MOST POPULAR FCEs

MOST POPULAR FCEs

Flexible elective time during medical school year three for exploring career opportunities including surgical specialties NEGEA Annual Retreat April 17, 2015 Worcester, MA Dylan Perry1, Colleen Burnham1,4*, David Hatem, MD1,2, Christine Vigeant1,3, Mitchell Cahan, MD1,3, Samir Malkani, MD1,2+ University of Massachusetts Medical School 2 Department of Medicine 3 Department of Surgery 4 Office of Undergraduate Medical Education * FCE Program Manager + FCE Course Director

1 Goals and Objectives Describe a unique career exploration opportunity, Flexible Clinical Experiences (FCEs), offered during the third year at the University of Massachusetts Medical School. Identify most important medical school experiences for career decision-making across specialties, especially in fields outside the core 3rd year curriculum through a survey. Hypothesis: FCEs are most valuable to those ultimately pursuing fields outside the core curriculum. Analyze FCE enrollment data, including with deidentified paired data for residency matches. Flexible Clinical Experience (FCE) Course

Required 3rd year curriculum component Comprised of 4, 1-week experiences Options include faculty-designed or student-designed Individual exploration and self-directed learning in a variety of clinical and translational science fields, early in the students' career. Explore a career choice, find mentors, early exposure. Emphasize one-on-one interaction between student and teacher. Criteria for granting credit are elective-specific minimum standards of performance as laid down by sponsoring departments. Disadvantages: time subtracted from core clerkships, short duration 3rd year elective time in other medical school curricula

Wolf M, Akie T, Malkani S, Burnham C, Fischer M. Flexible clinical experiences: Self-selected learning opportunities for third year medical students. AAMC Meeting Poster Presentation. Survey of UMMS classes of 2014-15 Year of Graduation Specialty match Rating of importance of experiences in deciding on chosen specialty (and of deciding not to pursue surgery if that is the case) FCE impact on career decision making N=58 started survey N=52 completed survey Population size ~ 250 Nomenclature Surgeons vs. Non-Surgeons Surgeons = General Surgery, OB/GYN, Surgical Specialties (Plastic, Neuro, Vascular, Ophtho, ENT, Urology, Orthopedics) Non-surgeons = everyone else

Core vs. Non-Core Core = Core curriculum specialties every student rotates through (Internal Medicine, Pediatrics, Family Medicine, Psychiatry, General Surgery, OB/GYN, Neurology) Non-Core = Surgical specialties + Anesthesiology, Emergency Medicine, Pathology, Dermatology, Radiology, Radiation Oncology, PMR, etc Surgeons + Non-surgeons = Core + Non-core Survey respondents, n=52 45 39 40 37

35 30 25 20 15 15 13 10 5 0 SURGEONS NON-SURGEONS CORE

NON-CORE All respondents: How important were the following experiences in deciding to pursue the field you are in or going in to? Pre-medical experience Pre-clinical medical school experience 3rd year core clerkship rotation No impact on my decision Somewhat important 3rd year surgery clerkship specialty surgery rotation (surgeons only) Most important 3rd year Flexible Clinical Experience(s) (FCE) 4th year rotation or sub-internship other (specify below) Other responses: 0% 10% 20% 30% 40% 50% 60% 70% 80%

Being involved in Interest Groups, volunteering Mentors Personality of the specialty Clinical research in my chosen field N/A Did you find FCEs useful for career planning? 100% 90% 80% 70% 60% No Yes 50% 40%

30% 20% 10% 0% SURGEONS NON-SURGEONS CORE NON-CORE Flexible Clinical Experiences as career decision factor N/A Surgeons Most

important Somewhat important Non-Surgeons No impact on my decision Core Non-Core 0% 10% 20% 30%

40% 50% 60% 70% 80% 90% 100% FCEs impact on career decision making (can select >1) Reaffirmed my prior career plan NON-CORE Sparked interest in new field I am now pursuing

CORE NON-SURGEONS Sparked interest in a new field, but I decided not to enter it SURGEONS Made me decide against pursuing a field I thought I was interested in FCEs had no effect on my career planning Other (please specify) 0% 10% 20% 30%

40% 50% 60% Non-surgeons: At this time, do you plan to pursue a fellowship after residency? Non-surgeons importance of FCE for career decisions based on fellowship plans 30 27 25 Yes Fellowship, Yes FCE 1 7 4

Most important 20 15 12 Yes Fellowship, No FCE 10 3 7 2 Somewhat important

No impact on my decision 5 0 Yes No Fellowship 3 0% 10% No

6 20% 30% 40% 50% 3 60% 70% 80% 90% 100%

FCE impact on Non-Surgeons based on whether planning fellowship Reaffirmed my prior career plan Sparked interest in new field I am now pursuing Yes Fellowship, Yes FCE Sparked interest in a new field, but I decided not to enter it Yes Fellowship, No FCE Made me decide against pursuing a field I thought I was interested in No Fellowhsip FCEs had no effect on my career planning Yes, FCEs Useful for career planning Other (please specify) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Other responses: Helped add knowledge I still use in primary care

gave breadth of knowledge- things I wouldnt be exposed to or do again 100% 90% 80% 70% N/A 60% Most important 50% Somewhat important 40% No impact on my

decision 30% 20% 10% 0% Non-surgical Surgical How important were the following experiences in deciding NOT to pursue a surgical specialty? (non-surgeons only) Pre-medical experience Pre-clinical medical school experience 3rd year core clerkship rotation (General surgery or OB/GYN) No impact on my decision 3rd year surgery clerkship specialty surgery rotation

3rd year Flexible Clinical Experience(s) (FCE) Somewhat important 4th year rotation or sub-internship Most important N/A other (specify below) 0 5 10 15

20 25 30 35 Non-Surgeons: How seriously did you consider surgery? How important was FCE in deciding against surgery? Not at all n=18 N/A Most important Somewhat n=16 Somewhat important No impact on my decision Very n=5 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

To what extent did this experience help you make an informed decision regarding your career/specialty choice? (scale 1-4), n=1024, avg=3.50 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 Average of each FCE's overall rating 1. Student-Designed Clinical 2. Path Week! 3. Dominican Republic Trip 4. Capstone Research

MOST POPULAR FCEs 5. Pediatric Radiology 6. Invasive Cardiology 7. Plastic Surgery 8. Student-Designed Research 9. Newborn ICU 10. Pediatric Critical Care 11. Homeless Services 12. Intro to Anesthesiology 13. Critical Care Medicine 14. Physical Medicine and Rehabilitation 15. Infectious Disease 16. Intro to Med/Peds 17. Orthopedics 18. Pediatric Endocrinology 19. Clinical Dermatology 1. Student-Designed Clinical

2. Path Week! 3. Dominican Republic Trip 4. Capstone Research STUDENT-DESIGN 5. Pediatric Radiology 6. Invasive Cardiology 7. Plastic Surgery 8. Student-Designed Research 9. Newborn ICU 10. Pediatric Critical Care 11. Homeless Services 12. Intro to Anesthesiology 13. Critical Care Medicine 14. Physical Medicine and Rehabilitation 15. Infectious Disease 16. Intro to Med/Peds 17. Orthopedics

18. Pediatric Endocrinology 19. Clinical Dermatology 1. Student-Designed Clinical 2. Path Week! 3. Dominican Republic Trip 4. Capstone Research NON-CORE SPECIALTIES 5. Pediatric Radiology 6. Invasive Cardiology 7. Plastic Surgery 8. Student-Designed Research 9. Newborn ICU 10. Pediatric Critical Care 11. Homeless Services 12. Intro to Anesthesiology 13. Critical Care Medicine

14. Physical Medicine and Rehabilitation 15. Infectious Disease 16. Intro to Med/Peds 17. Orthopedics 18. Pediatric Endocrinology 19. Clinical Dermatology 1. Student-Designed Clinical 2. Path Week! 3. Dominican Republic Trip 4. Capstone Research FELLOWSHIP POSSIBILITIES 5. Pediatric Radiology 6. Invasive Cardiology 7. Plastic Surgery 8. Student-Designed Research

9. Newborn ICU 10. Pediatric Critical Care 11. Homeless Services 12. Intro to Anesthesiology 13. Critical Care Medicine 14. Physical Medicine and Rehabilitation 15. Infectious Disease 16. Intro to Med/Peds 17. Orthopedics 18. Pediatric Endocrinology 19. Clinical Dermatology 1. Student-Designed Clinical 2. Path Week! 3. Dominican Republic Trip 4. Capstone Research RESEARCH

5. Pediatric Radiology 6. Invasive Cardiology 7. Plastic Surgery 8. Student-Designed Research 9. Newborn ICU 10. Pediatric Critical Care 11. Homeless Services 12. Intro to Anesthesiology 13. Critical Care Medicine 14. Physical Medicine and Rehabilitation 15. Infectious Disease 16. Intro to Med/Peds 17. Orthopedics 18. Pediatric Endocrinology 19. Clinical Dermatology 1. Student-Designed Clinical 2. Path Week! 3. Dominican Republic Trip

4. Capstone Research UNDERSERVED POPULATIONS 5. Pediatric Radiology 6. Invasive Cardiology 7. Plastic Surgery 8. Student-Designed Research 9. Newborn ICU 10. Pediatric Critical Care 11. Homeless Services 12. Intro to Anesthesiology 13. Critical Care Medicine 14. Physical Medicine and Rehabilitation 15. Infectious Disease 16. Intro to Med/Peds 17. Orthopedics 18. Pediatric Endocrinology

19. Clinical Dermatology Limitations Sample size/lack of statistical rigor Survey wording need to be more specific Limit survey response of most important to only one possible selection Anecdotal Conclusions Overall FCEs are an important factor in career decision making, especially for students pursuing surgical and non-core specialties, but not as important as longer 3rd and 4th year rotations. FCEs are not an important factor in deciding not to pursue a surgical specialty except for those most seriously considering surgery. Popular FCEs are often self-designed, in non-core specialties or fellowships, research, and serving underseved populations. Largely, FCEs appear to succeed in enabling self-directed exploration, and for a subset of students, provide critical experiences for deciding their future.

References 1: Hill EJ, Bowman KA, Stalmeijer RE, Solomon Y, Dornan T. Can I cut it? Medical students' perceptions of surgeons and surgical careers. Am J Surg. 2014 Nov;208(5):860-7. doi: 10.1016/j.amjsurg.2014.04.016. Epub 2014 Jul 1. PubMed PMID: 25092269. 2: Hochberg MS, Billig J, Berman RS, Kalet AL, Zabar SR, Fox JR, Pachter HL. When surgeons decide to become surgeons: new opportunities for surgical education. Am J Surg. 2014 Feb;207(2):194-200. doi: 10.1016/j.amjsurg.2013.10.010. Epub 2013 Dec 4. PubMed PMID: 24468025. 3: Patel MS, Mowlds DS, Khalsa B, Foe-Parker JE, Rama A, Jafari F, Whealon MD, Salibian A, Hoyt DB, Stamos MJ, Endres JE, Smith BR. Early intervention to promote medical student interest in surgery and the surgical subspecialties. J Surg Educ. 2013 Jan-Feb;70(1):81-6. 4: Johnson AL, Sharma J, Chinchilli VM, Emery SE, McCollister Evarts C, Floyd MW, Kaeding CC, Lavelle WF, Marsh JL, Pellegrini VD Jr, Van Heest AE, Black KP. Whydo medical students choose orthopaedics as a career? J Bone Joint Surg Am. 2012 Jun 6;94(11):e78. 5: McCord JH, McDonald R, Sippel RS, Leverson G, Mahvi DM, Weber SM. Surgical career choices: the vital impact of mentoring. J Surg Res. 2009 Jul;155(1):136-41. 6: McCord JH, McDonald R, Leverson G, Mahvi DM, Rikkers LF, Chen HC, Weber SM. Motivation to pursue surgical subspecialty training: is there a gender difference? J Am Coll Surg. 2007 Nov;205(5):698-703. 7: Zeldow PB, Preston RC, Daugherty SR. The decision to enter a medical specialty: timing and stability. Med Educ. 1992 Jul;26(4):327-32.

Special Thanks Special thanks to Colleen Burnham and Samir Malkani for their guidance and assistance throughout this project! The following slides are extras in case of questions Ratio of # FCEs in a specialty to # Matches (2014-5) Plastic Surgery Pathology Physical Medicine and Rehabilitation Vascular Surgery Radiology Ophthalmology Anesthesiology Surgery Medicine Orthopedics

Urology Psychiatry Family Medicine OB-GYN Dermatology Pediatrics Emergency Medicine Neurosurgery Neurology Otolaryngology 0 2 4 6 8

10 12 14 16 UMass Surgical matches (% of class) 25% 20% Specialty surg % of class 15% GS/OB % of class 10%

5% 0% 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Total Surg % class 90% Core vs non-core UMMS matches (% of class) 80% 70% 60% 50% 40% % Core

Matches % Non-core Matches 30% 20% 10% 0% 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Core = Core curriculum specialties (IM, pediatrics, FM, psychiatry, general surgery, OB/GYN, neurology) Non-core = Surgical specialties + anesthesiology, EM, dermatology, radiology, pathology, radiation oncology Brief prior knowledge intro Surgeons and orthopedists may decide on a surgical career earlier (e.g. pre med school) than other fields (Hochberg, Johnson) Majority of students may be able to predict their ultimate

match by end of 2nd year medical school (Zeldow) Mentoring is an important factor in choosing surgical specialty (McCord) Perceptions of poor surgical lifestyle may affect decision to enter surgery, especially for women (McCord) and surgeon stereotypes may deter some (Hill)

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