Idea Transcript
Specialty Characteristics Intellectual challenge (bread and butter) Skills involved Competitiveness Work hours/Call Income/Debt Work activities Professional satisfaction Subspecialty options
Projected need Training period Future challenges/ Research Competitiveness Technology focus
Ways to Categorize Medicine vs Surgery vs Both
Both Ophthalmology, ENT, OB/Gyn, Urology Generalist vs specialist
Patient relationship
Wellness vs sickness Chronic vs acute Short-term vs long-term
Patient population
Peds vs adults vs geriatrics Urban vs suburban vs rural
Location
Academic vs community Hospital vs office (size of group)
Personality
“If we recognize our talents and use them appropriately, and choose a field that uses those talents, we will rise to the top of our field.” Dr. Ben Carson, MD
Carson, Think Big, 1993
Specialty Selection Rule out the specialties you are not interested in Confirm/deny previous thoughts Candid self-assessment
Professional interest inventory
Learn about the specialties your interests lead you to
Specialty association web-sites FRIEDA Local and national meetings (cost savings for students)
Self-Assessment Questions At what have I done well so far in life? In what school subjects have I done well? Why did I choose those subjects? What do I kike to do that has caused others to compliment me? What do I do well and think of as fun although my friends see it as work-- or as a boring activity? To do well does not mean to do perfectly
Carson, Think Big, 1993
Carson’s Self-Assessment Analyze yourself and your situation Find someone whose judgment is respected
Write down their responses Compare to what you have said about yourself Think about daily for several days
Carson, Think Big, 1993
Self-Assessment University of Virginia assessment
www.med-ed.virgina.edu/specialties/
Residency Guide Books
Iserson. Iserson’s Getting Into a Residency: A Guide for Medical Students. Taylor. How to Choose a Medical Specialty. Wischnitzer and Wischnitzer. Residency Manual: Selecting, Securing, Surviving, Succeeding.
Careers in Medicine (AAMC sponsored) Strong Vocational Interest Inventory ($$) Application of the Myers-Briggs Type Indicator to Medicine and Other Health Professions
“…what I like the most. Go with that no matter what people tell you (i.e. money, job market ,etc.) Life is too short for that kind of thinking.” Current Resident
Choosing a Residency Location People
Quality of departmental personnel Residents, faculty, support
Stability of faculty, fellows, and residents
Program structure
Breadth and depth Clinical exposure Bread and butter AND Zebras
Organization of curriculum
Choosing a Residency Education
Clinical vs didactic Board performance How do they address what is not seen on the wards?
How valued Encouraged/enabled to attend lectures Priority Organization of curriculum Development of independent critical thinking skills
Relationship of Program Director to residents
“Supportive”--ness of program
Choosing a Residency Workload vs efficiency
“The harder you work in residency, the better doctor you will be.” What hurdles institutionally are there to providing good care? Quality vs quantity of consults Quality of other major programs (i.e. IM, EM, G-Surg)
Research requirements vs resources Job & fellowship placement support and opportunities
Where do there grads go? What do they do?
Choosing a Residency Financial stability of institution Benefits-- any hidden issues? What made the current fellows go there? If you could change one thing about your program what would it be?
Look for candid answers
Spend a day vs rotation
Things I Wish I had Known
“Doctoring 2009: Embracing the Challenge” Concerns of the Day
Social, Scientific, Political, Economic Medical Professionalism vs Entrepreneurialism Delivery of a commodity Guild power replaced by business model
Charter of Medical Professionalism
Adopted by multiple medical organizations (AMA, ABIM, etc) “Cold, empty, and uncomfortable” Does not “move you” or speak to our ethos as a physicians Core Competencies of resident evaluations Stephen Sergay, MD, 2009 AAN Meeting
“Doctoring 2009: Embracing the Challenge” Depersonalization
Provider, Client, Encounter 48 billable points-- 4 HPI
Evidenced-based Practice Parameters
Do not address: Differential diagnostic questions Quality of patient/physician relationship
Risks diluting workplace autonomy
Stephen Sergay, MD, 2009 AAN Meeting
“Doctoring 2009: Embracing the Challenge” Osler
Doctoring is the fusion of Humanity Diagnostic uncertainty Scientific probability
Accumulating obligation
Coding EMR Pay-for-performance documentation E-prescribing Demands of insurers
Economics = quality Stephen Sergay, MD, 2009 AAN Meeting
“Doctoring 2009: Embracing the Challenge” Face-Face time threatened
Patient’s complain that their doctors do not listen or talk to them Is not encouraged or reimbursed
Technological advances = tools heathcare
Over past 5 years Lab tests 530% MRI 94% Office visits of established patients 12%
Ultimate result
“Dreams of physicians and patients are clouded by a sense of unfulfilled promise.”
Stephen Sergay, MD, 2009 AAN Meeting
Things I’ve Learned Money Work Hours
The Good, the Bad, and the Ugly
“Dr. Shit Magnet” Volumes of medical literature/knowledge …and how to manage it
Leadership Influence of Pharma
Reliance for education
We are taught to devalue ourselves Importance of a release You will change Life happens Family and friends know the real you
Resource Websites www.ama-assn.org
FRIEDA
www.aamc.org
Careers in Medicine
www.careermd.com (residency and fellowship database) www.i-r-i-s.com (internship and residency database) www.studentdo.com (osteopathic rotations and residency resource) Scutwork.com (residency reviews)
Resources Freeman, Brian MD. The Ultimate Guide to Choosing a Medical Specialty. McGraw Hill: New York, 2004. How to Select Residents. Ed: Donald G. Lampley, MD. American Board of Medical Specialties: Evanston, Ill, 1988. Iserson, Kenneth V MD. Iserson’s Getting Into a Residency: A Guide for Medical Students. Galen Press, Ltd: Tuscon, 2000. Ross, Robert H. and Harvey V. Fineberg. Innovators in Physician Education: The Process and Pattern of Reform in North American Medical Schools. Springer Publishing Co, 1996. Sergay, Stephan MB BCh. “Doctoring 2009: Embracing the Challenge.” AAN Annual Meeting Presidential Plenary Session. April 2009. Taylor, Anita D. How to Choose a Medical Specialty. 4th Ed Elsevier Science: Philadelphia, 2003. Wischnitzer, Saul and Edith Wischnitzer. Residency Manual: Selecting, Securing, Surviving, Succeeding. Cambridge University Press: New York, 2006.
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