gms | German Medical Science

GMS Journal for Medical Education

Gesellschaft für Medizinische Ausbildung (GMA)

ISSN 2366-5017

The FacharztDuell: innovative career counselling in medicine

project medicine

  • corresponding author Lena Welbergen - LMU München, Institute for Medical Education, München, Germany
  • author Severin Pinilla - Ludwig-Maximilians-Universität, Neurologische Klinik und Poliklinik, Klinikum Großhadern, München, Deutschland
  • author Tanja Pander - LMU München, Institute for Medical Education, München, Germany
  • author Maximilian Gradel - LMU München, Institute for Medical Education, München, Germany
  • author Philip von der Borch - LMU München, Medizinische Klinik IV, München, Deutschland
  • author Martin R. Fischer - Klinikum der Ludwig-Maximilians-Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Deutschland
  • author Konstantinos Dimitriadis - Ludwig-Maximilians-Universität, Neurologische Klinik und Poliklinik, Klinikum Großhadern, München, Deutschland

GMS Z Med Ausbild 2014;31(2):Doc17

doi: 10.3205/zma000909, urn:nbn:de:0183-zma0009097

This is the English version of the article.
The German version can be found at: http://www.egms.de/de/journals/zma/2014-31/zma000909.shtml

Received: November 4, 2013
Revised: January 20, 2014
Accepted: February 27, 2014
Published: May 15, 2014

© 2014 Welbergen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Abstract

Objective: The selection of a future medical specialty is a challenge all medical students face during the course of their studies. Students can choose from more than sixty specialties after graduation. There is usually no structured career counselling program available at German medical faculties. So far only little data on acceptance, formats and effects of different career counselling programs are available.

The aim of this study is to describe an innovative format of career counselling for medical students including its evaluation of acceptance and its possible influence on medical specialty preferences.

Methods: The need for career counselling became evident after the analysis of mentor-mentee conversations held within the mentoring program of our medical faculty, an online-based survey, an ad-hoc focus group and a pilot event. Panel discussions as an interactive format of presenting related medical specialties were developed and hence held four times under the name “FacharztDuell”. Students evaluated all events separately with a questionnaire and changes in medical specialty choice preferences were documented using an Audience-Response-System (ARS). The FacharztDuell is organized regularly and supported by faculty teaching funds.

Results: Among the student body FacharztDuell was well accepted (an average of 300 participants/event) and rated (average grade of 1.8 (SD= 0.7, 1=very good, 6=unsatisfactory, n=424). On average, 77.8% of the participating students considered the FacharztDuell to be a decision support for their future selection of a specialty. Up to 12% of the students changed their medical specialty choice preference throughout the event.

Conclusion: FacharztDuell was well accepted by medical students of all semesters and seems to be supportive for their selection of a future medical specialty. However, longitudinal studies are necessary to better understand the decision making process of medical students along their career path.

The FacharztDuell is easily transferrable to other faculties with respect to organization, staff and technical resources.

Keywords: Undergraduate medical education, graduate medical education, choice of specialty, mentoring, career counselling


Authors

Lena Welbergen and Severin Pinilla contributed equally.


Introduction

Career planning is a key element in undergraduate and graduate medical education [1], [2]. Studies conducted at LMU Munich indicated that 59.6% of undergraduate medical students identified career planning as one of the most widely discussed topic and 77.2% of students felt that their mentoring relationships had a positive impact on their career planning efforts (n=534). However, mentored students expressed a need for more support through faculty with regards to career planning [2], [3]. Approximately 60% of medical students change their specialty choice before graduating from medical school [4].

Faculties with large numbers of students face logistic challenges to implement effective and efficient career counseling offers. Ideally, those counseling activities should provide information around formal requirements of different residencies, transparency with regards to working conditions and working routine as well as opportunities for networking with residents in the respective specialties [5], [6].

Several different solutions have been implemented in the American medical education context. The Mayo Clinic for instance introduced one-week-long electives, consisting of workshops, discussion rounds and clinical experiences in order to support students with their specialty choice. However, in contrast to general counseling activities, these offers are specialty specific and aim at a distinct group of interested students [7].

The College of Physicians and Surgeons at Columbia University offers a more general career planning service. This service includes opportunities for clinical rotations, a separate mentoring program (‘Advisory Dean Program’) and informal discussions with members of the faculty. Additionally, informational meetings are being organized on an annual basis and include career lunch meetings, individual career planning sessions, discussion rounds with members of different specialties and support with regards to application procedures and interview trainings [8].

Previous studies have investigated the correlation between personality types and specialty choice [9], general influencing factors with regards to specialty choice [10], [11], [12], [13], involved role models and media [14] and the stability of medical students’ values during medical school [15].

However, there is no conclusive evidence on what type of career counseling formats work in the German-speaking medical education context. Our study is supposed to help closing this research gap and to provide data on the feasibility of regular moderated discussion rounds in lecture halls in order to support medical students with their specialty choice.

As part of the general mentoring program we established a career-counseling format with a focus on specialty choice that was evaluated throughout one academic year.

The ‘FacharztDuell’ (German for: ‘battle of specialists’ or ‘specialists’ duel’) was planned in a way that would allow for large numbers of participants as well as lively discussions between students, specialists and experts. We present the evaluation results of four different sessions of the ‘FacharztDuell’ and discuss its applicability to support the specialty choice of medical students at other faculties.


Methods

The underlying concept of the ‘FacharztDuell’ and the evaluation of the pilot project have been published elsewhere [16]. The Dean of Studies moderates each ‘FacharztDuell’-session with residents from specialties that share similarities to a certain extent. Residents are invited to discuss questions, which students have submitted anonymously before each session through an online tool on our mentoring homepage (https://www.mecum-mentor.de/facharztduell.html). This allows for discussing different aspects of each respective specialty according to the interests of medical students. Following each moderated discussion, students have the opportunity to directly ask questions during each session. Finally, students are invited to meet the panelists in small groups to ask further questions and exchange contacts.

After the successful pilot project (with the specialties heart surgery and cardiology) we adapted the didactic concept as well as the written evaluation and the continuous use of an audience-response-system (ARS by IML in Nuremburg, Germany) (see Table 1 [Tab. 1]), where each participant has the opportunity to react anonymously to general audience questions. The overall result of each question is immediately presented and commented. The study design was a pre-post comparison of specialty preferences among the participants. Additionally we conducted a qualitative analysis of submitted online questions and analyzed demographic data of participants as well as the written evaluations of each ‘FacharztDuell’.

Extended needs-analysis with an ad-hoc focus group

Through partly published results of mentoring evaluations at our faculty we identified the need for additional support with regards to specialty choice [3].

In order to prioritize the specialties for the sessions, we conducted an ad-hoc focus group with medical students from different years (n=23, 30 minutes). Additionally we collected and documented questions and themes that students identified as relevant for their specialty choice.

Organization and structure of the ‘FacharztDuell’

The scheme for each session is depicted in Table 1 [Tab. 1]. Following the pilot project we defined the order and combination of specialties for one academic year (see Table 2 [Tab. 2]). Each session was advertised through posters (example Duel 1, Appendix 1 [Attach. 1]), social media (Facebook) and faculty-specific mailing lists. Students were able to post anonymous questions before each session on our homepage. We selected residents (Duels 1 and 2) and specialists (Duels 3 and 4) from each specialty either through our mentoring network or through direct recruitment. We briefed each panelist on the submitted online questions. They were furthermore asked to provide authentic insights into their working routine and to discuss and critically reflect their individual reasons for why they chose their specialty. Based on our extended needs-analysis (mentoring survey and focus group) we conducted four sessions of the ‘FacharztDuell’ every two to three months from July 2012 to July 2013 (see Table 2 [Tab. 2]). The specialty combinations of the first three sessions were neurology, neurosurgery and psychiatry (Duel 1), pediatrics, gynecology and pediatric surgery (Duel 2) and general practice and internal medicine (Duel 3, represented by one oncologist and one gastroenterologist). The fourth session was advertised as ‘alternatives to clinical work’. Panelists included physicians who worked exclusively in research (without clinical work), in pharmaceutical industry, in strategic consulting or a non-government organization (Doctors Without Borders).

Each Duel was held in a lecture hall (total of 408 seats) and moderated by the Dean of studies (MRF). 100 ARS devices together with evaluation questionnaires were randomly distributed amongst participants. At the beginning of each Duel, participants were asked to use the ARS devices to answer general questions about each represented specialty (amongst others questions on length and content of residency training and formal requirements) as well as students’ current residency preferences.

After a short introduction of each panelist, the online submitted questions and additional questions from the audience were discussed and commented by the Dean of Studies. Each Duel lasted for about 90 minutes and ended with a second set of documented questions on students’ specialty preference using the ARS. We immediately demonstrated the results to all participants on a large screen and invited them to further discussions with panelists in small groups. Additionally we had invited mentors from each represented specialty to answer questions after each duel. We provided download files with key information on presented residencies on our homepage.

Measuring the change in terms of specialty preference

Through ARS-devices, students were asked about their specialty preferences at two different time points. Answer options included the presented specialty, another specialty or ‘not decided yet’. After roughly 60 seconds we documented and presented the results for each answer option. All steps were repeated after each Duel. We used the difference in percentages as measure for preference change.

Written evaluation

We designed a questionnaire with 22 items (18 closed and 4 open questions). Answer options were based on 6-point Likert Scales (strongly agree to strongly disagree) or the German school grading system (best score=1, worst score=6).

Open questions asked about general comments and ideas or wishes for improvement. Additionally we asked about demographic data and conducted descriptive quantitative analysis.

Statistical analysis

Data were administered with Excel (Microsoft Office). In order to calculate gender and duel association we used the chi-squared test. The significance level was set at α<0,05. Data were analyzed with Stata (Version 12.1, StataCorp).


Results

Online questions of students

Students from all semesters used the online question tool particularly for Duels 1 and 2. All questions were asked anonymously (the only visible information being the current semester) and directly published on our homepage in order to avoid duplicates of questions. Students submitted between 10 and 20 questions per Duel, which concerned different aspects of residency training, including application procedures, career chances, work-life-balance, average income, working conditions, gender issues, residency curricula, reasons and requirements for choosing a specific residency as well as typical patients in different specialties. A written summary of the questions was prepared for the moderator and the panelists.

Characteristics of participating students and duels

The number of students participating in each duel ranged from 300 to 450. The response rate of the written evaluation ranged from 24% to 37% (see Table 2 [Tab. 2]). Duels 2 and 4 had the highest number of participating students. The average gender ratio was 1:2 (male:female). Duel 4 had a ratio of 1:1, Duel 2 of approximately 1:3 and Duel 3 of approximately 1:4 (p<0,001, Chi2=20,79). Most students were from preclinical semesters, except in Duel 3, which attracted more students from the clinical semesters. On average, students were aged 22.8 (SD=3.9), as assessed for Duels 3 and 4.

Written evaluation of each FacharztDuell (Specialty-Duel)

The quantitative results of the written evaluation are summarized in Table 3 [Tab. 3].

The number of completed written evaluations ranged from 75 to 133 per event. The duels received an average grade of 1.7 (SD=0.7). Duel 3 (general practice and internal medicine) received the best grade (1.6, SD=0.6). The format of moderated discussions was considered as appropriate in order to gain information on choosing a residency (average score 1.48, SD=0.64, 1=strongly agree, 6=strongly disagree). On average, 77.8% of participants agreed to the statement that the Specialist-Duel would support the decision-making process with regards to the future specialty choice.

Written comments included positive mentioning of the interactive elements of the format, the option to directly ask question during each duel as well as the elaborating and clarifying moderation. Information “from first hand”, “honest answers” from residents, ARS-questions and concrete information on less common residencies were mentioned positively as well.

Respondents also indicated that they wished more specialists working in private practice as well as panelists working at the specialist level. They also asked for more exemplary case reports for each presented specialty and a precise description of a typical working day in the respective specialty.

Specialty preferences of students before and after a duel

Students identified their preferred specialty during each duel. We summarized the distribution of preferences for each specialty in percent as well as the change in preference, calculated as preference difference between time point t1 (before discussion) and t2 (after discussion). Each question included the answer option “none of the presented specialties” and “not decided yet” (see Figure 1 [Fig. 1]). The strongest positive changes (t2–t1) were found for the answer options “none of the presented specialties” (Duel 2, +12%), general practice (Duel 2, +11%) and neurology (Duel 1, +6%). The strongest negative changes were found for the answers “none of the presented specialties” (Duel 3, -10%), internal medicine (Duel 2, -7%) and “not decided yet” (Duels 1,2 and 4, each -6%).

On average 17.25% (SD=1.5) of respondents chose the answer option “not decided yet” before a duel and 12.5% (SD=3.3) after a duel, with an average difference of -4.8%. The answer option “none of the presented specialties” was stable at 10.5% (SD=4.43) before and after a duel.


Discussion

Summary

In the presented study we investigated the Specialist-Duel (FacharztDuell) as an innovative career-counseling format for undergraduate medical students. We looked at the acceptance of our new format, the students’ evaluation of the format to support their specialty choice as well as students’ specialty preferences before and after each Specialist-Duel. We used a mixed-method-approach (qualitative and quantitative evaluation) as well as a pre-post comparison of specialty preferences and state of decision of medical students in order to provide a broad picture of our novel career-counselling format.

The results indicate that the Specialist-Duel is well accepted and associated with acute changes in specialty preference. However, it is not possible to draw conclusions on the long-term decision effects of this format at this point. Longitudinal studies are needed in order to better understand the complex decision-making process in terms of choosing a specialty.

Acceptance of the FacharztDuell

Our results show that the FacharztDuell, as a voluntary and extracurricular format has a stable and high acceptance rate amongst medical students beyond the pilot project and regularly receives high evaluation grades. The combination of an online question submission platform and interactive moderation was positively evaluated in terms of active student participation. A clear majority of students thought of the FacharztDuell as helpful for their future choice of a specialty.

We are not aware of any other studies on large-scale career-counselling formats.

Research on related topics has shown that medical students tend to think about their career at an early stage during their studies and start thinking about their specialization during their preclinical years [17].

This finding is supported by our observation of two thirds of participants being enrolled in preclinical semesters. The feminization of medicine [18] might partly be reflected in the characteristics of the participants. Male medical students were significantly more interested in alternatives to clinical work and female medical students were significantly more interested in the specialties pediatrics, gynecology and pediatric surgery. We think that this observation might lead to interesting follow-up research questions on the influence of the hidden curriculum on gender specific career preferences of medical students.

Role of the FacharztDuell on choosing a specialty

Many factors influence the decision-making process in terms of choosing a specialty [19]. From our data we cannot estimate the real influence of the FacharztDuell on the final specialty choice. However, we think that the FacharztDuell-format allows medical students to clarify misunderstandings, collect relevant information and identify potential alternatives at an early stage of deciding for or against a specialty in an effective and efficient way. In the evaluations we conducted, 77.8% of all participating students found the FacharztDuell to be helpful in terms of choosing a specialty. With regards to difficulties recruiting trainees for general practice residencies [20], [21], our results indicate that large-scale and interactive formats like the FacharztDuell are useful in order to eliminate prejudices, misunderstandings or distorted perceptions particularly with regards to general practice. This becomes also relevant, considering that medical students decide at an early stage what type of mandatory clinical electives they will apply for [17]. In addition to general practice, we also found positive changes in terms of specialty preference for residencies in neurology. This might be particularly interesting for young professional organizations of the different medical societies, such as the “Junge Neurologen” (German for: Young Neurologists), [22] who might use this format during national congresses or summer schools.

Strengths and limitations of this study

Overall we analyzed 424 completed evaluations. The number of participants ranging between 300 and 450 indicates that medical students are strongly interested in such a format. We randomly distributed evaluations and ARS-devices in order to minimize a potential selection bias. By combining qualitative and quantitative evaluation methods we were able to get a fine-grained picture of our career-counselling format.

Two aspects of our study might limit the generalizability. On the one hand students might not be representative of the medical student population because of the non-mandatory participation. On the other hand we did not account for the factor ‘personality of panelist’, which might have an influence on the specialty preference assessed after each duel.

Finally, the preference for a specialty as investigated in our study is a subjective impression at a given moment and only one part of the ultimate decision.

Recommendations for follow-up studies

Our study provides first insights with regards to acceptance, effect correlations and feasibility of moderated panel discussions as career-counselling format for medical student and their choice of a medical specialty.

Longitudinal follow-up studies should investigate the complex decision-making process with regards to specialty choice at different time-points during undergraduate and graduate medical education. Qualitative studies, which investigate the meaning-making structures of medical students and trainees in-depth might be particularly useful to analyze these decision-making processes and to consequently design targeted quantitative studies.

Implications for practice

Medical students’ positive evaluation of the FacharztDuell and similar projects in other countries support the assumption that career-counselling interventions are important and helpful for students choosing a specialty.

A study by Bittaye et al. [23] showed that all of 202 asked medical students were convinced of the necessity of career-counselling offers at their home university.

Mellmann et al. [24] emphasize the role of medical faculties to support medical students on their career path during undergraduate and graduate medical education. Different studies confirm that medical students are influenced by role models when it comes to choosing a specialty [5], [14].

Students meet these role models typically at an early stage of undergraduate studies – long before choosing a residency or specialty. Mentors also play a role for prioritizing specialties and choosing relevant electives.

Besides direct information and counselling elements, the FacharztDuell also provides opportunities for finding a personal mentor through the small group discussions following each duel. We thus recommend integrating the FacharztDuell in existing mentoring programs.

The FacharztDuell was successfully implemented at the Ludwig-Maximilians-Universität in Munich. Using an innovative format and advertising strategies were crucial in this context. The FacharztDuell is well accepted and was identified as relevant by participating students. We were able to show changes in specialty preference comparing students’ answers before and after moderated discussion rounds. In conclusion we think that the FacharztDuell can be successfully implemented at other medical faculties as well.


Acknowledgement

We would like to thank Roland Mayer for organizing and conducting the ARS questions and managing the TED-System in all duels.


Competing interests

The authors declare that they have no competing interests.


References

1.
Buddeberg-Fischer B, Beck Schimmer B, Hornung R, Dietz C, Mattanza G, Klaghofer R. Mentoring zur klinischen und akademischen Karriereförderung junger Ärztinnen und Ärzte. Schw Ärztez. 2005;86(46):2566-2572.
2.
von der Borch P, Dimitriadis K, Störmann S, Meinel FG, Moder S, Reincke M, Tekian A, Fischer MR. A novel large-scale mentoring program for medical students based on a quantitative and qualitative needs analysis. GMS Z Med Ausbild. 2011;28(2):Doc26. DOI: 10.3205/zma000738 External link
3.
Dimitriadis K, von der Borch P, Störmann S, Meinel FG, Moder S, Reincke M, Fischer MR. Characteristics of mentoring relationships formed by medical students and faculty. Med Educ Online. 2012;17:17242. DOI: 10.3402/meo.v17i0.17242 External link
4.
Gold A. Studienmotive und Zukunftsvorstellungen von Studienanfängerinnen und Studienanfängern der Humanmedizin. Freiburg: Albert-Ludwigs-Universität Freiburg i. Brsg.; 2009.
5.
Basco Jr WT, Reigart JR. When do medical students identify career-influencing physician role models? Acad Med. 2001;76(4):380-382. DOI: 10.1097/00001888-200104000-00017 External link
6.
Mihalynuk T, Leung G, Fraser J, Bates J, Snadden D. Free choice and career choice: clerkship electives in medical education. Med Educ. 2006;40(11):1065-1071. DOI: 10.1111/j.1365-2929.2006.02614.x External link
7.
Keating EM, O'donnell EP, Starr SR. How we created a peer-designed specialty-specific selective for medical student career exploration. Med Teach. 2013;35(2):91-94. DOI: 10.3109/0142159X.2012.731110 External link
8.
Columbia. Planning a medical career. Canada: Columbia University; 2013 [cited 2013 August 25th]; Zugänglich unter/vailable from: http://ps.columbia.edu/education/academic-career-planning/planning-medical-career External link
9.
Mehmood SI, Khan MA, Walsh KM, Borleffs JC. Personality types and specialist choices in medical students. Med Teach. 2013;35(1):63-68. DOI: 10.3109/0142159X.2012.731104 External link
10.
Abdulghani HM, Al-Shaikh G, Alhujayri AK, Alohaideb NS, Alsaeed HA, Alshohayeb IS, Alyahya MM, Alhaqwi AI, Shaik SA. What determines the selection of undergraduate medical students to the specialty of their future careers? Med Teach. 2013;35(s1):S25-S30. DOI: 10.3109/0142159X.2013.765548 External link
11.
Al-Fouzan R, Al-Ajlan S, Marwan Y, Al-Saleh M. Factors affecting future specialty choice among medical students in Kuwait. Med Educ Online. 2012;17:1-7. DOI: 10.3402/meo.v17i0.19587 External link
12.
Chan BT, Degani N, Crichton T, Pong RW, Rourke JT, Goertzen J, McCready B. Factors influencing family physicians to enter rural practice: does rural or urban background make a difference? Can Fam Physician. 2005;51(9):1246-1247.
13.
Hayes BW, Shakya R. Career choices and what influences Nepali medical students and young doctors: a cross-sectional study. Hum Resour Health. 2013;11(1):5. DOI: 10.1186/1478-4491-11-5 External link
14.
Blissett S, Law C, Morra D, Ginsburg S. The Relative Influence of Available Resources During the Residency Match: A National Survey of Canadian Medical Students. J Grad Med Educ. 2011;3(4):497-502. DOI: 10.4300/JGME-D-11-00043.1 External link
15.
Borges NJ, Hartung PJ. Stability of values during medical school. Med Teach. 2010;32(9):779-781. DOI: 10.3109/01421591003692706 External link
16.
Welbergen L, Von der Borch P, Pander T, Dimitriadis K. Battle of the specialties: innovative career counselling for students. Med Educ. 2013;47(5):515. DOI: 10.1111/medu.12159 External link
17.
Scott I, Gowans MC, Wright B, Brenneis F. Why medical students switch careers Changing course during the preclinical years of medical school. Can Fam Physician. 2007;53(1):94-95.
18.
Bundesärztekammer. Analyse - Ärztemangel trotz steigender Arztzahlen. Berlin: Bundesärztekammer; 2013 [cited 2013 April 25th ]. Zugänglich unter/vailable from: http://www.bundesaerztekammer.de/page.asp?his=1.128.129 External link
19.
Dornan T. Medical education: theory and practice. Edinburgh: Elsevier; 2011. S.364ff.
20.
Steinhäuser J, Miksch A, Hermann K, Joos S, Loh A, Götz K. What do medical students think of family medicine? Dtsch Med Wochenschr. 2013.
21.
Bradner M, Crossman SH, Vanderbilt AA, Gary J, Munson P. Career advising in family medicine: a theoretical framework for structuring the medical student/faculty advisor interview. Med Educ Online. 2013;18.
22.
DGN. Wegweiser Nachwuchsförderung. Berlin: DGN; 2013 [cited 2013 August 5th]. Zugägnlich unter/vailable from: http://www.dgn.org External link
23.
Bittaye M, Odukogbe AT, Nyan O, Jallow B, Omigbodun AO. Medical students' choices of specialty in The Gambia: the need for career counseling. BMC Med Educ. 2012;12(1):72. DOI: 10.1186/1472-6920-12-72 External link
24.
Mellman LA, Paquette B. Academic and career counseling for medical students and the complex role of the Student Affairs Dean. Acad Psych. 2012;36(3):169-173. DOI: 10.1176/appi.ap.10020034 External link