Professional Development Series

Part 1

What will I be when I grow up?

The answer is no longer just “doctor”

The Big Decision

• Most med students spend more time deciding what car to buy than on selecting a career.

• Little thought goes into a lifelong decision.• Hasty decisions can lead to burnout, changing

residency programs, an unhappy career.

Statistics/Job Satisfaction

• 40% of physicians report being very satisfied• 20% of physicians report complete

dissatisfaction• The rest are somewhere in between

Pitfalls to Choosing a Specialty:

• Anxiety over exams/grades detracts from focusing on the merits of the specialty

• Subjective grades can influence final impressions• Bitter residents and attendings/personality conflicts• One bad rotation does not preclude one from choosing

that specialty• Lack of participation• Lack of “nitty gritty”outpatient experience• Not enough time to look at every specialty in 1 year• Lack of guidance resources/lack of time

Over 60 Specialties and Subspecialties

• Allergy and Immunology Anesthesiology • Cardiology Colon and Rectal Sx • Dermatology Emergency Med • Family Practice General Sx• Genetics Infectious Disease• Internal Medicine Neurology • Neurosurgery Nuclear Medicine • OBGYN Oncology • Ophthalmology Orthopedic Surgery • Otolaryngology Pain Management• Pathology Pediatrics• Physical Med/Rehab Plastic Sx• Preventive Med Psychiatry• Radiology Rheumatology • Thoracic/CV Sx Urology

Sample Specialty Divisions

Hospital Based Specialties:Radiology, Pathology, Emergency, Surgery

Comprehensive care for one population:Pediatrics, OBGYN

Primary Care:Family Practice, Internal Medicine, Pediatrics

Tertiary Care/Referral-Based/One Organ System:GI, Dermatology, Urology, Neurology, Cardiology

Myths and folklore or truth??

• All orthopods are jocks.• Gynecologists have the worst sex lives of all doctors• Pathologists are socially inept.• You should be a surgeon like your father.• Psychiatrists are crazy!• Dermatology is good money and short hours.• General surgeons do all the work with little pay.• ER docs are adrenaline addicts.• Internists are nerds.

Four Domains of Career Assessment

• Personal Values – what is important to you– Physician Values in Practice Scale

• Interests – what you like– Medical Specialty Preference Inventory

• Personality – what are you like?– Myers-Briggs Type Indicator

• Skills – what you can do and do well– Experience on clinical rotations

Personal Values:

• Hours• Income• Intellectual Stimulation• Type of Patient Population• Generalist vs Specialist• Work Environment• Patient Contact• Social Status

Other considerations:

• Paperwork/Managed Care• Job Opportunities• Length of Training• Academic Competitiveness• Malpractice/Litigation

What are your interests?Anatomy Surgery, Radiology

Histology Pathology, Derm

Biochemistry Internal Medicine

Neuroscience Neuro, Neurosx, Psych, Rehab

Immunology Path, Infectious Disease

Physiology Surgery, IM, Anesthesiology

Behavioral Science Psychiatry

Genetics Peds

Molecular Biology Pathology

Microbiology Infectious Disease

Pathology IM, FP, Pathology

Pharmacology Anesthesiology, IM

Personality: What are you like?

Results of multiple studies:Surgeons: extroverted, practical, social, less creative,

competitive, structuredControllable lifestyle specialists: withdrawn and rebelliousHospital-based specialties: low tolerance for ambiguity,

desire high structureOBGYN: warm and helpfulPrimary care: desired long term patient relationshipsAction oriented people who desire immediate gratification:

sought out ER, surgery, anesthesiology

Myer-Briggs Personality Type IndicatorMBPTI

• Developed in the 1950’s• Used in medical schools across the country• Helps guide specialty selection by determining

personality and temperament• Identify strengths and weaknesses• Take each year for best results• www.capt.org for a fee can get expert

feedback

MBTI: Four dimensions of personality yield 16 different personality types

– Extroversion (E) vs Introversion (I): How we interact with the world and where we direct our energy

– Sensing (S) vs Intuition (I): The kind of information we naturally notice

– Thinking (T) vs Feeling (F): How we make decisions

– Judgment (J) vs Perception (P): Whether we prefer to live in a more structured way or a more spontaneous way

Extraversion IntroversionInterest Orientation

E IOuter world of actions,

objects, and people

Inner world of ideas and concepts

Sensing IntuitionPerception

S NImmediate reality and

direct experience

Inferred meanings and relationships

Thinking FeelingJudgment

T FReliability of logical order –

cause and effect

Priorities based on personal

importance and values

Judgment PerceptionEnvironment Orientation

J PJudging attitude – Control of events and systematic planning

Spontaneity – Curious, awaiting

events and adapting to

them

ISTJ“Take Your

Time and Do It Right”

ISFJ“On My Honor,

to Do My Duty…”

INFJ“Catalyst for

Positive Change”

INTJ“Competence + Independence =

Perfection”

ISTP“Doing the Best

I Can With What I’ve Got”

ISFP“It’s the

Thought That Counts”

INFP“Still Waters Run Deep”

INTP“Ingenious

Problem Solvers”

ESTP“Let’s Get

Busy!”

ESFP“Don’t Worry, Be Happy”

ENFP“Anything’s

Possible”

ENTP“Life’s

Entrepreneurs”

ESTJ“Taking Care of

Business”

ESFJ“What Can I Do

For You?”

ENFJ“The Public

Relations Specialist”

ENTJ“Everything’s Fine – I’m in

Charge”

ISTJDerm, OBGYN,

FP, Urology, Ortho

ISFJAnesth,

Ophthal, FP, Peds

INFJPsych, IM,

Thoracic Sx, Gen Sx, Path

INTJPsych, Path, Neuro, IM,

Anesth

ISTPENT, Anesth,

Radio, Ophthal, FP

ISFPAnesth, Uro, FP,

Thoracic Sx

INFPPsych, Cardio, Neuro, Derm,

Path

INTPNeuro, Path,

Psych, Cardo, Thoracic Sx

ESTPOrtho, Derm,

FP, Radio, Gen Sx

ESFPOphthal,

Thoracic Sx, OBGYN, Ortho,

Gen Sx

ENFPPsych, Derm,

ENT, Peds

ENTPENT, Psych, Radio, Peds,

Path

ESTJOBGYN, FP,

Gen Sx, Ortho, Peds

ESFJPeds, Ortho, ENT, FP, IM

ENFJThoracic Sx, Derm, Psych,

Ophthal, Radio

ENTJNeuro, Cardio, Uro, Thoracic

Sx, IM

Choosing Your Specialty

• Step 1: Select specialties of interest• Step 2: Select factors important to you• Step 3: Rate your specialties

Glaxo Pathway Evaluation Program

http://www.smbs.buffalo.edu/RESIDENT/CareerCounseling/interior.htm?self-assessment.htm

Self assessment will rate medical specialties according to compatability

Co-sponsored by Duke University

Glaxo Critical Factors

• Caring for Patients• Continuity of Care• Autonomy• Diversity• Personal Time• Expertise• Income Satisfaction• Creativity• Certainty of Outcomes• Clinical Decision Making

• Patient Decision Making• Interacting with Other P

hysicians/ Members of Health-care Team

• Manual /Mechanical Activities

• Pressure• Responsibility• Schedule• Security• Sense of Accomplishme

nt

AAMC Careers in Medicine Program

Password protected

• Year 1• Orientation to Careers in Medicine• Seek out an advisor or mentor• Understanding Yourself• Complete the Specialty Indecision Scale for

personalized guidance on your career concerns.

• Attend CiM workshops• Begin completing self-assessment exercises

Year 2 * Continue self-assessment * Complete self-assessment exercises * Review completed Personal Profile with advisorExploring Options* Begin gathering basic information about specialties of interest through CiM Specialty Pages, other online sites, and library research * Attend Specialty Panel and Information Group sessions provided by your school * Compare your self-assessment information to the information you have gathered about specialties. Narrow down your specialty interests to 3-4 top choices * Plan your 3rd year schedule * Take Boards Step 1

• Year 3• Begin clinical rotations • Review the Charting Outcomes in the Match

report to assess qualifications and competitiveness for different specialties

• Conduct informational interviews and/or participate in preceptorships

• Contact associations and specialty organizations • Meet with your advisor to discuss your top choices • Complete the "Choosing Your Specialty" exercise

• Year 4: Getting into Residency• Research residency training programs through

AMA's FREIDA , AMA's Graduate Medical Education Directory (Green Book), or Osteopathic Opportunities http://opportunities.osteopathic.org/

• Complete the Residency Preference Exercise• Begin reviewing and comparing residency programs• Begin preparing residency applications. • Complete applications and designate programs to which

your materials will be submitted • Take Boards Step 2 • Interview with residency programs• Complete the Residency Program Evaluation Guide

Sources for Researching Residency Training Programs

• CiM specialty pageshttp://www.aamc.org/students/cim/start.htm

• AMA’s FREIDA http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.shtml

• Graduate Medical Education Directoryhttp://opportunities.osteopathic.org/

What Do I Do Now?• Excel in your clinical clerkships

– Program directors like to see as many clerkships with Honors as possible – especially in specialty of choice

• Explore extramural elective opportunities:– http://www.aamc.org/students/medstudents/electives/start.htm– Shadow drs on breaks and holidays, engage in research projects– Summer between 1st and 2nd year: National Health Service Corps,

AMSA/SALUD• Participate in CiM self-assessment and Glaxo Pathway

Program• Explore specialties through personal experience, talking to

others, CiM, Glaxo, and other resources

Session 2: Surviving 3rd and 4th YearClerkships

Session 3: Getting Into Residency

• Applying for residency• Writing a CV and personal statement• Getting letters of recommendation• Residency interviewing

Choosing a Career in Medicine:

Sources:1. The Ultimate Guide to Choosing a Medical Specialty,

second editionby Brian Freeman, MD

2. Ren Stinson / University of Iowa

3. Michael G. Kavan, Ph.DAssociate Dean for Student AffairsCreighton University School of Medicine