Seventy members of the class that entered Dartmouth Medical School in 1984 responded in 1984 and again in 1988 to statements regarding their attitudes towards family medicine, their general criteria for choosing a specialty, and their concerns about lifestyle; also, the students were asked in 1984 to indicate their interest in a career in family medicine and in 1988 to indicate their long-term specialty choices. The students' attitudes towards family medicine were generally positive on entry and became even more positive by their fourth year. Of the 25 students who indicated an initial interest in family medicine, six chose residencies in this field. Because most of the students studied showed strengthening agreement with both (1) the belief that family practitioners are particularly capable of providing comprehensive care and (2) the desire to concentrate on a specialty that would enable them to feel very competent and sure of their work, the authors hypothesize that the students may have feared that their desire for competence and certainty was incompatible with the comprehensiveness of family medicine.