Pursuing a Public Health Degree during Medical School Robin Sautter, MS2 Sarah McFarland, MPH, MS3 Peter J. Meyers, MPH, MS4 Amanda Honsvall, MS2 Jacob Prunuske, MD, MSPH STFM MSE 15

Audience Survey

Background ■Rapidly changing health care climate ■Increased integration of public health and primary care through PH training ■Limited knowledge of students pursuing dual degrees in public health and medicine Research Goals: 1)Identify factors involved in medical students’ decision to pursue MD/MPH degrees 1)Describe the decision making process

Methods ■Phase 1: Focus Group Discussions o 6 students in medical school (MS1, MS2) o 5 students in an MD/MPH program (MS3, MS4) ■Phase 2: One-on-one phone interviews o 23 interviews (16 women, 7 men) o 15 medical schools ■Open coding and thematic analysis “My interest in public health came from an interest in poverty…I saw medicine as a way to alleviate a symptom of poverty.”

Results ■Thematic Analysis Categories o Motivation for entering a PH program o Perceptions of career benefits o Factors considered o Decision making process o Resources that could/would increase confidence in decision making

Results ■Motivation for entering a PH program ○Gaining knowledge beyond clinical knowledge ○Previous work, education and/or volunteering in PH ○Gaining the ability to see the “bigger picture” ■Perceptions of career benefits ○Gaining skills and vocabulary ○Better understanding/utilizing of community resources ○Building perspective on health care systems as a whole

Results ■Factors considered ○Sync with family/partner (pro) ○Additional opportunities (pro) ○Finances (con) ■Decision making process ○Helpful to have role models or colleagues with a dual degree ○Being pushed by a mentor

Results ■Resources that could/would increase confidence in decision making ○Mentor (physician or peer) to discuss option ○Presentation of alternative options to a dual degree “I’d love to know how people used their degree…and they can say that without reasonable doubt, this is something that they could NOT have done without a MPH degree.”

Decision Making Model Iterative decision making process Variability in weighing factors -Academic -Personal -Financial

Decision Making Model Some students become “stuck” Peer & mentor guidance are significant “Gut feelings” influence decision points

Conclusions ■Decision making process- recurrent themes and multiple factors ■Framework for understanding the decision making process ■Peer mentoring influential in decision- making process ■Future studies

Thank you! Robin Sautter, MS2 Sarah McFarland, MPH, MS3 Peter J. Meyers, MPH, MS4 Amanda Honsvall, MS2 Jacob Prunuske, MD, MSPH

Questions?

Results Motivation for entering a PH program Learning new topics and gaining knowledge beyond clinical knowledge Broadening the scope of action at a community level Previous work, education and/or volunteering in PH Interest in health policy, health systems’ management, preventative medicine, or primary care specialty Gaining the ability to see the “big picture” and build perspective Influence of MD/MPH and other mentors Interest in system-wide health issuesScholarship opportunities linked to the MPH Interest in social justice, health disparities, and social determinants of health Future work in underserved populations

Results Perception of career benefits Gain knowledge, skills (e.g. statistical analysis, academic writing), and vocabulary More robust and effective patient education Better understanding/utilizing of community resources Perspective on prevention vs treatment Building perspective on health care system as a whole More qualified to implement programs in the community Becoming more adept at interpreting/understanding literature and biostatistics Networking and credibility Being more informed on PH issuesCareer opportunities within medicine and outside the clinical setting (leadership positions)

Results Factors considered Pros Sync with family/partnerMay provide competitive edge for residency Additional opportunities (opens doors)Change of pace from MD program Building perspective early on in medical trainingLower likelihood of burnout New skill set not obtained from an MD Cons Finances (tuition + delaying practice)Out of sync with classmates (timing) Building PH skills then not using them for yearsPursuing PH degree too soon Lack of communication between MD & MPH programsMight forget skills/training before getting to practice

Results Decision making process Peer mentoring; helpful to have role models or colleagues with the dual degree Funding or scholarship opportunities for the PH degree program Being pushed by a mentorMay be able to accomplish PH goals without the PH degree

Results Resources that could/would increase confidence in decision making process Mentor (physician or peer) to discuss options with Knowing how the timing of when you get the PH degree affects what you do with it Presentation of options (e.g. lunch talk by someone with the degree about pros and cons, career possibilities, what they could NOT have done without a PH degree, etc.) More specific debt information A single point of contact/coordinator for the MD-PH program/track Having a better idea of whether the MPH will be helpful More options to complete the degree during residency or without taking extra time

Resources 1.Davis K, Schoen C, Stremikis K. Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update. The Commonwealth Fund; Institute of Medicine (US) Committee on Educating Public Health Professionals for the 21st Century, Gebbie K, Rosenstock L, Hernandez L. Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century. Washington DC: National Academies Press; Association of American Medical Colleges Medical School Graduation Questionnaire All Schools Summary Report. Accessed December 29, Pope C, Mays N. Qualitative research in health care. In: Malden, MA: Blackwell Pub/BMJ Books; 2006.