The Impact of Family Medicine Interest Groups and Student-Run Free Clinics on Primary Care Career Choice: A Narrative Synthesis

There is a consistent need for more family physicians. The family medicine academic community has sought methods to increase the number of students who choose family medicine and other primary care specialties as their future practice.1 Medical schools control admissions processes and curricular materials, and faculty members provide mentorship and act as role models. On the other hand, students proactively engage in extracurricular activities that can shape their identities as future physicians, and ultimately, their career choices. In this review, we examined the effect of family medicine interest groups (FMIG) and student-run free clinics (SRFC) on student entry into family medicine and primary care.

FMIGs in the United States are supported by the American Academy of Family Physicians, and often by departments of family medicine.2,3 The first mention of such interest groups in medical education literature was in 1978, as “Family Practice Club.”4 FMIGs are student-run interest groups with oversight by faculty advisors. They allow students to explore their interests in primary care, gain leadership experience, and be involved in community service.3 SRFCs are also organized by students and aim to provide free medical care and other services for underserved communities. For medical schools, SRFCs fulfill service-learning requirements for accreditation.5 Though SRFCs are specialty-agnostic, it is known that caring for underserved communities is a factor for students choosing family medicine.6 We reviewed publications on FMIG and SRFC because they are common programs across many US medical schools, and the value of investing in FMIG and SRFC by departments of family medicine is unknown.

The literature review was conducted in two stages: a primary and secondary search. In the primary search we considered medical school structures, policies, and practices that promote primary care specialty choice.7 Results from the primary search are described in a scoping review,7 and we used topic-specific articles from the primary search in this focused review.

We conducted a secondary search with search terms “family practice club,” “Family Medicine Interest Group,” “FMIG,” “student-run free clinic,” “mentor,” “mentorship,” and “role model” through PubMed, Scopus, and CINAHL. We selected these additional search terms based on language mapping from the original scoping review. We deduplicated pre-2016 articles that had been identified in the original scoping review. We included papers that met inclusion criteria for role model or mentoring in a separate publication.8

We also reviewed the citations of articles meeting inclusion criteria (citation chaining) to ensure a comprehensive search. In total, we reviewed titles and abstracts of 361 articles (47 from the primary search, 199 from the secondary search, 14 related articles, and 101 after citation chaining). When necessary, the full text of the article was reviewed.

Consistent with the primary search, we selected research papers for inclusion if they were published in English and took place in the United States, Australia, New Zealand, or Canada, based on similarity of educational structure and workforce challenges. Additionally, they needed to relate to the research question, “Do FMIGs and SRFCs impact interest and entry to family medicine?” Papers were included if they included “FMIG” or “SRFC” as either a specific variable in the analysis (for quantitative papers) or as a theme (for qualitative papers). The outcomes of interest were student primary care/family medicine interest, intention to match, or entering a primary care career, as determined by study authors. Concordant with the broader study, nonresearch studies and studies without a primary care outcome were excluded. Where uncertainty about inclusion existed, one or more additional researchers discussed each article until consensus was reached.

Authors T.S. and A.K. conducted a quality review using a previously described rubric to evaluate each of the included articles.7 We compared quality review scores by t test for all articles, FMIG articles, and SRFC articles with clear outcomes. We performed a narrative synthesis to group and report key findings from similar papers. The study was determined to be non-human subjects research by the Michigan State University Institutional Review Board.

We included a total of 18 papers in the FMIG and SRFC review (Table 1). Eleven articles were included describing FMIG (1978 - 2019) 2,4,9-17 and seven describing SRFC (1985-2016).18-24

For FMIG, seven were single-institution and four were multi-institutional studies. The first paper published in 1978, termed the program “Family Practice Club,” but otherwise “FMIG” was the shared name for this entity.4 Most were surveys (four student surveys, one predoctoral director survey, and one medical school survey); four used institutional program records and match data, and one was based on a student focus group (Table 2). Ten of the articles were specifically family medicine and FMIG-related, and one article included all specialty student interest groups. For outcomes, 10 examined match data or definitive choice of family medicine as a specialty, and one discussed FMIG effect on specialty interest. Of the nine articles that looked at whether FMIG was associated with entry into family medicine, five papers noted a positive relationship, one paper did not specifically study FMIG as a discrete variable but included FMIG as part of a larger program, and three papers noted that FMIG participation was not associated with entry into family medicine (Table 3). 

For SRFC, six were single-institution studies and one was a multi-institutional study. Three studies asked students about increased interest or intent to go into primary care and three articles examined match data (Table 2). Only one paper indicated that SRFC activity correlated with entry into primary care; it was the oldest paper, published in 1985.18

Quality review scores range from 6.5-26, and are included in Table 3. There was no statistically significant difference of quality scores for studies with either positive or negative outcome, when comparing all articles, FMIG articles and SRFC articles.

Although studies have mixed results, most indicate a positive association between FMIG participation and family medicine interest. Several papers measured student-reported interest and intent to consider family medicine as a career instead of using more advanced metrics, such as match and practice data. Only one study examined primary care careers as an outcome. Only one study employed qualitative methodology.16 FMIGs vary widely in their programming, governance, and support, and it is difficult to know what elements of FMIG participation impact student choice. It is not clear whether FMIG participation primarily helps undifferentiated students gain interest in the specialty, or whether it helps support those who already have an established interest in family medicine, though one study concluded that participation can engage both groups of students.12

There were few papers that examined the relationship between participation in SRFC and specialty choice. The literature suggests that SRFC participation does not correlate with entry into primary care. However, a limitation is that most papers were based at a single institution and had lower quality review scores. 

Larger-scale and higher quality research are needed to investigate how FMIGs and SRFCs may impact entry into family medicine. An FMIG research network could generate multi-institutional studies. The Society of SRFC could support higher impact scholarly work.²⁵ A national medical student survey through the Council of Academic Family Medicine Educational Research Alliance (CERA) could be used to gather multi-institutional data. Single institutions wishing to examine these issues should consider conducting in-depth, qualitative studies to better understand how FMIGs and SRFCs shape students’ career formation.

Although the literature has limitations, participation in FMIGs is more positively associated with student choice to match to family medicine residencies, while participation in SRFC more consistently lacks an association with matching to primary care residencies. If institutions have limited resources to support student-led activities in primary care with the goal to improve family medicine match rates, this study suggests those resources should be focused on FMIGs.