for the renewal of the undergraduate medical education program at the University of Kentucky College of Medicine. The fully revised medical curriculum, adapted to changing professional and societal needs and completely in place by the 1994-95 academic year, was influenced by the recommendations of the General Professional Education of the Physician (GPEP) Report, issued by the Association of American Medical Colleges in 1984. This paper details each of the student-centered curricular changes in the context of the GPEP recommendation that it particularly addresses.

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Since 1985, nearly half of the graduates of the University of Kentucky College of Medicine have chosen generalist careers, even though its students received almost no outpatient ambulatory training in primary care before 1990. This study determined the factors influencing the choice of generalist specialties in the absence of ambulatory training experience. A questionnaire was mailed to the 516 graduates of the classes of 1964 through 1989 who had entered a generalist specialty. A three-way ANOVA with one repeated measure was used to determine whether there were statistically significant differences in the responses of practitioners in the three generalist specialties (family practice, general internal medicine, or general pediatrics). Sufficiently complete responses were received from 187 graduates (116 family practitioners, 40 general pediatricians, and 31 general internists). Many of the physicians who had spent formative years in rural areas were practicing in rural communities. Many respondents had already decided upon a generalist career before entering medical school. Clerkships in internal medicine and pediatrics were an important influence, as was mentor role modeling. For pediatricians, an elective ambulatory care experience was also important. Educational experiences exert meaningful influences on students interested in a generalist career. Formal ambulatory care training experiences, while not critical for the selection of a generalist career, may heighten or confirm interest. Efforts that encourage students from rural communities to enter medical school appear to produce rural physicians.

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PURPOSE: To identify demographic, psychosocial, and educational variables that differentiate physicians who have chosen careers in primary care from those who have chosen academic medicine. METHOD: Questionnaires were distributed in the spring of 1992 to 704 physicians (546 in primary care practices and 143 in academic medicine) who had graduated from the University of Kentucky College of Medicine, 1964-1991. Mann-Whitney U tests and analyses of variance were used for statistical comparisons. RESULTS: A total of 336 physicians responded: 246 in primary care and 90 in academic medicine. The primary care physicians tended to come from smaller cities than did the academic physicians (p < .0001). The primary care physicians also had made their career choices earlier than did the academic physicians (p < .0001). For the academic physicians, long-term participation in research, intellectual stimulation, content of specialty, and influence of a mentor or role model were significantly more important factors than they were for the primary care physicians, for whom length of training, direct patient contact, and threats of malpractice suits were significantly more important. CONCLUSION: The results corroborate the findings of previous studies that suggest that career-choice factors are influenced by admission procedures and curricular structures. The number of graduates choosing careers in either primary care or academic medicine may be increased by increasing their experiences in those fields. Medical schools may be able to use demographic, psychosocial, and curricular factors to fulfill their particular primary mandates, whether they be producing physicians in primary care or in academic medicine.

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BACKGROUND: The goal of this study was to examine whether recently observed changes in the distribution of medical school graduates' choices are linked to level of academic achievement, graduation year, or both. METHOD: The authors studied the specialty selections made by two groups of graduates of the University of Kentucky College of Medicine: 319 who were elected to Alpha Omega Alpha and 276 who ranked academically in the bottom 10% of their classes. They also divided the groups into two time frames: 1964-1979 and 1980-1991. Two-way factorial analyses of variance compared the distributions of specialty selections according to time frame and to academic group. RESULTS: Significantly higher percentages of students in the low-achievement group selected primary care specialties (F = 14.76, p < .001), and this difference between the academic groups increased in recent years: 67% versus 41% in 1980-1991 compared with 53% versus 46% in 1964-1979. CONCLUSIONS: The specialty options most readily available to academically low-achieving medical school graduates are narrowing. Low achievers may be funneled into primary care simply because they cannot compete for other specialties. The authors recommend that: (1) recruitment and selection into primary care specialties should be made only after each candidate has been assessed over a broad range of cognitive and noncognitive factors and (2) academically low-ranking graduates should not end up in primary care specialties simply because no other specialty options are available to them.

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