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AAMC Strives for Improved AMCAS Residents' Lawsuit Takes Aim at the NRMP Confronting "Unequal Treatment"
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A Word From the PresidentWhat Do You Want to Be When You Grow Up?
My own experience, although admittedly dated, may serve to illustrate what, by all accounts, is still a common occurrence. I entered medical school planning to become a psychiatrist, a plan that lasted about three months. Thereafter, whatever my most recent instructor happened to be was what I wanted at the time to become. Largely because surgery came last in my sequence of third-year clerkships, I applied for a surgical internship and interviewed at some six programs. That was before I had my fourth-year medicine sub-internship. After that experience, I withdrew my surgery applications and became an internist instead. Such was the "guidance" I received in making what, for me, turned out to be a good decision - but hardly one that was fully informed. Despite my own good fortune, I do not recommend relying on lady luck for career counseling. And yet I worry that many students are still relying on luck to lead them to the "right field" because they feel as much on their own in choosing their specialty as I did. Most schools still lack adequate resources to provide truly comprehensive career counseling services, even though the need is arguably greater now than it was in my day. The array of career options, both within and outside the conventional boundaries of medicine, is rapidly expanding. And today's students rack up record-breaking debt just to get through school, making the stakes of choosing the "right" field for them higher than ever. In an effort to help both students and their school-based counselors access more robust career planning tools, the AAMC developed Careers in Medicine (originally "MedCareers"). Launched in 1999, this program is designed to equip medical students with the tools and information they need to assess their spec- ific talents and values, to explore the various specialty options of interest to them, and to assist them through the residency application process. The only program of its kind, Careers in Medicine is structured so that students can begin benefiting from it as early as their first year of medical school and subsequently use it to support their individual decision-making processes as they progress through their four years of education and training. The program comprises a four-stage process - personal career assessment, career exploration, decision-making, and implementation. A central feature of the program is easy-to-use tools that allow students to perform honest self-evaluations of interests, values, skills, and personality characteristics. Students are then guided to use what they learn about themselves when exploring and assessing the program's extensive collection of information describing in detail the nature of the various medical specialties and sub-specialties. Students may use the program in its Web-based version or work with printed materials. Those choosing the latter option are provided with manuals that serve as portfolios for storing copies of completed worksheets and inventories, notes on career plans, and other relevant data. The 2.0 Web-based version of Careers in Medicine is now available at www.aamc.org/careersinmedicine; it allows students to store online as personal profiles all of the data they enter as they progress through the program. When they arrive at the decision-making and implementation stages, students can use Careers in Medicine to explore individual residency programs, to navigate the interviewing process, and to master the Electronic Residency Application Program (ERAS) as well as the National Resident Matching Program (NRMP). We know from published studies that as many as 20 percent of medical school graduates switch specialties before completing their first residency. An additional 15 percent or so change specialties after completing residencies. And perhaps most troubling of all, some 20 percent of practicing physicians claim to have ended up in specialties in which they are not satisfied. Providing solid, reliable career counseling throughout medical school is essential if we are to change these numbers. No one wants a dissatisfied physician. And no physician wants to be dissatisfied. I hope that Careers in Medicine can help ensure that our students experience greater satisfaction in their chosen careers in medicine.
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My
guess is that no more than a handful of students begin medical school
with a resolute answer to that question. More likely, the vast majority
of students begin their medical school careers much less certain
about their future - other than their desire to be "a doctor."
For that reason, many students are understandably eager to receive
guidance to ensure they choose the "right" kind of doctor
to become. More often than not, however, that guidance is anything
but explicit, and certainly not well tailored to individual students
and their unique attributes. Such "guidance" can take
the form of contact with a charismatic teacher, or a chance encounter
with a fascinating patient, or a summer job as a research assistant,
or "authoritative" pronouncements by an all-knowing upper-classman.
Not the kind of thoughtful, prospective, well- informed, individualized
advice commensurate with the gravity of deciding how to spend one's
professional life.