Electives and Career Planning

John Graneto, D.O., M.Ed. Professor and Associate Dean Disclosure

• This study was supported by a grant from the American Association of Colleges of Osteopathic Medicine and the Osteopathic Heritage Foundation. IRB

• This study was reviewed by the IRB at Midwestern University, Downers Grove IL. Acknowledgements

• Statistical Support provided by: • Matthew S. Mayo, Ph.D., MBA • Founding Chair and Professor, Department of Biostatistics • KU Medical Center, Kansas City Introduction

• Osteopathic medical students face decisions such as “should they enter primary care or a specialty field?” • Factors that ultimately influence an individual medical student’s specialty choice are also varied. 1,2 • What is less well described are the rotation elective choices students make based on entering these specialties. • The objective for this study is to compare the elective choices that students make. Background

• Medical school curricula, generally consist of earlier years of foundational teachings in the science-based disciplines or systems and during the later years more clinically focused rotation-based bedside patient encounters with physician preceptors.6,7 • Every year thousands of osteopathic medical students throughout the country make the transition from these pre-clinical classroom years to the rotation-based clinical experiences.8,9 Background

• Each student may have limited number of electives • Perceived lifestyle of that career choice is cited as one factor that influences students’ decisions to match in a particular area such as EM.13 • Earlier exposure to a specific specialty may in fact make a student’s choice of matching in that specialty more desirable.4,14,15 Background

• Clinical rotation requirements are generally include several electives available at the student’s discretion.20 • Students may seek the advice of faculty and staff as to which rotation electives to choose.21 These decisions are sometimes based on an individual student’s general interest in the specific elective rotation or • they may be based on the specialty being sought for residency training and the students need to audition for their desired career choice.22-24 Methods

• A retrospective records review of students who attended Chicago College of Osteopathic Medicine from 2008 through 2012. Approval from the IRB at Midwestern University was attained. Data was obtained through the office of Clinical Education and entered into spreadsheet. • Analysis of data findings was conducted by separate individuals after specific identifying information had been removed from the spreadsheet data.

746 records were reviewed

• Retrospective Review • Class of 2008, 09, 10, 11, 12 • After all NMS, NRMP, secondary match, scramble and SOAP Top Choices for Careers

• Family 27% • Internal 22% • Emergency 11% • Pediatrics 7% • Radiology 3% • Surgery 3% Definitions

• Auditions or Sub-I (in the same specialty)

• Other electives as follows…. Family - 201 Students 90 80 70 80 60 50 40 49 30 20 30 10 0 Radiology Hospice PM&R Internal Medicine - 167 Students 90 80 70 78 60 63 50 57 40 30 20 10 0 Radiology Nephrology Cardiology Emergency - 81 Students 45 40 35 39 30 31 25 20 15 19 10 5 0 Radiology Family Anesthesiology Pediatrics - 49 Students 25

20 21 19 15 15 10

0 Neonatology Radiology Ped/GI Radiology -24 Students 8 7 7 6 5 5 5 4 3 2 1 0 Family Pathology Internal Medicine General Surgery - 23 Students 12

10 11 11

6 7

0 Radiology Plastics Ortho PSYCH - 22 Students 12

10 11 10 8

4 4 2

0 Family Radiology Neurology ENT - 21 Students 12

10 11

6 7

0 Neurology Ped Neurology Orthopedics - 19 Students 8 7 6 7 6 5 5 4 3 2 1 0 Family Radiology Emergency Medicine PM&R - 19 Students 9 8 7 8 8 6 5 4 5 3 2 1 0 Radiology Family Neurology Anesthesiology - 18 Students 16 14 15 12 10 8 9 6 4 2 3 3 0 PM&R Radiology Ortho Critical Care OB/GYN - 17 Students 12

10 10 8

6 6 4 4 2

0 Maternal Fetal Radiology Research Neurology - 11 Students 7

6 6 5

4 4 3 3 3 3 2

0 Radiology Family Psych Critical Care Neuro Surg Clinical Rotations

• Conclusions References • 1. Kiolbassa K, Miksch A, Hermann K, et al. Becoming a general practitioner--which factors have most impact on career choice of medical students? BMC Fam Pract. 2011;12:25. • 2.Love JN, Howell JM, Hegarty CB, et al. Factors that influence medical student selection of an emergency medicine residency program: implications for training programs. Acad Emerg Med. 2012;19(4):455-460. • 3.Gill H, McLeod S, Duerksen K, Szafran O. Factors influencing medical students' choice of family medicine: effects of rural versus urban background. Can Fam Physician. 2012;58(11):e649-657. • 4.Zun LS, Downey L. Is a third year clerkship in emergency medicine correlated with a career choice in emergency medicine? Teach Learn Med. 2004;16(1):14-17. • 5.Carraccio CL, Englander R. From flexner to competencies: reflections on a decade and the journey ahead. Acad Med. 2013;88(8):1067-1073. • 6.Duffy TP. The Flexner Report--100 years later. Yale J Biol Med. 2011;84(3):269-276. • 7.Ludmerer KM. Abraham Flexner and medical education. Perspect Biol Med. 2011;54(1):8-16. • 8.Levitan T. AACOM projections for growth through 2012: results of a 2007 survey of US Colleges of Osteopathic Medicine. J Am Osteopath Assoc. 2008;108(3):116-120. • 9.O'Brien BC, Poncelet AN. Transition to clerkship courses: preparing students to enter the workplace. Acad Med. 2010;85(12):1862-1869. • 10. Terry R, Hill F. Analysis of AOA/ACGME accredited family medicine residency programs. Fam Med. 2011;43(6):387-391. • 11. Jolly P, Boulet J, Garrison G, Signer MM. Participation in U.S. graduate medical education by graduates of international medical schools. Acad Med. 2011;86(5):559-564. • 12. Fabri PJ, Powell DL, Cupps NB. Is there value in audition extramurals? Am J Surg. 1995;169(3):338-340. References • 13. Boyd JS, Clyne B, Reinert SE, Zink BJ. Emergency medicine career choice: a profile of factors and influences from the Association of American Medical Colleges (AAMC) graduation questionnaires. Acad Emerg Med. 2009;16(6):544-549. • 14. Colwill JM, Cultice JM. The future supply of family physicians: implications for rural America. Health Aff (Millwood). 2003;22(1):190-198. • 15. Cummings M, Dobbs KJ. The irony of osteopathic medicine and primary care. Acad Med. 2005;80(7):702-705. • 16. Tong ST, Phillips RL, Berman R. Is exposure to a student-run clinic associated with future primary care practice? Fam Med. 2012;44(8):579-581. • 17. Clinite KL, Reddy ST, Kazantsev SM, et al. Primary Care, the ROAD Less Traveled: What First-Year Medical Students Want in a Specialty. Acad Med. 2013. • 18. Penciner R. Emergency medicine preclerkship observerships: evaluation of a structured experience. CJEM. 2009;11(3):235-239. • 19. Heidelbaugh J, Cooke J, Wimsatt L. Opportunities for medical student engagement with family medicine. Fam Med. 2013;45(7):484-491. • 20. Mueller PS, McConahey LL, Orvidas LJ, et al. Visiting medical student elective and clerkship programs: a survey of US and Puerto Rico allopathic medical schools. BMC Med Educ. 2010;10:41. • 21. Miller JB, Koehn NN, Schaad DC, Crittenden RA, Oriol NE. The departmental advisor's effect on medical students' confidence when the advisor evaluates or recruits for their own program during the match. Teach Learn Med. 2004;16(3):290-295. • 22. Goldacre MJ, Goldacre R, Lambert TW. Doctors who considered but did not pursue specific clinical specialties as careers: questionnaire surveys. J R Soc Med. 2012;105(4):166-176. • 23. Hobbs J, Rosenthal TC, Newton WP, Medicine AoDoF. Difficult choices in medical student education. Ann Fam Med. 2006;4(6):564-565. • 24. Bahn TJ, Cronau HR, Way DP. A comparison of family medicine and internal medicine experiences in a combined clerkship. Fam Med. 2003;35(7):499-503. Thanks Alternative Specialty Choices

• What is my Back Up Plan? Alternative Specialty Choices

What is my Back Up Plan? Alternative Specialty Choices

What if specialty X didn’t exist? What would you suggest your classmate do? Anesthesia 30

25 26 20

0 Radiology Dermatology 50 45 40 45 35 30 25 20 15 19 10 5 0 Plastic Ophthalmology Emergency 40 35 38 30 25 20 15 17 10 5 0 General Surgery Anesthesia ENT 100 90 92 80 70 60 50 40 30 20 24 10 0 Ophthalmology Plastic Family 140

120 128

100 108

60 69 57 40 36 32 20 31

0 Internal Pediatrics Psychiatry OB/GYN PM&R Emergency Dermatology General Surgery 70

60 60 58 50 53 53

30 35

24 20 22

10 14

0 Neurosurgery Orthopedics OB/GYN Plastic Urology Emergency Anesthesia ENT Internal Medicine 120

100 104 80

40 42 41 20 12 0 Family Emergency Neurology ENT Nephrology 30

25 28

0 Urology Neurology 45 40 42 41 35 30 25 20 15 10 11 5 0 Neurosurgery Psychiatry Ophthalmology Neurosurgery 16 14 15 12 10 8 6 4 2 0 Neurology OB/GYN 45 40 42 35 36 30 25 27 20 15 10 5 0 Urology General Surgery Pediatrics Ophthalmology 50 47 40

0 ENT Orthopedics 60

50 51 40

20 22 10

0 PM&R General Surgery Pathology 90 80 80 70 60 50 40 30 20 10 0 Radiology Pediatrics 35 30 30 25 20 15 10 5 0 OB/GYN Plastics 35 30 29 25

20 22 15 10 5 0 Dermatology ENT PM&R 50

40 39 30

0 Orthopedics Psychiatry 60

50 53

0 Neurology Radiology 120

100 102 80

40 49

0 Pathology Anesthesia Sports Medicine 30

25 24 20

0 Orthopedics Urology 12

10 10 10 8

0 General Surgery OB/GYN Thanks