© 2004 Canadian Medical Association or its licensors Research

In Canada the number of medical students choosing fam-ily medicine as a career option is declining. The propor-tion of students selecting family medicine as a first choice for residency fell from a high of 44 % in 1992 to 25% in 2003, the lowest percentage ever.1 In 2004, there were 124 unmatched family medicine positions in the Canadian Resi-dent Matching Service’s (CaRMS) first iteration.2 After the second iteration, 29 positions remained unfilled.3 These re-sults have left governments, medical workforce experts and all others interested in maintaining or increasing the number of family physicians expressing considerable concern. The reasons why medical students choose their careers are complex. Factors shown to be associated with choosing family medicine include medical school characteristics,4–9 personal interactions,10–17 and lifestyle preferences, personal fit and workforce factors, including expected income, pres-tige, job opportunities, longitudinal care and societal need.16,18–23 Others have demonstrated that career preference at the time of entering medical school may be a significant pre-dictor of students ’ eventual career choice.4,24–26 Colwill, for example, suggests that students usually see themselves as either generalists or specialists at the start of medical school.27 Although there is movement during medical school between the desire to practise family medicine and the desire to practise specialty care, many students end up in careers that are closely related to their choice at the be-ginning of medical school.28 Consequently, defining the factors that influence career choice at the start of medical school is important. The purpose of this study was twofold: to understand what career preferences medical students have at the begin-ning of medical school and to determine what factors influ-ence choosing family medicine as a career