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1.  Attitudes and perceptions of medical students about family medicine in Spain: protocol for a cross-sectional survey 
BMJ Open  2011;1(2):e000231.
Background
Despite the fact that family medicine (FM) has become established as a specialty in the past 25 years, this has not been reflected in the inclusion of the specialty in the majority of medical schools in Spain. Almost 40% of the students will work in primary care but, in spite of this, most universities do not have an assessed placement as such. There are only specific practice periods in health centres or some student-selected components with little weight in the overall curricula.
Objectives
To evaluate the attitudes and perceptions of medical students about FM in the health system and their perception about the need for specific training in FM at the undergraduate level. To explore change over time of these attitudes and perceptions and to examine potential predictive factors for change. Finally, we will review what teaching activity in FM is offered across the Spanish schools of medicine.
Methods
Descriptive cross-sectional survey. Each one of the different analyses will consist of two surveys: one for all the students in the first, third and fifth year of medical school in all the Spanish schools of medicine asking about their knowledge, perceptions and attitudes in relation to primary care and FM. There will be an additional survey for the coordinating faculty of the study in each university about the educational activities related to FM that are carried out in their centres. The repetition of the study every 2 years will allow for an analysis of the evolution of the cohort of students until they receive their degree and the potential predictive factors.
Discussion
This study will provide useful information for strategic planning decisions, content and educational methodology in medical schools in Spain and elsewhere. It will also help to evaluate the influence of the ongoing changes in FM, locally and at the European level, on the attitudes and perceptions of the students towards FM in Spain.
Article summary
Article focus
There is a need to explore further the reasons for which students choose a specific specialty for training and future practice. This protocol outlines the design of a cross-sectional survey to evaluate attitudes and perceptions of medical students about family medicine.
The project will assess the potential impact of medical school teaching on the final profiles of students, both in perceptions and expectations and in the choice of specialty.
Key messages
This is a protocol of a multicentre survey that will take place in Spanish medical schools. The study includes a survey for students and one for the coordinators of family medicine in each centre.
The repetition of the student survey every 2 years will allow for an analysis of the evolution of student cohorts until the end of their studies.
The results of this study will provide valuable information for curriculum development related to family medicine in the different schools of medicine and will help to prioritise those activities that are likely to be most effective for promoting this specialty.
Strengths and limitations of this study
The research team for this study includes coordinating faculty from 22 of the 27 universities throughout Spain. The study will be repeated every 2 years and will explore change over time of the issues addressed.
The principal limitations of this study are related to its design, of observational nature. The results observed will serve as hypotheses generating and cannot be regarded as definitive. Finally, the fact that the survey will be anonymous will impede the evaluation, at an individual level, of change over time.
doi:10.1136/bmjopen-2011-000231
PMCID: PMC3278481  PMID: 22189348
2.  Medical students’ perceptions and attitudes about family practice: a qualitative research synthesis 
BMC Medical Education  2012;12:81.
Background
During the last decade medical students from most Western countries have shown little interest in family practice. Understanding the factors that influence medical students to choose family medicine is crucial.
Objective
To systematically review and synthesize published evidence about medical students’ attitudes and perceptions towards family practice.
Methods
A qualitative systematic review. The literature search was undertaken in July 2010 in PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Social Science Citation Index (SSCI), and ProQuest Dissertations & Theses. Two authors independently selected the studies for their inclusion and assessed their quality. The selected studies were thoroughly read. Key themes and categories were identified. A matrix was created for allowing the comparison of each theme across studies.
Results
Ten studies were finally included. Seven broad themes were identified across them: 1) Scope and context of practice was a broad theme comprising linked sub-themes: perception of a varied specialty, broad practice, holistic perspective and flexibility that allows having a family; 2) Lower interest or intellectually less challenging: treating common disease, repetitive, quasi administrative job; 3) Influence of role models, either positive and negative, and society: negative comments from other professionals, peers and family; 4) Lower prestige; 5) Poor remuneration; 6) Medical school influences, being important both the length and quality of the exposure; 7) Post graduate training, where the shorter duration and the lower intensity were perceived as positive aspects. After identifying these seven key themes, were also looked into patterns in the distribution of these themes among studies.
Conclusions
Our qualitative review provides a comprehensive picture of medical students’ attitudes towards family practice in the available literature. In general, although some students find family medicine appealing, it is regarded as a career of low interest and prestige. More research is needed on the influence of role models, medical school and post graduate training.
doi:10.1186/1472-6920-12-81
PMCID: PMC3546071  PMID: 22909189
Family practice; Attitudes; Perceptions; Students, Medical; Qualitative research; Review
3.  Medical student attitudes towards family medicine in Spain: a statewide analysis 
BMC Family Practice  2012;13:47.
Background
Family and community medicine (FM) became a recognized specialty in Spain in 1978; however, most medical schools in Spain still lack mandatory core courses in FM. In order to explore the perceptions, expectations and level of information amongst medical students in Spain in relation to FM and PC, and the training in these areas in the curriculum of the Medical Schools, a survey was developed to be administered in medical schools every two years. This article presents data from the first questionnaire administration.
Methods
The study population was all first-, third-, and fifth-year students (2009–2010) in 22 participating medical schools in Spain (of 27 total). The 83-item survey had three sections: personal data, FM training, professional practice expectations, and preferences). Chi-squared test or analyses of variance were used, as appropriate.
Results
We had a 41.8% response rate (n = 5299/12924); 89.8% considered the social role of FM to be essential, while only 20% believed the specialty was well respected within the medical profession. The appeal of FM increased with years of study, independent of student characteristics or medical school attended. Among third and fifth-year students, 54.6% said their specialty preferences had changed during medical school; 73.6% felt that FM specialists should teach FM courses, and 83.3% thought that FM rotations in primary care centres were useful.
Conclusions
Students valued the social role of FM more highly than its scientific standing. The vast majority believe that FM training should be mandatory. Only 25% of first-year students have clear preferences for a specialization. Interest in FM increases moderately over their years of study. Working conditions in FM have decisive influence in choosing a specialty.
doi:10.1186/1471-2296-13-47
PMCID: PMC3436784  PMID: 22642617

Results 1-3 (3)