Residency Specialty Choice in Primary Care: When Do Students Make Their Decision and Why? Alice Fornari, EdD Maria Santos, MD Darwin Deen, MD AECOM/DFSM

Why Ask the Question?  Understand the primary care career selection process of AECOM students Clarify career choice overlapping with FM, i.e. ER and Ob/Gyn Clarify career choice overlapping with FM, i.e. ER and Ob/Gyn  Gather data to improve mentoring for students interested in primary care Use data to increase students’ applications to family medicine residency, as a primary care specialty Use data to increase students’ applications to family medicine residency, as a primary care specialty

Background Literature Variables associated with the choice of Family Medicine as a specialty: Age Age Hispanic ethnicity Hispanic ethnicity Rural background and interest in rural background Rural background and interest in rural background Lower income expectations Lower income expectations Preference for FM at matriculation Preference for FM at matriculation Attending a public school Attending a public school Special program focused on primary care physicians Special program focused on primary care physicians *FM Clerkship (required) *FM Clerkship (required) *Competence of FM faculty *Competence of FM faculty *relevant to AECOM Campos-Outcalt D, Senf J, Pugano P, McGaha A; Family Medicine specialty selection: A proposed research agenda; Fam Med 2007;39(8):585-89

Background Literature Variables not consistent with the choice of Family Medicine as a specialty:  Gender and marital status  Student debt  *Family Medicine faculty participation in 1 st 2 years of medical school  Admissions committee composition *relevant to AECOM Campos-Outcalt D, Senf J, Pugano P, McGaha A; Family Medicine specialty selection: A proposed research agenda; Fam Med 2007;39(8):585-89

Medical School Experiences in Family Medicine (FM) Climate offers negative comments for some students Climate offers negative comments for some students Faculty role models- more impt. in FM Faculty role models- more impt. in FM Perceived low intellectual content vs. perception of competence as high Perceived low intellectual content vs. perception of competence as high Interest in research or academic career negatively impacts choice Interest in research or academic career negatively impacts choice Interest in obstetrics, behavioral sciences and procedures can influence FM selection Interest in obstetrics, behavioral sciences and procedures can influence FM selection Fam Med 2004; 36(2 and 4) : and 260-4

Instrument  Self-designed survey instrument (handout)  Piloted in 2006 by electronic distribution as an attachment  Same instrument distributed through Survey Monkey in 2007

Methodology Post residency match day identified each MSIV student who matched in the following specialties: 1. Med/Peds (1) 2. PC medicine (0)-unusual 3. Pediatrics (21) 4. OB-GYN (9) 5. Family Medicine (5) 6. Emergency Medicine (18)

Methodology  Each student matching in the selected specialties received an invitation to participate in the questionnaire using Survey Monkey  Electronic reminders were sent weekly for one month post initial request, 4 total, including initial request

Methodology  The introductory stated: We are seeking ways to improve the career selection process for AECOM students. We are especially interested in ways that we can improve the experience of AECOM students who might be interested in a career in Family Medicine. As a student who selected a primary care career choice, your opinions are important to us. Please take a few minutes to fill out this anonymous short survey. Results are not released to anyone until after graduation. All responses will be aggregated before sharing with interested medical school admissions or faculty. Your feedback is appreciated and will be used to make improvements in AECOM mentoring, especially focused on primary care careers. We are seeking ways to improve the career selection process for AECOM students. We are especially interested in ways that we can improve the experience of AECOM students who might be interested in a career in Family Medicine. As a student who selected a primary care career choice, your opinions are important to us. Please take a few minutes to fill out this anonymous short survey. Results are not released to anyone until after graduation. All responses will be aggregated before sharing with interested medical school admissions or faculty. Your feedback is appreciated and will be used to make improvements in AECOM mentoring, especially focused on primary care careers.

Results  54 surveys were electronically distributed  32 survey were returned (59%) 14 (44%) pediatrics 14 (44%) pediatrics 10 (31%) ER 10 (31%) ER 4 (12.5%) OB/GYN 4 (12.5%) OB/GYN 3 (9.4%) FM 3 (9.4%) FM 1 (3.1%) Med/Peds 1 (3.1%) Med/Peds

Results Cont.  Prior to beginning clinical clerkships 56% of the respondents anticipated ranking FM as their residency choice 56% of the respondents anticipated ranking FM as their residency choice 43% anticipated pediatrics as their first choice 43% anticipated pediatrics as their first choice 33% anticipated surgery 33% anticipated surgery

Results Cont.  44% made a decision on their specialty during clinical clerkship  21% made a decision before medical school or during electives

Results Cont.  Factors most influencing their decision: Patient Care Model for individual specialty Patient Care Model for individual specialty Multiple factors Multiple factors Preference for a population Preference for a population Mentor/role model in selected discipline Mentor/role model in selected discipline

Results Cont.  AECOM educational experiences that positively influence decision making Clerkship experience Clerkship experience Great mentors (esp. pediatric) Great mentors (esp. pediatric) Supportive clerkship faculty Supportive clerkship faculty

Results Cont.  AECOM educational experiences that negatively influence decision making Poor career advisement Poor career advisement Individual attending experience Individual attending experience Clerkship experience Clerkship experience

Results Cont.  AECOM student perception of why FM has so few applicants: Lack of prestige (research/scholarship) Lack of prestige (research/scholarship) Lack of respect (peers, colleagues, education leaders) Lack of respect (peers, colleagues, education leaders) Too broad a discipline Too broad a discipline Low compensation Low compensation

Steps at AECOM  Increased longitudinal mentoring, through a HRSA grant, from MSI year forward  Changed leadership in FSMIG to younger junior attendings  Improved FM subinternship experience  Reassessed clerkship sites for MS III  Maintain electives for MS IV year  Summer experiences

Discussion  How to maintain an early and often, multiple point contact system with students to promote Family Medicine as a PC career choice?