Professional Development Series . Part 1. What will I be when I grow up?. The answer is no longer just “doctor”. The Big Decision. Most med students spend more time deciding what car to buy than on selecting a career. Little thought goes into a lifelong decision.
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What will I be when I grow up? The answer is no longer just “doctor”
The Big Decision • Most med students spend more time deciding what car to buy than on selecting a career. • Little thought goes into a lifelong decision. • Hasty decisions can lead to burnout, changing residency programs, an unhappy career.
Statistics/Job Satisfaction • 40% of physicians report being very satisfied • 20% of physicians report complete dissatisfaction • The rest are somewhere in between
Pitfalls to Choosing a Specialty: • Anxiety over exams/grades detracts from focusing on the merits of the specialty • Subjective grades can influence final impressions • Bitter residents and attendings/personality conflicts • One bad rotation does not preclude one from choosing that specialty • Lack of participation • Lack of “nittygritty”outpatient experience • Not enough time to look at every specialty in 1 year • Lack of guidance resources/lack of time
Over 60 Specialties and Subspecialties • Allergy and Immunology Anesthesiology • Cardiology Colon and Rectal Sx • Dermatology Emergency Med • Family Practice General Sx • Genetics Infectious Disease • Internal Medicine Neurology • Neurosurgery Nuclear Medicine • OBGYN Oncology • Ophthalmology Orthopedic Surgery • Otolaryngology Pain Management • Pathology Pediatrics • Physical Med/Rehab Plastic Sx • Preventive Med Psychiatry • Radiology Rheumatology • Thoracic/CV Sx Urology
Sample Specialty Divisions Hospital Based Specialties: Radiology, Pathology, Emergency, Surgery Comprehensive care for one population: Pediatrics, OBGYN Primary Care: Family Practice, Internal Medicine, Pediatrics Tertiary Care/Referral-Based/One Organ System: GI, Dermatology, Urology, Neurology, Cardiology
Myths and folklore or truth?? • All orthopods are jocks. • Gynecologists have the worst sex lives of all doctors • Pathologists are socially inept. • You should be a surgeon like your father. • Psychiatrists are crazy! • Dermatology is good money and short hours. • General surgeons do all the work with little pay. • ER docs are adrenaline addicts. • Internists are nerds.
Four Domains of Career Assessment • Personal Values – what is important to you • Physician Values in Practice Scale • Interests – what you like • Medical Specialty Preference Inventory • Personality – what are you like? • Myers-Briggs Type Indicator • Skills – what you can do and do well • Experience on clinical rotations
Personal Values: • Hours • Income • Intellectual Stimulation • Type of Patient Population • Generalist vs Specialist • Work Environment • Patient Contact • Social Status
Other considerations: • Paperwork/Managed Care • Job Opportunities • Length of Training • Academic Competitiveness • Malpractice/Litigation
Personality: What are you like? Results of multiple studies: Surgeons: extroverted, practical, social, less creative, competitive, structured Controllable lifestyle specialists: withdrawn and rebellious Hospital-based specialties: low tolerance for ambiguity, desire high structure OBGYN: warm and helpful Primary care: desired long term patient relationships Action oriented people who desire immediate gratification: sought out ER, surgery, anesthesiology
Myer-Briggs Personality Type IndicatorMBPTI • Developed in the 1950’s • Used in medical schools across the country • Helps guide specialty selection by determining personality and temperament • Identify strengths and weaknesses • Take each year for best results • www.capt.org for a fee can get expert feedback
MBTI: Four dimensions of personality yield 16 different personality types • Extroversion (E) vs Introversion (I): How we interact with the world and where we direct our energy • Sensing (S) vs Intuition (I): The kind of information we naturally notice • Thinking (T) vs Feeling (F): How we make decisions • Judgment (J) vs Perception (P): Whether we prefer to live in a more structured way or a more spontaneous way
Extraversion Introversion Interest Orientation E I Outer world of actions, objects, and people Inner world of ideas and concepts
Sensing Intuition Perception S N Immediate reality and direct experience Inferred meanings and relationships
Thinking Feeling Judgment T F Reliability of logical order – cause and effect Priorities based on personal importance and values
Judgment Perception Environment Orientation J P Judging attitude – Control of events and systematic planning Spontaneity – Curious, awaiting events and adapting to them
Choosing Your Specialty • Step 1: Select specialties of interest • Step 2: Select factors important to you • Step 3: Rate your specialties
Glaxo Pathway Evaluation Program http://www.smbs.buffalo.edu/RESIDENT/CareerCounseling/interior.htm?self-assessment.htm Self assessment will rate medical specialties according to compatability Co-sponsored by Duke University
Glaxo Critical Factors • Caring for Patients • Continuity of Care • Autonomy • Diversity • Personal Time • Expertise • Income Satisfaction • Creativity • Certainty of Outcomes • Clinical Decision Making • Patient Decision Making • Interacting with Other Physicians/ Members of Health-care Team • Manual /Mechanical Activities • Pressure • Responsibility • Schedule • Security • Sense of Accomplishment
AAMC Careers in Medicine Program Password protected
Year 1 • Orientation to Careers in Medicine • Seek out an advisor or mentor • Understanding Yourself • Complete the Specialty Indecision Scale for personalized guidance on your career concerns. • Attend CiM workshops • Begin completing self-assessment exercises
Year 2 * Continue self-assessment * Complete self-assessment exercises * Review completed Personal Profile with advisor Exploring Options * Begin gathering basic information about specialties of interest through CiM Specialty Pages, other online sites, and library research * Attend Specialty Panel and Information Group sessions provided by your school * Compare your self-assessment information to the information you have gathered about specialties. Narrow down your specialty interests to 3-4 top choices * Plan your 3rd year schedule * Take Boards Step 1
Year 3 • Begin clinical rotations • Review the Charting Outcomes in the Match report to assess qualifications and competitiveness for different specialties • Conduct informational interviews and/or participate in preceptorships • Contact associations and specialty organizations • Meet with your advisor to discuss your top choices • Complete the "Choosing Your Specialty" exercise
Year 4: Getting into Residency • Research residency training programs through AMA's FREIDA, AMA's Graduate Medical Education Directory (Green Book), or Osteopathic Opportunities http://opportunities.osteopathic.org/ • Complete the Residency Preference Exercise • Begin reviewing and comparing residency programs • Begin preparing residency applications. • Complete applications and designate programs to which your materials will be submitted • Take Boards Step 2 • Interview with residency programs • Complete the Residency Program Evaluation Guide
Sources for Researching Residency Training Programs • CiM specialty pages http://www.aamc.org/students/cim/start.htm • AMA’s FREIDA http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.shtml • Graduate Medical Education Directory http://opportunities.osteopathic.org/
What Do I Do Now? • Excel in your clinical clerkships • Program directors like to see as many clerkships with Honors as possible – especially in specialty of choice • Explore extramural elective opportunities: • http://www.aamc.org/students/medstudents/electives/start.htm • Shadow drs on breaks and holidays, engage in research projects • Summer between 1st and 2nd year: National Health Service Corps, AMSA/SALUD • Participate in CiM self-assessment and Glaxo Pathway Program • Explore specialties through personal experience, talking to others, CiM, Glaxo, and other resources
Session 3: Getting Into Residency • Applying for residency • Writing a CV and personal statement • Getting letters of recommendation • Residency interviewing
Choosing a Career in Medicine: Sources: 1. The Ultimate Guide to Choosing a Medical Specialty, second edition by Brian Freeman, MD • Ren Stinson / University of Iowa 3. Michael G. Kavan, Ph.D Associate Dean for Student Affairs Creighton University School of Medicine