Mark Floyd, MDMark Floyd, MD

WVU Department of OrthopaedicsWVU Department of Orthopaedics

May 18, 2011May 18, 2011

Influences on the Selection of Orthopaedic Influences on the Selection of Orthopaedic Surgery as a Career: An Evaluation of 4th Year Surgery as a Career: An Evaluation of 4th Year

Medical Students and Post Graduate Year Medical Students and Post Graduate Year (PGY)-1 Residents in Orthopaedics (PGY)-1 Residents in Orthopaedics

Why Ortho?Why Ortho?

• ““Tore my ACL”Tore my ACL”

• ““Worked on cars”Worked on cars”

• ““My dad was an orthopaedist”My dad was an orthopaedist”

• Examples in the communityExamples in the community

• Med school rotationMed school rotation

• Experience with residentsExperience with residents

Best and BrightestBest and Brightest

• Sanford E. Emery, James P. Waddell, Andrea E. Waddell, Sanford E. Emery, James P. Waddell, Andrea E. Waddell, Michael McCaslin and Kevin Black. Orthopaedic Education: Michael McCaslin and Kevin Black. Orthopaedic Education: Are We Attracting the Best and the Brightest? Are We Attracting the Best and the Brightest? J Bone Joint J Bone Joint Surg AmSurg Am. 2009;91:1253-1263.. 2009;91:1253-1263.

• Discusses three areas believed to be relevant for Discusses three areas believed to be relevant for the medical student decision making process the medical student decision making process regarding specialty choice:regarding specialty choice:– practice environmentpractice environment– money issuesmoney issues– the influence of role models or mentorsthe influence of role models or mentors

Why ask the question?Why ask the question?

????????

2008 Match Results

Study DesignStudy Design• Online survey: 4Online survey: 4thth yr med students and PGY-1 Ortho yr med students and PGY-1 Ortho

residentsresidents– Group 1: Non-orthoGroup 1: Non-ortho– Group2: OrthoGroup2: Ortho

• Multiple institutionsMultiple institutions– University of Iowa Medical SchoolUniversity of Iowa Medical School– University of Maryland College of MedicineUniversity of Maryland College of Medicine– University of Michigan College of MedicineUniversity of Michigan College of Medicine– Ohio State College of MedicineOhio State College of Medicine– Penn State University College of MedicinePenn State University College of Medicine– University of Rochester Medical SchoolUniversity of Rochester Medical School– SUNY Upstate College of MedicineSUNY Upstate College of Medicine– West Virginia University College of MedicineWest Virginia University College of Medicine

SurveySurvey

• School?School?• Field of medicine?Field of medicine?• Knew before med school?Knew before med school?• Career choice most heavily influenced by:Career choice most heavily influenced by:

• People before med schoolPeople before med school• Residents in the field I choseResidents in the field I chose• Faculty in the fieldFaculty in the field• Family memberFamily member• otherother

SurveySurvey

• Required ortho during 3rd year?Required ortho during 3rd year?• Ortho experience in 3rd/4th year?Ortho experience in 3rd/4th year?• If you did ortho:If you did ortho:

– Already decided to do orthoAlready decided to do ortho– Rotation inspired me to do orthoRotation inspired me to do ortho– Other factors influenced my decisionOther factors influenced my decision– Rotation inspired my interest, but I chose elsewhere Rotation inspired my interest, but I chose elsewhere

because I didn’t think I could matchbecause I didn’t think I could match– Decided against orthoDecided against ortho– N/AN/A

SurveySurvey

• If ortho was required, how long?If ortho was required, how long?– 1 week or less1 week or less– 1-2 wks1-2 wks– 2 wks or longer2 wks or longer

• Income influence on career choice? 1-5.Income influence on career choice? 1-5.• What was most important?What was most important?

– Patient carePatient care– LifestyleLifestyle– IncomeIncome– Pressure from family/peersPressure from family/peers– Basic science/research Basic science/research (not sure if anyone picked this)(not sure if anyone picked this)

SurveySurvey

• Student debt?Student debt?– 00– <50K<50K– 50K-100K50K-100K– 100K-200K100K-200K– >200K>200K

• Debt influence?Debt influence?– MajorMajor– ModerateModerate– MinorMinor– nonenone

SurveySurvey

• Gender?Gender?

• Md/PhD?Md/PhD?

• Ethnicity?Ethnicity?

• Marital status?Marital status?

• Kids?Kids?

ResultsResults

• Knew before: 15.4% vs. 27%, Knew before: 15.4% vs. 27%, p=0.008p=0.008• Biggest influence: Biggest influence:

– before med school: 15.3% vs 28.2%, before med school: 15.3% vs 28.2%, p>0.05p>0.05– During 3During 3rdrd/4/4thth yr: 72.9% vs 60%, yr: 72.9% vs 60%, p=0.003p=0.003

• Individual influence: Individual influence: – Before med school: 6.5% vs 17.5%, Before med school: 6.5% vs 17.5%, p<0.0001p<0.0001– medical school faculty: 57% vs. 41%, medical school faculty: 57% vs. 41%, p=0.001p=0.001

ResultsResults

• Required ortho: 33%, 28%, Required ortho: 33%, 28%, p=0.78p=0.78

• Take ortho? 50%, 99.2% (one did not?)Take ortho? 50%, 99.2% (one did not?)

• Effect of rotation:Effect of rotation:– Decided before: 1%, 50%Decided before: 1%, 50%– Rotation made decision: 1%, 41%Rotation made decision: 1%, 41%– Other factors for ortho: 1%, 8%Other factors for ortho: 1%, 8%– Didn’t think qualified: 13%, 0%Didn’t think qualified: 13%, 0%– Decided against: 85%, 0%Decided against: 85%, 0%

ResultsResults

• Length of required rotationLength of required rotation– 1 wk: 41%, 31%1 wk: 41%, 31%– 1-2wk: 28%, 22%1-2wk: 28%, 22%– 2+ wk: 30%, 47%2+ wk: 30%, 47%– Skipped: 275, 56Skipped: 275, 56

• Income:Income:– Group 1: 24.5%, 29%, 33.5%, 11.3%, 1.4%Group 1: 24.5%, 29%, 33.5%, 11.3%, 1.4%– Group 2: 8%, 19%, 54%, 18%, <1%Group 2: 8%, 19%, 54%, 18%, <1%

ResultsResults

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

ResultsResults

• Debt:Debt:– 0: 10.3%, 5.6%0: 10.3%, 5.6%– <50K: 5.1%, 6.4%<50K: 5.1%, 6.4%– 50-100K: 9.6%, 12%50-100K: 9.6%, 12%– 100-200K: 48.9%, 42.4%100-200K: 48.9%, 42.4%– <200K: 26.1%, 33.6%<200K: 26.1%, 33.6%

• Influence of debt: Influence of debt: p = 0.73p = 0.73– Major: 6%, 5%Major: 6%, 5%– Moderate: 15%, 15%Moderate: 15%, 15%– Mild: 23%, 28%Mild: 23%, 28%– None: 56%, 52%None: 56%, 52%

ResultsResults• EthnicityEthnicity

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

Results: Female Ortho (N=20)Results: Female Ortho (N=20)Analysis limited due to small sample size. Analysis limited due to small sample size. Would have needed 60 female students to have a Would have needed 60 female students to have a

statistical power of 80%statistical power of 80%

• Knew before: 15% vs 60%, Knew before: 15% vs 60%, p=0.08p=0.08• Biggest Influence:Biggest Influence:

– Yr 3/4: 80% vs 56%, Yr 3/4: 80% vs 56%, p=0.001p=0.001

• Individual influence:Individual influence:– Faculty: 55% vs 37%, Faculty: 55% vs 37%, p=0.0003p=0.0003

• Married:Married:– 25% vs 45%, p =25% vs 45%, p = 0.13 0.13

Conclusions…Conclusions…

• It appears that although many students It appears that although many students who apply for orthopaedics have decided who apply for orthopaedics have decided prior to medical school, most students prior to medical school, most students decide based on influences of their 3decide based on influences of their 3rdrd/4/4thth year clinical rotations. year clinical rotations.

• By increasing orthopaedic exposure, the By increasing orthopaedic exposure, the orthopaedic applicant pool may become orthopaedic applicant pool may become more diverse.more diverse.

Some Light Reading…Some Light Reading…• Bernstein, Joseph; DiCaprio, Matthew; Mehta, Samir. The Relationship Between Required Medical School Instruction in 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. Musculoskeletal Medicine and Application Rates to Orthopaedic Surgery Residency Programs. The Journal of Bone and Joint Surgery. 2004. 2335 – 2338. 2004. 2335 – 2338.

• National Resident Matching Program, Results and Data: 2010 Main Residency Match. National Resident Matching Program, National Resident Matching Program, Results and Data: 2010 Main Residency Match. National Resident Matching Program, Washington, DC. 2010.Washington, DC. 2010.

• Solomon, David; Dipette, Donald. Specialty Choice Among Students Entering the Fourth Year of Medical School. The American 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 – 288Journal of the Medical Sciences, 1994; 308(5): 284 – 288

• Templeton, Kimberly; Wood, Jamacia; Haynes, Richard. Women and Minorities in Orthopaedic Residency Programs. Journal of 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.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. Wright, Scott; Wong, Annie; Newill, Carol. The Impact of Role Models on Medical Students. Journal of General Internal Medicine. 1997;12:53-56.1997;12:53-56.

• Musunuru, Sandeepa; Lewis, Barbara; Rikkers, Layton; Chen, Herbert. Effective Surgical Residents Strongly Influence Medical 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.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 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;90:307-315Musculoskeletal 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;193:90-93Nguyen, 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 Freedman, Kevin; Bernstein, Joseph. The Adequacy of Medical School Education in Musculoskeletal Medicine. The Journal of Bone

and Joint Surgery, 1998;80A(10)1421-1427and 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 Sanford E. Emery, James P. Waddell, Andrea E. Waddell, Michael McCaslin and Kevin Black. Orthopaedic Education Are we

Attracting the Best and the Brightest? Attracting the Best and the Brightest? J Bone Joint Surg Am. J Bone Joint Surg Am. 2009;91:1253-1263 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 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. Intern Med. 2009; 24(8):946-9. • Blakemore LC, Hall JM, Biermann JS. Women in Surgical Residency Programs. Blakemore LC, Hall JM, Biermann JS. Women in Surgical Residency Programs. J Bone Joint Surg Am.J Bone Joint Surg Am. 2003; 85-A(12):2477-80 2003; 85-A(12):2477-80 • Clark, John; Hanel, Douglas. The contribution of MD-PhD training to academic orthopaedic faculties. The Journal of Orthopaedic Clark, John; Hanel, Douglas. The contribution of MD-PhD training to academic orthopaedic faculties. The Journal of Orthopaedic

Research 19 (2001) 505-510.Research 19 (2001) 505-510.