BACKGROUND. A major concern of medical educators is to understand better how the experience of medical school influences students' career choices. This concern is of particular relevance for specialties experiencing or anticipating serious shortages (e.g., psychiatry, generalist specialties, general surgery). METHOD. To construct a case study of a model to determine the influence of medical school on students' selections of specialty, Association of American Medical Colleges (AAMC) databases were used to examine students' interests in one specialty (psychiatry) at two time periods: (1) at or before matriculation and (2) in the first year of residency. Data were examined for all graduates of all U.S. medical schools from 1991 and 1992. In addition to examining data for each school individually, comparisons were made of schools by region and by institutional control (public or private). RESULTS. Increased interest in psychiatry was found in seven of eight regions across the country. The greatest increases were found among graduates of public and private medical schools in the southeast: both types of schools increased the interest in psychiatry among their graduates by 250%, compared with the national average of 170%. A decrease in interest in careers in psychiatry was found among graduates of private medical schools in the northeast. CONCLUSION. The findings point to one way of understanding better the influence of a medical school on its students' career choices. By using this model, each specialty may be able to develop studies to examine the complex interactions between students and specific medical schools.