Family Medicine Wants You! Techniques to Improve Medical Student Recruitment Natasha J. Pyzocha, DO Megan B. Mahowald, MD Douglas M. Maurer, DO, MPH, FAAFP Madigan Army Medical Center Family Medicine Residency

Disclosures The opinions or assertions contained herein are the private views of the author(s) and are not to be construed as official or as reflecting the views of the Department of Defense

Objectives Identify factors that lead to successful medical student recruitment Describe techniques to improve recruitment Integrate techniques into your programs

Activity #1 In small groups, brainstorm unique characterisitics of Family Medicine that start with each letter of the alphabet 5 Minutes

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Student Recruiting Evidence 2004 BMC Medical Education, Schultz et al. Final year medical students and residents at 5 medical schools in Ontario surveyed about site characteristics and preceptor behaviors most enhancing their learning in clinic

Student Recruiting Evidence “Having an adequate number and variety of patients while being supervised by enthusiastic preceptors who give feedback and are willing to discuss their reasoning processes and delegate responsibility was valued by almost all learners”

Student Recruiting Evidence Preceptor interaction most important Valued preceptor behaviors –Open to questions –Gave constructive feedback –Demonstrated enthusiasm for teaching

Student Recruiting Evidence 2013 Academic Medicine, Clinite et al. Cross-sectional survey of first-year medical students from 11 medical schools (n=1020) Respondents rated importance of 5 domains of good lifestyle and 21 characteristics related to specialty selection

Our Residency Program Started as a QA/QI project –Resident led Medical Student Committee –Pre and post rotation surveys Three focus areas –Academic –Social –Communication

Our Residency Program Committee started because previous efforts were fragmented and efforts poorly communicated Regular meetings, resident and staff representation, delegation of activities

See Handout for Pre- Rotation Survey Example

Examples of What Students Wanted Wide diversity 1 on 1 contact with attendings Freedom/encouragement to function on own Given responsibility More procedures Feeling comfortable asking questions Interaction with residents

Pre-Survey Enjoy about previous rotations Wide diversity- OBGYN call, inpatient, outclinic 1v1 contact with attendings, see patients on own Freedom/encouragement to get involved in patient care, procedures, OMT, being asked for assessment and plan Give responsibility for own patients and small assignements Variety of patients, freindliness of staff 1v1 instruction, good number of patients, excellent attendings Diversity, learning new procedures, interviweing patients Daily morning report, presentations on essential topics Procedures Diversity of care, residents very willing to teach Responsibility for patient care, good relationship with instructors Reinforcement of text with practical application. Also seeing paitenets presenting with clasic symptoms Feeling like I had ownership of my patients (follow up phone calls about labs, first to see them on my own) Taking ownership for patients on the inpatient ward Felt comfortable asking questions

Pre-Survey Improve previous rotations More procedures More hands on rather than shadowing Don’t take social/dispo issues as there's not much learning Diversity of patients, more procedures, more peds Decreased down time and improved communication Longer rotations More diversity Engage attendings in the teaching process More hands on with procedures, writing less notes so able to see more patients Spending less time in the nursery and more time in NICU and sub-specialty (did peds) More self-studying early on

New Ideas LecturesPatient Diversity Pre & Post Rotation Surveys Existing Rotation InpatientOutpatientProcedures Our Outcomes: Academic

New Ideas Scheduled DinnersScheduled Mid-Month Activities Proactive Retreat InvitationList Nearby Activities Existing Rotation Sporatic DinnersRetreat Invitation Our Outcomes: Social

Resident Activities Relaxed environment –Dinner at resident’s house –Holiday parties –Trivia nights Athletics –Hiking –Bowling Local attractions –Restaurants –Museums

New Ideas Formal LettersThank-you LettersResident & Student Bios Individual Student Introductions During AM Report Existing Rotation Program Director LedChief Resident Led Our Outcomes: Communication

Thank-you Letter Example Dear Stacy: Thank you for coming to visit Madigan Army Medical Center to see what full spectrum Family Medicine is about. We really enjoyed having you here and hope you had a great experience and exposure to our specialty. The knowledge and clinical experiences you’ve learned here will serve you well throughout your future clinical rotations and practice of medicine. If you are considering Family Medicine as a prospective career, we strongly encourage you to consider us for your residency training. We have something to offer for everyone to meet your goals. Our strengths include having a fully functioning patient centered medical home to promote continuity of care and increase patient satisfaction, experienced faculty and staff with a plethora of military and combat experience, a strong didactics program that caters to the adult learner, direct access to subspecialist, ample research opportunities, and numerous potential fellowships after completing residency training including Wilderness Medicine, Colonoscopy, or Faculty Development. We were excited to have you and appreciate any feedback you have to make this experience better. If you have any questions or concerns about our program or residency training, please don’t hesitate to contact anyone listed below. We appreciate your decision to serve our country and take care of the medical needs for America’s sons and daughters!

Resident Bio Example Name and class year (R1, R2, R3): Medical School: Where you call “home”: Why did you go into medicine? What is your favorite activity? What is one unique thing about you?

Medical Student Bio Example Name: Medical School: Where you call “home”: Why did you go into medicine? What is your favorite activity? What is one unique thing about you?

Activity #2 In small groups, address each factor of recruitment and barriers to each Academic Social Communication 5 Minutes

Activity #3 In small groups, discuss strategies to overcome the barriers previously discussed Create a plan to improve recruitment Be prepared to present –Objective measures –Implementation –Pitfalls 15 Minutes

Our Statistics Overall Post-Rotation Surveys improved from Pre-Rotation Surveys Qualitative data most useful for project Objective outcomes the following year: –Increased number of applicants –Increased #1 rankings in Military Match –Special recognition from Uniformed Services University of Health Sciences

Our Statistics Overall Post-Rotation Surveys were improved from Pre-Rotation Surveys Of most benefit, write in answers Next year had increased number of applicants, increased number stating rank #1, special recognition from Uniformed Services University of Health Sciences Question # pre post

Post-Survey Qualitative Data Enjoy about this rotation Yes Working with different providers, being able to work with PD and other military Procedure days, paintball Residents and staff Relaxed environment Retreat The entire clinic appears to work well as a team. Good open learning with daily knowledge points The chemistry of the residents, how they all interact, and how willing they are to take time to teach Great teaching, great student activities Interaction with residents and getting to know them More or an orientation/tour when I first arrived Staff and residents were extremely helpful and created a positive learning environment, good balance of clinic, inpatient, and studytime Procedures, wide variety of patients Great atmosphere, everyone seems to enjoy what they do and likes teaching The amount of responsibility and support Hands on experiences, independence in clinic an don FMIT, good repport and support from attendings and residents, teaching conferences FMIT. I enjoyed thinking about how to help patients and creating a plan as part of a team… and then doing it The community and teamwork, the atmosphere of teaching, the guidance and support Treating real patients

Post-Survey Qualitative Data Improve this rotations It was prefect Wish I had more OB Opportunity to work with R2/carry OB on FMIT Even out the days of procedures (give all students same amount) New computer system/EMR The schedules got mixed up sometimes and sometiems people were surprised we were working with them, so more transparency regarding where each student is going to be felt very isolated from others in the "med student room", didn't get to interact with residents outside fo clinic (ie. during lunch/breaks) More continuity (seeing same patient more than once), working with same attendings More time with residents in clinic. Not doubled up with med students for procedures Assign patients for FMIT earlier to allow for pre-rounding and do walk rounds Allow students to follow an attending/resident for more than a day at a time. Less evaluators but maybe a better sense by the student Procedures are super fun and they gave us an opportunity to do hands on pt care but none of them are on our "completion list"

Challenges Creating feedback to produce clear statistical evidence to guide improvement Turning stats into student-based changes Making adjustments and seeing results with limited evidence (1-4 students per month) Maintaining momentum Personnel changes

Improvements Planned for Next Year Resident-Medical Student Buddy Pairs Revise pre- and post-rotation survey to include questions about improvements to recruitment (i.e. lectures and activities) Monthly “Adjustment Meetings” to review surveys and make real time changes Integration with other residency programs including “Residents as Teachers”

Objectives Identify factors that lead to successful medical student recruitment Describe techniques to improve recruitment Integrate techniques into your programs

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