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Mark Floyd, MD WVU Department of Orthopaedics May 18, 2011

Influences on the Selection of Orthopaedic Surgery as a Career: An Evaluation of 4th Year Medical Students and Post Graduate Year (PGY)-1 Residents in Orthopaedics. Mark Floyd, MD WVU Department of Orthopaedics May 18, 2011. Why Ortho?. “Tore my ACL” “Worked on cars”

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Mark Floyd, MD WVU Department of Orthopaedics May 18, 2011

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  1. Influences on the Selection of Orthopaedic Surgery as a Career: An Evaluation of 4th Year Medical Students and Post Graduate Year (PGY)-1 Residents in Orthopaedics Mark Floyd, MD WVU Department of Orthopaedics May 18, 2011

  2. Why Ortho? • “Tore my ACL” • “Worked on cars” • “My dad was an orthopaedist” • Examples in the community • Med school rotation • Experience with residents

  3. Best and Brightest • Sanford E. Emery, James P. Waddell, Andrea E. Waddell, Michael McCaslin and Kevin Black. Orthopaedic Education: Are We Attracting the Best and the Brightest? J Bone Joint Surg Am. 2009;91:1253-1263. • Discusses three areas believed to be relevant for the medical student decision making process regarding specialty choice: • practice environment • money issues • the influence of role models or mentors

  4. Why ask the question? ????

  5. 2008 Match Results

  6. Study Design • Online survey: 4th yr med students and PGY-1 Ortho residents • Group 1: Non-ortho • Group2: Ortho • Multiple institutions • University of Iowa Medical School • University of Maryland College of Medicine • University of Michigan College of Medicine • Ohio State College of Medicine • Penn State University College of Medicine • University of Rochester Medical School • SUNY Upstate College of Medicine • West Virginia University College of Medicine

  7. Survey • School? • Field of medicine? • Knew before med school? • Career choice most heavily influenced by: • People before med school • Residents in the field I chose • Faculty in the field • Family member • other

  8. Survey • Required ortho during 3rd year? • Ortho experience in 3rd/4th year? • If you did ortho: • Already decided to do ortho • Rotation inspired me to do ortho • Other factors influenced my decision • Rotation inspired my interest, but I chose elsewhere because I didn’t think I could match • Decided against ortho • N/A

  9. Survey • If ortho was required, how long? • 1 week or less • 1-2 wks • 2 wks or longer • Income influence on career choice? 1-5. • What was most important? • Patient care • Lifestyle • Income • Pressure from family/peers • Basic science/research (not sure if anyone picked this)

  10. Survey • Student debt? • 0 • <50K • 50K-100K • 100K-200K • >200K • Debt influence? • Major • Moderate • Minor • none

  11. Survey • Gender? • Md/PhD? • Ethnicity? • Marital status? • Kids?

  12. Results • Knew before: 15.4% vs. 27%, p=0.008 • Biggest influence: • before med school: 15.3% vs 28.2%, p>0.05 • During 3rd/4th yr: 72.9% vs 60%, p=0.003 • Individual influence: • Before med school: 6.5% vs 17.5%, p<0.0001 • medical school faculty: 57% vs. 41%, p=0.001

  13. Results • Required ortho: 33%, 28%, p=0.78 • Take ortho? 50%, 99.2% (one did not?) • Effect of rotation: • Decided before: 1%, 50% • Rotation made decision: 1%, 41% • Other factors for ortho: 1%, 8% • Didn’t think qualified: 13%, 0% • Decided against: 85%, 0%

  14. Results • Length of required rotation • 1 wk: 41%, 31% • 1-2wk: 28%, 22% • 2+ wk: 30%, 47% • Skipped: 275, 56 • Income: • Group 1: 24.5%, 29%, 33.5%, 11.3%, 1.4% • Group 2: 8%, 19%, 54%, 18%, <1%

  15. Results • Most important factor: • Pt care: 70.8%, 75%, p = 0.16 • Lifestyle: 16.1%, 10% • Income: 0, 0 • Family: 0, 0 • Research: 4.9%, 2% • Other: 7.8%, 12%

  16. Results • Debt: • 0: 10.3%, 5.6% • <50K: 5.1%, 6.4% • 50-100K: 9.6%, 12% • 100-200K: 48.9%, 42.4% • <200K: 26.1%, 33.6% • Influence of debt: p = 0.73 • Major: 6%, 5% • Moderate: 15%, 15% • Mild: 23%, 28% • None: 56%, 52%

  17. Results • Ethnicity • African American: 2%, 3% • American Indian: 0, 0 • Asian: 6%, 3% • Carib: 1%, 2% • Latino: 1%, 2% • Indian: 4%, 6% • Middle Eastern: 2%, 3% • Mixed: 2%, 3% • Pacific Islander: <1%, 0 • White: 80.4%, 79.1% • Other: 1%, <1% • Decline: 4%, 0%

  18. Results: Female Ortho (N=20) Analysis limited due to small sample size. Would have needed 60 female students to have a statistical power of 80% • Knew before: 15% vs 60%, p=0.08 • Biggest Influence: • Yr 3/4: 80% vs 56%, p=0.001 • Individual influence: • Faculty: 55% vs 37%, p=0.0003 • Married: • 25% vs 45%, p = 0.13

  19. Conclusions… • It appears that although many students who apply for orthopaedics have decided prior to medical school, most students decide based on influences of their 3rd/4th year clinical rotations. • By increasing orthopaedic exposure, the orthopaedic applicant pool may become more diverse.

  20. Some Light Reading… • Bernstein, Joseph; DiCaprio, Matthew; Mehta, Samir. The Relationship Between Required Medical School Instruction in Musculoskeletal Medicine and Application Rates to Orthopaedic Surgery Residency Programs. The Journal of Bone and Joint Surgery. 2004. 2335 – 2338. • National Resident Matching Program, Results and Data: 2010 Main Residency Match. National Resident Matching Program, Washington, DC. 2010. • Solomon, David; Dipette, Donald. Specialty Choice Among Students Entering the Fourth Year of Medical School. The American Journal of the Medical Sciences, 1994; 308(5): 284 – 288 • Templeton, Kimberly; Wood, Jamacia; Haynes, Richard. Women and Minorities in Orthopaedic Residency Programs. Journal of American Academy of Orthopaedic Surgeons. 2007; 15 (suppl 1): S37-S41. • Wright, Scott; Wong, Annie; Newill, Carol. The Impact of Role Models on Medical Students. Journal of General Internal Medicine. 1997;12:53-56. • Musunuru, Sandeepa; Lewis, Barbara; Rikkers, Layton; Chen, Herbert. Effective Surgical Residents Strongly Influence Medical Students to Pursue Surgical Careers. Journal of American College of Surgeons. 2007;204:164-167. • Yeh, Albert; Franko, Orrin; Day, Charles. Impact of Clinical Electives and Residency Interest on Medical Students’ Education in Musculoskeletal Medicine. Journal of Bone and Joint Surgery. 2008;90:307-315 • Nguyen, Scott; Divino, Celia. Surgical residents as medical student mentors. The American Journal of Surgery. 2007;193:90-93 • Freedman, Kevin; Bernstein, Joseph. The Adequacy of Medical School Education in Musculoskeletal Medicine. The Journal of Bone and Joint Surgery, 1998;80A(10)1421-1427 • Sanford E. Emery, James P. Waddell, Andrea E. Waddell, Michael McCaslin and Kevin Black. Orthopaedic Education Are we Attracting the Best and the Brightest? J Bone Joint Surg Am. 2009;91:1253-1263 • West CP, Drefahl MM, Popkave C, Kolars JC. Internal medicine resident self- report of factors associated with career decisions. J Gen Intern Med. 2009; 24(8):946-9. • Blakemore LC, Hall JM, Biermann JS. Women in Surgical Residency Programs. J Bone Joint Surg Am. 2003; 85-A(12):2477-80 • Clark, John; Hanel, Douglas. The contribution of MD-PhD training to academic orthopaedic faculties. The Journal of Orthopaedic Research 19 (2001) 505-510.

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