Objective: To determine the attitudes of medical students toward careers in internal medicine.
Design: Cross-sectional national survey of U.S. medical school seniors.
Participants: The 10 379 respondents to the 1988 Medical Student Graduation Questionnaire from the Association of American Medical Colleges.
Measurements and Main Results: Most men and women selecting internal medicine (n = 1931) as well as those switching from earlier preferences for internal medicine (n = 1606) made their final decisions about specialty during the third and fourth years of medical school. Almost 50% of students planning to be internists cited "intellectual content" as the most important factor in their choice of specialty. "Diagnostic challenge" was next most frequently cited. "Type of patient seen" and "role models" were more frequently cited as the most important factors in specialty choice for all other specialties than for internal medicine. Students who switched away from earlier preferences for general internal medicine cited the following most important factors in descending order of frequency: "too demanding of time and effort," "inconsistent with personality," "negative clerkship experiences," "don't like the type of patient," and "specialty chosen more fulfilling." The same five factors, in a different order of frequency, were given for switching from the subspecialties of internal medicine.
Conclusions: Most medical students make their final choices about specialty during or after their clerkship year. Knowledge of these students' attitudes toward internal medicine could form the basis for the development of strategies to enhance the attractiveness of internal medicine among these students while they are making their final decisions about specialty.