1. Employing a Prevention Metaphor for Family Medicine Medical Student Advising Steven Crossman, MD; James Tysinger, PhD; Judy Gary, MEd; Christopher Woleben, MD; Kaparaboyna Kumar, MD, FRCS, FAAFP; Marjorie Hermes, MD; Andry Nehman, MD; Carol Tran, BS 1 February 2014

2. Disclosures Steven Crossman, James Tysinger, Judy Gary, Christopher Woleben, K. Ashok Kumar, Marjorie Hermes, Andry Nehman, and Carol Tran have no relevant relationships with commercial interests to disclose. Each presenter completed and submitted a Disclosure Form to STFM.

3. Objectives Share strategies to prepare students for Match Explain factors affecting applicants’ abilities to match Critique current advising methods: -Departmental -Institutional Develop advising approaches that anticipate / prepare students for successful match in family medicine Describe approaches to navigate SOAP process.

4. Activity #1 Our most challenging advising scenario from the past 3 years.

5. Match Trends: Recent Numbers Match Year PGY-1 Slots PGY-2 Slots Total Applicants 195210,400 --- 6,000 ( all US grads) 201123,4212,73730,589 201224,0342,73831,355 201326,392 (“all-in” rule) 2,77934,355

6. 2013 Applicants: total 34,355 US Allopathic Seniors (match rate) US Allopathic Prev Grads (match rate) US Osteopath Stdnts/Grads (match rate) US Int’l Stdnts/Grads (match rate) Non-US Int’l Stdnts/Grads (match rate) 17,487 (93.7%) 1,487 (49%) 2,677 (75.4%) 5,095 (53.1%) 7,568 (47.6%) 960170 50%740 highest ever

7. Family Medicine Slots in the Match YearAvailable FM SlotsUnfilled FM Slots 20092535224 20102608224 20112708153 20122740149 20133037123

8. VCU Recent National Survey

9. Prevention Metaphor Medical Definition Medical Example Metaphor Definition Metaphor Example Primary Prevention (Vaccination) Preventing a disease or condition from ever developing Vaccination to prevent tetanus Using admissions criteria, anticipatory guidance, educational programs, and support systems to ensure satisfactory academic and professional performance in med school Supportive bio- psychosocial environment; education, outreach and recruitment; engagement of partners to help immunize learners. Prophylactic interventions as needed

10. Prevention Metaphor Medical Definition Medical Example Metaphor Definition Metaphor Example Secondary Prevention (Screening) Once a patient has a condition or disease, preventing it from causing any morbidity or mortality A patient is diagnosed with DM and has an A1C of 6.5% - Mobilize interventions to effectively prevent the complications of DM (Identify and remediate problems before application) Closely monitor performance on self-assessments and low-stakes evaluations to identify poor performance and intervene early Use timely and effective screening measures to avoid delays in diagnosis and ensure prompt and targeted intervention to avoid losing students to follow-up

11. Prevention Metaphor Medical Definition Medical Example Metaphor Definition Metaphor Example Tertiary Prevention Once a condition or disease is present and has caused some morbidity, intervening to prevent further complications A patient with DM is discovered to have micro- albuminuria and is started on an ACE inhibitor Once a student has not matched, put into action immediate stabilizing measures when able and mobilizing resources to better understand the situation and remediate issues Stabilize and address immediate needs; consult and refer to specialists as needed; develop a plan for acute needs and long-term remediation; monitor and re- assess progress vs. setbacks

12. Advising Case Studies 10 min – Discussion 20 min - Debriefing

13. Minimum Requirements for a Departmental MSE Advising Program?

14. Our List: Minimum Requirements for a Departmental MSE Advising Program Faculty Advisors 4 year FM career development curriculum 1:1 time with students 1:1 “acute issue” student/advisor meetings Application review/guidance Screening consultation with students who fail to Match

15. UTHSC-SA Faculty advisors 4 year FM career development curriculum 1:1 student/faculty advisor continuity meetings 1:1 meetings (e.g., “acute issue”) Application review Help with learning and performance issues Interview rehearsals Consultations with residency leaders Screening consultations with students who fail to Match

16. VCU Patient Care Continuity of care Comprehensive care Patient-centered Coordination of care Student Education & Recruitment Longitudinal contact Comprehensive approach Student-centered Coordinated efforts

17. VCU PreadmissionsGraduation M2 Preceptorship I2CRP M1 Outreach FMIG M3 Clerkship Global Health Programs fmConnect Community Service Programs M4 Advising M4 Electives CELEBRATE! fmSTAT

20. Our collective sense of best practices in departmental student advising…

21. From a SOM Perspective VCU School of Medicine Advising Program: –Project H.E.A.R.T. –Medical Student Societies –Career Specific Advisors

22. SOM Interests / Concerns Residency Match Rate –Important for recruitment of strong medical school applicants –Increased class size = more students with academic problems Parallel Plans for Residency Applications Increased Competition (IMG/DO) AAMC – Physician Workforce Goals

23. Career Advising Program – M1 Orientation –Myers Briggs workshop Match 101 Presentation –Planning for summer activities –Discuss competitive nature of the Match Project H.E.A.R.T. –AAMC Careers in Medicine self assessments Annual Career Fair

24. Career Advising Program – M2 Careers in Medicine Course –Match 102 presentation – Match algorithm demystified –CV, personal statement workshops –Residency Program Director panel –Financial implications of choosing specialty Project H.E.A.R.T. –Transition to clinical curriculum

25. Career Advising Programs – M3 How to Make a Decision –6 Thinking Hats Model Match 103 Presentation –Plan M4 year, application for away electives, Match timeline Career Specific Advisor Assignment –Training of advisors, provide local and national Match data

27. Career Advising Programs – M4 ERAS/NRMP Workshop Interviewing Skills / Mock Interviews Personal Statement Reviews Match Update / Match Survey Interview Travel Support Rank List Support S.O.A.P. Preparation / Support

28. General Advice Weak Students do not fare well in S.O.A.P. –MUST have alternative plans Students listen when you provide them with hard data –Know local and national match trends –Monitor student progress with interview offers

29. Medical Student Advising