Medical Student Career Advising: Helping Students Find Their Fit

University of Texas Health Science Center at San AntonioJuly 11, 2013

Jeanette Calli, M.S.Program Manager

Introduction & Objectives• Become familiar with the national Careers in

Medicine program and structure• Describe the resources available to assist

you in your advising role• Obtain basic skills in advising and working

with students in their specialty decisions

Influences on Specialty Choice

* Source: 2012 AAMC Graduation Questionnaire

Percentage of students responding

Level of educational debt

Family expectations

Length of residency training

Competitiveness of specialty

Income expectations

Options for fellowship training

My future family plans

Work/Life balance

Role model influence

Content of specialty

Fit with personality, interests, and skills

0 10 20 30 40 50 60 70 80 90 100

Moderate Influence

Strong Influence

Students need…• to know if their interests, values and

personality fit with the specialty.• good specialty information and early

opportunities to explore their options.• trained mentors and advisors who can guide

students through the process.

Making a specialty decision

BMJ 2005;331:1529

Or the ever-popular GTI (Goo Tolerance Index)

Premise:1. The practice of medicine involves a lot of goo.

2. Goo is yucky.3. Tolerance to goo is as good a predictor as any of what specialty one is suited for.

CMAJ December 4, 2007 vol. 177 no. 12 doi: 10.1503/cmaj.071435

BMJ Specialty decision algorithm

What is Careers in Medicine?A career-planning program to help students• Identify career goals • Explore specialty and practice options • Choose a specialty • Select and apply to residency programs • Make good career decisions

The Career Planning ProcessHelps students effectively gather and use information about themselves and their options to make decisions that meet their career and educational goals.

Careers in Medicine model

Land a

residency

Choose a specialty

Explore options

Understand yourself

Year 1 Year 2 Year 3 Year 4

UnderstandYourself

ExploreOptions

Choosea Specialty

Land aResidency

Careers in Medicine timeline

Careers in Medicine model

Understand yourself

First step in the career planning process• The “foundation for fit”• Focus is on self-assessment

Helps students gather a baseline of information about themselves• What do I like to do?• What is important to me?• What are my greatest strengths?

Understand Yourself

Find your fit: Interests and ValuesMedical Specialty Preference Inventory, Revised Edition (MSPI-R)• Measures interest in various activities, tasks, and experiences

found in medicine • Ratings on 150 items provides the probability of entering 16 medical

specialties and preference for 18 areas of medical practice

Physician Values in Practice Scale (PVIPS)• Identifies priorities regarding six values (Autonomy, Management,

Prestige, Service, Lifestyle, and Scholarly Pursuits)• Used to compare to various environments and activities in medical

practice.

Careers in Medicine model

Understand yourself

Explore options

Explore Options

Second step in the career planning processFocus is on learning about:• Specialties• Practice setting• Academic medicine• Alternatives careers

Careers in Medicine model

Understand yourself

Explore options

Choose a specialty

Third step in the career planning processFocus is on decision-makingHelps students integrate what they have learned about themselves with what they have learned about specialties• What is the best fit for me?• What other things do I need to consider?• How realistic am I being in my decision?

Choose a Specialty

Careers in Medicine model

Understand yourself

Explore options

Choose a specialty

Land a residency

Land a ResidencyFinal step in the career planning process

Focus is on the transition to residency

Helps students get the information they need to apply to residency and go through the Match• How do I apply to programs?• How do I decide the best programs for me?• How do I have a successful Match?

Program featuresWebsite that includes • self assessments and assessment tracker• descriptions and data for more than 120 specialties/medical fields• specialty comparison tool• descriptions of practice options, including academia and non-clinical

jobs • clinical and research opportunities for medical students• tons of advice

School-based advising and programs

Choices, CiM’s quarterly newsletter

www.aamc.org/cim

That’s all good but…

Advising is the cornerstone of a successful Careers in Medicine program.

That’s where you come in!

Common Student Pitfalls Premature decisions (foreclosure) Lack of personal awareness Limited knowledge of training requirements

and competitiveness Failure or inability to integrate information

Helping Students with Career Planning

Career AdvisingA developmental process which assistsstudents in:• the clarification of their life/career goals and• the development of educational plans for the

realization of these goals.

Advising is ongoing, multi-faceted, and the responsibility of both the student and advisorDavid S. Crockett, Ed.   (1987). Advising Skills, Techniques and Resources: A Compilation of

Materials Related to the Organization and Delivery of Advising Services.   Iowa City, Iowa . ACT Corporation.

Developmental Advisors help students to:

• Learn about their interests, values, abilities, and learning patterns, and integrate this knowledge into their specialty choice

• Learn about current specialty choice trends and realities

• Set academic and career goals• Develop plans to meet academic and career goals and

support students in achieving those goals• Understand the relationship between academic and

specialty information and make informed decisions

Your advising role…

Discussion: Defining advisingClarify roles

• How does your institution define advising?• What do students see as your role?

Define individual expectations• What is the student expecting from you?• What support are you capable of providing?

Develop goals• Share goals and gain agreement

Resources and data are key• CiM Specialty info• Charting Outcomes in the Match• FREIDA• NRMP Program Director’s Survey• CiM Residency Preference Exercise• ERAS & NRMP Guidance• Fellow Veritas & MiM advisors• Specialty specific advisors

NRMP, Advanced Data Tables: 2013 Main Residency Match

Making a good decision – Match 201334, 355 active applicants

• 17,487 U.S. M.D. Seniors (960 more than in 2012)• 2677 Osteopaths• 5095 U.S. IMGs• 7568 IMGs

Applicants

29,171 total positions• 26,392 PGY1• 2799 PGY2

Positions

25,463 (74.1%) applicants matched• 16,390 (93.7%) of U.S. M.D. Seniors (95% in 2012)• 2019 (75.4%) of Osteopaths (74.7% in 2012)• 2706 (53.1%) of U.S. IMGs (49.1% in 2012)• 3601 (47.6%) of IMGs (40.6% in 2012)

Match Rates

The Match is becoming more competitive

NRMP, Advanced Data Tables: 2013 Main Residency Match

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

658758

1097

2389

3967

929

2013 Main Residency Match

Non-U.S. Citizen IMGs

U.S. Citizen IMGs

U.S. M.D. Seniors

Previous U.S. M.D. Graduates

Osteopathic Ap-plicants

Other (23)

U.S. M.D. Seniors in SOAP 2013 13,000 total applicants eligible for SOAP

2,076 U.S. M.D. seniors either completely or partially unmatched

980 completely unmatched 452 obtained positions 528 with no position at the end of SOAP

97 percent overall match rate (98.5% in 2012)61 positions unfilled, most in child neurology

(17) & prelim surgery (10)

NRMP, 2013 Post-Match Press Release

Highly competitive specialties: Ratio Step 1 Mean # of ranks

Plastic surgery 1.6 249 10.7Orthopedic surgery 1.2 240 11.5Otolaryngology 1.1 243 11.7Radiation oncology 1.1 240 10.8Dermatology 1.0 244 9.0Neurological surgery 1.0 239 15.2

Ratio of U.S. seniors ranking the specialty first to available positions; mean Step 1 scores; and mean number of ranks for matched seniors

AAMC & NRMP, Charting Outcomes in the Match, August 2011

32

Moderately competitive specialties:

Ratio Step 1 Mean # of ranks

Med/Peds 0.9 230 8.6General surgery 0.9 227 11.2Emergency medicine 0.9 223 10.8Radiology 0.8 240 13.3Anesthesiology 0.8 226 13.2Ob/Gyn 0.8 220 11.0Ratio of U.S. seniors ranking the specialty first to available positions; mean Step 1

scores; and mean number of ranks for matched seniors

AAMC & NRMP, Charting Outcomes in the Match, August 2011

33

Less competitive specialties: Ratio Step 1 Mean # of ranks

Pediatrics 0.7 221 9.6Internal Medicine 0.6 226 9.6Neurology 0.6 225 10.2 Psychiatry 0.6 214 8.5Pathology 0.5 226 8.9PM & R 0.5 214 10.9Family Medicine 0.5 213 8.0Ratio of U.S. seniors ranking the specialty first to available positions; mean Step 1

scores; and mean number of ranks for matched seniors

AAMC & NRMP, Charting Outcomes in the Match, August 2011

34

Common Advising ChallengesAdvising the:• undecided student• under-qualified student• unrealistic student

The Undecided StudentThey come in several different varieties:• Not ready to commit• Want the “perfect choice” or someone to tell

them the “right choice.”• Too many areas of interest or too few• Don’t know where to find the information they

need• Chronically indecisive

Advising the Undecided Student*Step 1: Help the student determine why he or she is undecidedStep 2: Help the student organize a plan for exploringStep 3: Help the student integrate all the informationStep 4: Help the student initiate an action planStep 5: Support the student in their decision-making

*Adapted from:Gordon, V.N. (1995). The undecided college student: An academic and career advising challenge (2nd ed.). Springfield, IL: Charles C. Thomas

Advising the Under-qualified StudentProviding a reality check vs. crushing dreams• Use good, up-to-date data

Charting Outcomes in the Match School-specific Match information

• Brainstorm options• Encourage a parallel plan

Advising the Unrealistic StudentUnrealistic students are determined to stay the course, despite advising to the contrary• Refer to another advisor so they get multiple

perspectives• Give examples of students from previous

years who faced similar situations and their outcomes

• Discuss candidly the options if they don’t match

Case Study #1Charlie, a first year medical student, has an interest in family medicine but is still in the process of exploring other choices. He would like some guidance about choosing a specialty – which experiences can help him learn more about his options, how he should go about making a decision, and what to do to make his application strong. He also notes that he has a high level of undergraduate debt ($80,000), and that his total debt burden when he finishes medical school will exceed $250,000. He is concerned about whether he will make enough money to have a family and a comfortable lifestyle after residency.

Case Study #2Shalini is a second year student and has come to you for guidance about her performance in medical school. She doesn’t seem to be doing very well and is unsure what effect this will have on her career prospects. She is not sure that she even wants to practice medicine since she has an interest in policy. She is also getting pressure from her family (her father is a successful neurosurgeon) about her performance and her non-clinical interests.

Case Study #3Marie is not sure what specialty to choose. She is leaning toward internal medicine and would like to do a fellowship although she’s concerned her academic performance will limit her options. Her USMLE Step I score was 212. Her performance during the first two years as well as her clinical performance in the core clerkships was “Satisfactory”. She did a clinical research project in gastroenterology and is working on the final paper for publication. She is about to begin her 4th year and would like your advice on applying. She has considered a few other specialty options (psychiatry and family medicine) but she is having difficulty with her decision.

Case Study #4James is a third year who has wanted to be a surgeon since before medical school. He initially failed Step I but then passed it on a retake with a score of 191. He received a satisfactory on all his third year core clerkships, but had to retake the shelf exam in ob-gyn. He received a satisfactory on his surgery rotation. Several comments from different clerkships (including surgery) mentioned a defensive and sometimes confrontational attitude. He has received remedial counseling from student affairs for academic performance and professionalism. James has plenty of excuses (some perhaps legitimate – his parents are divorcing) for the clerkship comments and his overall performance. He asks you for advice on matching in surgery.

Case Study #5Charlotte is a fourth year medical student who has done well thus far in medical school. She intends to apply in anesthesiology. She has a Step I score of 250, received favorable comments from faculty and several Honors in the third year core clerkships. She is married and her husband has accepted a junior faculty member position at Arizona State University. She will have a significant geographic restriction in applying to residency. There are two anesthesiology programs in Arizona. She asks for advice on a strategic plan to ensure a successful match.

What if Charlotte was an average student? Does this change your advice?

Case Study #6Adam is a rising fourth year who is tired of being away from home. He has a wife and kids and wants to get back to the west coast. He doesn’t seem committed to one particular specialty. There are several he likes--FM, IM, and Ob/gyn--and he can see himself enjoying any of them after doing the majority of his 3rd year clerkships. His top priority is really location so if he ends up back in San Francisco, he’ll be happy in any of those fields. His Step 1 score was a 215. He comes to you for advice on applying to multiple specialties in the San Francisco area.

Case Study #7Peter and Julia are both early fourth year medical students couples matching into emergency medicine (EM). Peter performed at a satisfactory level throughout medical school (USMLE Step I 210), including receiving only a Pass in EM. Julia (USMLE Step I 256) has obtained many Honors and favorable written evaluation comments in her third year and received a Honors in EM. Julia is very competitive and would like a strong residency. They are planning to get married after graduation.

What advice would you give in this situation? What advice would you give in general to students interested in couples matching?

Career Advising ResourcesCiM Web Site – www.aamc.org/cimAMA’s FREIDA – www.ama-assn.orgAAMC & NRMP report – Charting Outcomes in the MatchNRMP – Program Director SurveyCiM List serve – cim@lists.aamc.orgTraining and Development opportunities

• CiM WorkshopOctober 3-4, 2013 in Washington, DC

Follow us on our Facebook and Twitter accounts

CareersinMedicine @careersinmed

Getting StartedMedical students go to www.aamc.org/cim and sign in with

your AAMC account (used for MCAT, AMCAS, ERAS, etc.)

Faculty and Staff need an access email to register and use the site.

Access emails will be available through Dave Henzi and Norma Fox (CiM Liaisons).

Thanks!

Please complete the evaluation and feel free to contact me with any questions.

Jeanette CalliCiM Program Manager202-862-6270jcalli@aamc.org