Why do some medical schools produce more General Practitioners than others?

By Simon Thornton
GP registrar and academic clinical fellow
Centre for Academic Primary Care

As someone who has come into general practice via another specialty, I am particularly interested in what leads people to choose a career in primary care, and how we might be able to help improve recruitment.

There are lots of factors that influence people to choose a career in general practice. These include certain personality traits, such as scoring more highly on measures of empathy, being a graduate entry medic, exposure to general practice at an undergraduate level, and the attitudes of other healthcare professionals towards general practice. What I find most interesting is that there is a huge influence depending on which medical school you went to.

In 2012, of all doctors finishing their foundation programme training, only 11% of Cambridge graduates entered primary care training compared to 38.5% of Keele graduates.

Does this difference reflect the different entry characteristics and aspirations of students (nature), or does it reflect how they are moulded by their undergraduate experiences (nurture)? Are medical students truly undifferentiated, toti-potent ‘stem doctors’ or do they already exhibit strong career preferences at an early stage as some have suggested?

Well – evidence suggests that the first year student cohort is fairly homogenous in terms of their career aspirations. So this begs the question – what does one medical school do to its students that is so different from another?

An area that I’m interested in is the hidden curriculum. In essence it is that which is learnt but not formally taught. In particular I’m interested in the idea of ‘institutional slang’. This is the ‘bashing’ or ‘badmouthing’ of other specialties that occurs within medicine. This is something that has been experienced by virtually all medical students and has been shown to have a negative effect on students’ career choices. So why might the hidden curriculum differ between medical schools?

One theory suggests that different schools value different types of ‘capital’ which influences the hidden curriculum at that institution, with some schools striving for academic recognition and others focusing on producing graduates for the health service and fulfilling the GMC’s agenda.

I am exploring institutional slang around general practice through a comparative case study of a university producing a high proportion of GPs with one producing a low proportion. This project forms the dissertation for my masters in medical education which is funded by the NIHR. I’m currently awaiting the outcome of the ethics review and hope to start collecting data in the autumn term through interviews with students and faculty as well as review of documents such as the undergraduate prospectus.

I hope my findings will provide useful information to those seeking to address the workforce crisis in general practice resulting in more trainee doctors wanting to be GPs. And not “just” GPs.