Context: Multiple non-clerkship curricula and electives that may impact the likelihood of medical students choosing primary care have been studied, but not systematically reviewed or synthesized. Examining non-clerkship curricula and electives in a comprehensive manner could inform evidence-based approaches toward increasing the number of primary care physicians in the United States. Objective: Determine evidence-based institutional curricula and faculty-driven electives that are associated with increased numbers of medical students choosing primary care. Study Design: systematic review and narrative synthesis. Setting or Dataset: PubMed, Scopus, and CINAHL. Population Studied: Included research articles in English on undergraduate medical education that describe a curricular or elective intervention and outcome relevant to primary care specialty choice. Excluded articles that studied students outside of the United States, Canada, Australia, and New Zealand; non-research articles, such as essays and commentaries; reviews; graduate medical education interventions; articles not addressing student choice of primary care; articles that solely examined geographic or patient population outcomes. Outcome Measures: Narrative description of institutional curricula and electives associated with increased numbers of medical students choosing primary care, and the characteristics of successful curricula and electives.
Results: Search resulted in 8,083 titles. Reviewed 1,334 abstracts and 598 full text articles yielding 34 articles that met inclusion criteria. Methodological rigor varied. Most are cross-sectional surveys or retrospective cohort studies. Few involve more than one institution. Successful curricula include longitudinal ambulatory care clerkships and ambulatory courses. Mixed results on exposure to family medicine faculty and early clinical experiences. Successful elective themes included international health, community medicine, and summer preceptorships. Most showed potential correlations, but were not designed to show causation.