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Medical Student
Career Advising:
Helping Students Find
Their Fit
University of Texas Health Science
Center at San Antonio
July 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
Fit with personality, interests, and skills
Content of specialty
Role model influence
Work/Life balance
My future family plans
Options for fellowship training
Income expectations
Competitiveness of specialty
Moderate Influence
Length of residency training
Strong Influence
Family expectations
Level of educational debt
0
10
20
30
40
50
60
70
Percentage of students responding
* Source: 2012 AAMC Graduation Questionnaire
80
90
100
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 Specialty decision algorithm
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 2005;331:1529
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 Process
Helps 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
Careers in Medicine timeline
Year 1
Year 2
Year 3
Year 4
Understand
Yourself
Explore
Options
Choose
a Specialty
Land a
Residency
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?
Find your fit: Interests and Values
Medical 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
Explore Options
Second step in the career planning process
Focus is on learning about:
• Specialties
• Practice setting
• Academic medicine
• Alternatives careers
Careers in Medicine model
Choose a Specialty
Third step in the career planning process
Focus is on decision-making
Helps 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?
Careers in Medicine model
Land a Residency
Final 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 features
Website 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 Advising
A developmental process which assists
students 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 advisor
David 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 advising
Clarify 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
Making a good decision – Match 2013
Applicants
34, 355 active applicants
• 17,487 U.S. M.D. Seniors (960 more than in 2012)
• 2677 Osteopaths
• 5095 U.S. IMGs
• 7568 IMGs
Positions
29,171 total positions
• 26,392 PGY1
• 2799 PGY2
Match Rates
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)
NRMP, Advanced Data Tables: 2013 Main Residency Match
The Match is becoming more competitive
2013 Main Residency Match
10000
9000
Non-U.S. Citizen
IMGs
8000
7000
U.S. Citizen IMGs
3967
6000
U.S. M.D. Seniors
5000
4000
Previous U.S. M.D.
Graduates
2389
3000
2000
1097
1000
758
658
0
Unmatched PGY1
Applicants
Osteopathic
Applicants
Other (23)
929
Unfilled PGY1 Positions
NRMP, Advanced Data Tables: 2013 Main Residency Match
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
10.7
Orthopedic surgery
1.2
240
11.5
Otolaryngology
1.1
243
11.7
Radiation oncology
1.1
240
10.8
Dermatology
1.0
244
9.0
Neurological 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:
Med/Peds
General surgery
Emergency medicine
Radiology
Anesthesiology
Ob/Gyn
Ratio
Step 1
0.9
0.9
0.9
0.8
0.8
0.8
230
227
223
240
226
220
Mean # of ranks
8.6
11.2
10.8
13.3
13.2
11.0
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
33
Less competitive specialties:
Ratio
Step 1
Mean # of ranks
Pediatrics
0.7
221
9.6
Internal Medicine
0.6
226
9.6
Neurology
0.6
225
10.2
Psychiatry
0.6
214
8.5
Pathology
0.5
226
8.9
PM & R
0.5
214
10.9
Family Medicine
0.5
213
8.0
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
34
Common Advising Challenges
Advising the:
• undecided student
• under-qualified student
• unrealistic student
The Undecided Student
They 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
undecided
Step 2: Help the student organize a plan for exploring
Step 3: Help the student integrate all the information
Step 4: Help the student initiate an action plan
Step 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
Student
Providing 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 Student
Unrealistic 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 #1
Charlie, 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 #2
Shalini 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 #3
Marie 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 #4
James 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 #5
Charlotte 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 #6
Adam 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 #7
Peter 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 Resources
CiM Web Site – www.aamc.org/cim
AMA’s FREIDA – www.ama-assn.org
AAMC & NRMP report – Charting Outcomes in the Match
NRMP – Program Director Survey
CiM List serve – [email protected]
Training and Development opportunities
• CiM Workshop
October 3-4, 2013 in Washington, DC
Follow us on our Facebook and
Twitter accounts
CareersinMedicine
@careersinmed
Getting Started
Medical 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 Calli
CiM Program Manager
202-862-6270
[email protected]