Background: Medical schools include career direction experiences to help students make informed career decisions. Most experiences are short, precluding students from attaining adequate exposure to long-term encounters within medicine. We investigated the impact of the First Patient Program (FPP), which fosters longitudinal patient exposure by pairing junior medical students with chronically ill patients through their healthcare journey, in instilling career direction. Methods: Medical students who completed at least 6-months in the FPP participated in a cross-sectional survey. Students’ answers were analyzed with respect to the number of FPP appointments attended. Thematic analysis was conducted to explore qualitative responses.Results: One hundred and forty-eight students participated in the survey. Only 28 (19%) students stated that the FPP informed their career decisions. Thirty-nine percent of students who attended four or more appointments indicated that the FPP informed their career decisions, compared to 16% of students who attended less (p=0.021). Thematic analysis revealed two themes: 1) Students focused mainly on patient encounters within FPP; and 2) Students sought career directions from other experiences.Conclusion: The majority of students did not attain career guidance from the FPP, but rather used the program to understand the impact of chronic illness from the patient’s perspective

Bowes, Kathryn

Kwok, Jason

Pinchin, Sheila

Sanfilippo, Anthony

Wu, Vincent

Canadian Medical Education Journal

English

PubMed

Background: Medical schools include career direction experiences to help students make informed career decisions. Most experiences are short, precluding students from attaining adequate exposure to long-term encounters within medicine. We investigated the impact of the First Patient Program (FPP), which fosters longitudinal patient exposure by pairing junior medical students with chronically ill patients through their healthcare journey, in instilling career direction. 
Methods: Medical students who completed at least 6-months in the FPP participated in a cross-sectional survey. Students’ answers were analyzed with respect to the number of FPP appointments attended. Thematic analysis was conducted to explore qualitative responses.
Results: One hundred and forty-eight students participated in the survey. Only 28 (19%) students stated that the FPP informed their career decisions. Thirty-nine percent of students who attended four or more appointments indicated that the FPP informed their career decisions, compared to 16% of students who attended less (p=0.021). Thematic analysis revealed two themes: 1) Students focused mainly on patient encounters within FPP; and 2) Students sought career directions from other experiences.
Conclusion: The majority of students did not attain career guidance from the FPP, but rather used the program to understand the impact of chronic illness from the patient’s perspective

Jason Kwok

Vincent Wu

Anthony Sanfilippo

Kathryn Bowes

Sheila Pinchin

Directory of Open Access Journals

Examining the impact of early longitudinal patient exposure on medical students’ career choices

University of Calgary Journal Hosting

Canadian	Medical	Education	Journal	2017,	8(1)		Correspondence:	Vincent	Wu,	Undergraduate	Medical	Education,	Queen’s	University,	80	Barrie	Street,	Kingston,	ON,	K7L	3J8;	email:	vwu@qmed.ca	 e101	Canadian	Medical	Education	Journal	Brief	Report	Examining	the	impact	of	early	longitudinal	patient	exposure	on	medical	students’	career	choices	Jason	Kwok,1*	Vincent	Wu,1*	Anthony	Sanfilippo,1	Kathryn	Bowes,1	Sheila	Pinchin1		1Undergraduate	Medical	Education,	Faculty	of	Health	Sciences,	Queen’s	University,	Ontario,	Canada	*Authors	contributed	equally	to	this	work	Published:	February	24,	2017	CMEJ	2017,	8(1):e101-e105		Available	at	http://www.cmej.ca	©	2017	Kwok,	Wu,	Sanfilippo,	Bowes,	Pinchin;	licensee	Synergies	Partners	This	is	an	Open	Journal	Systems	article	distributed	under	the	terms	of	the	Creative	Commons	Attribution	License	(http://creativecommons.org/licenses/by/2.0)	which	permits	unrestricted	use,	distribution,	and	reproduction	in	any	medium,	provided	the	original	work	is	properly	cited.	Abstract	Background:	Medical	schools	include	career	direction	experiences	to	help	students	make	informed	career	decisions.	Most	experiences	are	short,	precluding	students	from	attaining	adequate	exposure	to	long-term	encounters	within	medicine.	We	investigated	the	impact	of	the	First	Patient	Program	(FPP),	which	fosters	longitudinal	patient	exposure	by	pairing	junior	medical	students	with	chronically	ill	patients	through	their	healthcare	journey,	in	instilling	career	direction.			Methods:	Medical	students	who	completed	at	 least	6-months	in	the	FPP	participated	in	a	cross-sectional	survey.	Students’	answers	were	analyzed	with	respect	to	the	number	of	FPP	appointments	attended.	Thematic	analysis	was	conducted	to	explore	qualitative	responses.	Results:	One	hundred	and	forty-eight	students	participated	in	the	survey.	Only	28	(19%)	students	stated	that	the	FPP	 informed	 their	 career	 decisions.	 Thirty-nine	 percent	 of	 students	who	 attended	 four	 or	more	 appointments	indicated	that	the	FPP	informed	their	career	decisions,	compared	to	16%	of	students	who	attended	less	(p=0.021).	Thematic	 analysis	 revealed	 two	 themes:	 1)	 Students	 focused	mainly	 on	 patient	 encounters	 within	 FPP;	 and	 2)	Students	sought	career	directions	from	other	experiences.	Conclusion:	The	majority	of	students	did	not	attain	career	guidance	from	the	FPP,	but	rather	used	the	program	to	understand	the	impact	of	chronic	illness	from	the	patient’s	perspective.				Canadian	Medical	Education	Journal	2017,	8(1)		 e102	Introduction	Making	 informed	 career	 choices	 is	 arguably	 one	 of	the	most	important	decisions	medical	students	must	make	 during	 their	 journey	 through	 medical	 school.	The	 importance	 is	 highlighted	within	 the	 CANMEDs	2015	Series	II	draft	framework	as	part	of	the	Leader	competency	role.1	Moreover,	studies	have	suggested	that	students	make	47-77%	of	their	career	decisions	by	the	end	of	pre-clerkship	(years	1	and	2).2,3	To	aid	students	 in	 this	 regard,	 many	 Canadian	 medical	schools,	have	focused	on	enhancing	the	pre-clerkship	curriculum	 to	 include	 informative	 career	 direction	experiences.	 This	 includes,	 but	 is	 not	 limited	 to	lunchtime	 talks,	 mandatory	 observerships,	 and	faculty	career	nights.	Although	such	experiences	may	aid	 with	 career	 direction,	 they	 may	 not	 include	 all	factors	involved	in	making	an	informed	career	choice.	Factors	 such	 as	 the	 types	 of	 interactions	 students	seek	between	patients	and	healthcare	professionals,	and	 the	 desire	 for	 having	 continuity	 of	 care	 during	future	practice	are	not	addressed.4-7	These	elements	may	not	be	properly	considered	by	medical	students	due	 to	 the	 lack	 of	 long-term	 patient-care	 and	healthcare	 experiences	 available	 in	 the	 typical	 pre-clerkship	curriculum.		To	 our	 knowledge,	 the	 current	 undergraduate	curricula	 of	 Canadian	 medical	 schools	 offer	 few	opportunities	 for	 students	 to	engage	 in	 longitudinal	patient	care	early	on	in	their	training.	However,	one	program	that	exposes	students	to	this	form	of	care	is	the	 First	Patient	Program	 (FPP),	 a	unique	18-month	long	 program	 mandated	 within	 the	 undergraduate	medical	curriculum	at	Queen’s	University.	One	of	the	main	objectives	of	the	program	is	to	provide	students	with	early	clinical	patient	encounters	during	the	pre-clerkship	years	with	the	goal	of	allowing	students	to	experience	the	healthcare	system	from	the	patient’s	perspective.8	In	the	FPP,	first	year	medical	students,	at	the	beginning	of	the	year,	are	randomly	paired	with	chronically	ill	patients.	The	students	then	follow	their	patients	on	a	journey	through	the	healthcare	system,	attending	 at	 least	 three	 self-scheduled	 healthcare	appointments	with	their	patients	over	the	18-month	period.	 During	 these	 appointments,	 which	 can	include	visits	with	non-MD	healthcare	professionals,	students	 act	 as	 observers	 and	 reflect	 on	 their	experiences	 through	 structured	 reports.	 A	supervising	 physician,	 a	 family	 physician	 or	 other	specialist,	who	is	often	the	main	healthcare	provider	for	 the	 patient,	 acts	 as	 a	 mentor	 for	 students,	providing	insight	into	patient	care,	and	a	glimpse	into	his/her	specialty.	The	stated	objective	of	the	FPP	is	for	students	 to	 gain	 an	understanding	of	 the	 impact	 of	chronic	 diseases	 from	 a	 patient’s	 perspective,	something	that	would	otherwise	not	be	possible	for	medical	 students	 given	 the	 lack	 of	 longitudinal	experiences	normally	available	in	medical	school.		Although	 career	 exploration	 was	 not	 an	 explicit	objective	of	the	FPP,	we	aimed	to	investigate	whether	the	exposure	of	medical	students	to	patients	early	in	their	 training	 could	 provide	 guidance	 for	 career	decisions	as	an	unintended	outcome	of	the	program.	We	 hypothesized	 that	 students	 with	 increased	participation	 in	 such	 a	 program	would	 derive	more	career	guidance.	Methods	Study	design	This	was	 a	 cross-sectional	 study	with	 the	 use	 of	 an	online	 survey,	 which	 gathered	 qualitative	 and	quantitative	information.	Each	participant	submitted	and	answered	one	survey	containing	 four	questions	(Table	1).	The	Institutional	Review	Board	at	Queen’s	University	approved	this	study	(#6013162).		Table	1:	Survey	Questions	Participants	Queen’s	 University	 medical	 students	 from	 three	consecutive	 cohorts,	 who	 had	 participated	 at	 least	six-months	 in	 the	FPP,	were	 recruited	 to	voluntarily	participate	 in	 the	 study.	 An	 information	 sheet	 was	provided	prior	to	survey	administration	and	consent	was	 obtained	 as	 implied	 when	 the	 participant	submitted	 the	 survey.	 Incomplete	 surveys	 were	excluded	from	analysis.		Survey	questions	1. Which	year	of	medicine	are	you	in?		2. How	 many	 healthcare	 appointments	 were	 you	 able	 to	attend	with	your	First	Patient	through	the	duration	of	the	First	Patient	Program?		3. Has	 participating	 in	 the	 First	 Patient	 Program	 impacted	your	 personal	 choices	 regarding	 career	 direction?	(Yes/No)		4. For	question	3,	if	you	answered	“Yes”,	please	explain	how.	If	you	answered	“No”,	please	elaborate	on	the	response.	Canadian	Medical	Education	Journal	2017,	8(1)		 e103	Thematic	analysis		All	 responses	 to	 question	 four	were	 analyzed	 using	constant	comparison	methods,	where	the	data	were	contrasted	 and	 compared	 for	 significant	 sentences	and	 phrases.	 The	 open	 coding	 structure,	 computer	aided	thematic	analysis	software	–	nVIVO	(v2.0,	QSR	International	 Pty.	 Ptd.,	 Melbourne,	 Australia)	 was	used	for	data	organization	and	retrieval.		Statistical	analysis	Descriptive	 statistics	 were	 used	 to	 record	 the	students’	 year	 of	 study,	 the	 number	 of	 FPP	appointments	 attended,	 and	 whether	 students	believe	 the	 FPP	 had	 an	 impact	 on	 their	 career	decision.	 Pearson’s	 Chi	 Square	 Test	 was	 used	 to	compare	 the	 three	 cohorts’	 responses	 to	 perceived	impact	of	FPP	on	career	decision.	The	Fischer’s	Exact	Test	was	applied	to	compare	students	who	attended	three	or	fewer	FPP	appointments	to	those	with	four	or	 more	 in	 relation	 to	 career	 impact.	 All	 statistical	analyses	 were	 performed	 with	 SPSS	 (v18.0,	 IBM	Corporation,	 New	 York,	 United	 States).	 Statistical	significance	was	set	at	an	alpha	level	of	0.05.	Results	Overall,	 148	 students	 completed	 the	 survey,	with	 a	response	 rate	 of	 49%.	 Of	 the	 respondents,	 130	attended	three	appointments	or	fewer	at	the	time	of	the	survey,	while	18	attended	four	or	more.	Twenty-eight	 (19%)	 students	 reported	 that	 the	 FPP	impacted	 their	 personal	 choice	 regarding	 career	directions,	in	contrast	to	120	(81%)	who	indicated	the	FPP	did	not	help	with	career	guidance.	Comparisons	among	the	three	cohorts	did	not	reveal	differences	in	response	to	whether	FPP	impacted	career	directions	(p=0.685).	Of	 the	 students	 who	 attended	 four	 or	 more	appointments,	39%	(7/18)	responded	“Yes”	to	having	derived	career	guidance	from	the	FPP,	as	compared	to	 students	 who	 attended	 three	 or	 fewer	appointments,	 of	 which	 16%	 (21/130)	 answered	“Yes”	(p=0.021,	Figure	1).			Figure	1:	Number	of	appointments	attended	during	the	FPP	and	student	reported	FPP	impact	on	career	choices		Thematic	 analysis	 of	 qualitative	 responses	 to	 the	question	 “Was	 FPP	 as	 an	 influence	 on	 career	direction?”	 revealed	 two	 common	 themes	 among	students:	 1)	 Primary	 focus	of	 students	was	 to	 learn	more	about	a	complex	patient’s	journey	through	the	healthcare	 system;	and	2)	Although	all	 experiences,	including	 this	 program,	 help	 students	 guide	 their	career	choices,	other	experiences	are	more	influential	in	 this	 respect.	 Thematic	 breakdown	 and	 direct	quotations	are	included	in	Table	2.		Discussion	In	the	current	Canadian	medical	curriculum,	medical	students	have	limited	opportunity	to	follow	patients	over	the	long	term.	Recent	reports	revealed	that	long-term	patient	exposure	in	medical	school	could	impart	career	 guidance	 for	 students.9,10	 In	 our	 study,	 we	found	 that	 most	 students	 did	 not	 derive	 career	direction	 from	 the	 FPP,	 which	 we	 attributed	 to	several	 reasons	highlighted	 in	 the	 thematic	 analysis	results	 of	 the	 students’	 responses.	 The	 first	 theme	showed	 that	 students	 were	 overall	 well	 attuned	 to	the	FPP’s	main	objective	–	to	gain	an	enhanced	view	of	 the	 healthcare	 system	 from	 the	 patient’s	perspective.	 As	 a	 stated	 objective	 that	 was	subsequently	communicated	through	the	duration	of	the	 program,	 students	 were	 cognizant	 of	 the	program’s	intended	goals.			 	217109110204060801001203	or	less	appointments4	or	more	appointmentsNumber	of	responsesNumber	of	appointments	attended		with	patientYesNoCanadian	Medical	Education	Journal	2017,	8(1)		 e104	Table	2:	Thematic	analysis	results				However,	 as	 career	 exploration	 was	 not	 explicitly	stated	 as	 an	 intended	 objective,	 students	 may	 not	have	 actively	 used	 the	 FPP	 as	 a	 source	 of	 career	exploration.	More	explicit	objectives	and	scaffolding	within	 report	 templates	 centered	 on	 career	exploration	 within	 the	 FPP	 may	 guide	 students’	experiences.	Moreover,	the	second	theme	revealed	that	a	majority	of	 students	 used	 alternative	 experiences	 such	 as	observerships	 and	 clerkship	 rotations	 to	 guide	 their	career	 choices.	 Self-scheduled	observerships,	within	both	medicine	and	surgery,	have	been	shown	to	aid	students	in	career	decision	making.11,12	Observerships	are	 activities	 that	 have	 explicit	 goals	 of	 career	exploration	and	are	also	self-scheduled	by	students	to	potentially	align	with	their	interests.	The	FPP	was	not	designed	 to	 support	 career	 exploration:	 students	were	assigned	to	a	patient	and	supervising	physician	regardless	 of	 specialty,	 and	 many	 healthcare	 visits	were	 with	 non-MDs.	 For	 a	 longitudinal	 learning	exercise	 to	 derive	 increased	 career	 direction	experiences	we	believe	asking	for	and	accounting	for	students’	 fields	 of	 interest	 when	 assigning	 patients	and	mentors	may	be	helpful.		From	this	study	we	were	able	to	take	away	several	key	points	about	the	program’s	impact	and	several	ways	the	 FPP	 can	 improve	 to	 potentially	 impart	 career	direction	 experiences,	 an	 important	 objective	 of	medical	 school.	 Some	 students	 could	 not	 attend	enough	 FPP	 appointments	 due	 to	 time	 constraints	stemming	 from	 other	 curricular	 obligations,	 while	others	were	not	paired	with	patients	in	the	field	that	suited	 their	 interests.	 It	 may	 be	 helpful	 to	 ask	students	 to	consider	career	decision-making	as	part	of	 their	FPP	experience,	by	determining	 the	 type	of	interaction	 they	 desire	 between	 patients	 and	healthcare	professionals,	 and	whether	 continuity	of	care	 in	 their	 future	 practice	 is	 important.4-7	Additionally,	mandating	students	to	engage	 in	more	than	 three	 healthcare	 appointments	 may	 provide	students	with	increased	opportunity	to	observe	their	patients	 in	 their	 medical	 appointments,	 therefore	providing	 more	 insight	 into	 specific	 medical	disciplines.	 Improvements	 in	 all	 of	 these	 areas	 can	help	 to	 further	 enhance	 the	 student	 experience	within	FPP.		The	main	limitation	of	our	study	is	that	we	were	not	able	 to	 account	 for	 potential	 confounders	 like	students’	prior	experiences	or	pre-determined	career	interests.	 These	 factors	 may	 have	 altered	 how	 the	program	 impacted	 our	 students,	 and	 hence	 the	results	of	our	study.		Conclusion	Our	 study	 suggests	 that	 a	 program	 of	 longitudinal	patient	 exposure	 that	 emphasizes	 the	 impact	 of	chronic	 diseases	 from	 a	 patient’s	 perspective	 does	not	 convey	 significant	 career	 direction	 to	 medical	students,	 but	 further	 research	 is	 certainly	recommended.	 The	 integration	 of	 explicit	 career	Theme	1	-	Primary	focus	of	students	was	to	learn	more	about	a	complex	patient’s	journey	through	the	healthcare	system	• Writing	reflections	recalled	impact	and	motivating	moments	“The	events	especially	sticks	out	because	of	all	the	writing	and	reflection	that	went	with	it,	so	I	remember	my	thoughts	well”	• Appreciation	of	the	difficulties	and	frustrations	of	the	medical	system	for	patients	“The	focus	of	the	program	for	me	was	the	barriers	that	my	patient	faced	in	different	components	of	the	healthcare	system”	• Reinforced	importance	of	advocating	for	patients,	and	patient-centered	care	“It	reaffirmed	my	love	of	patient	interaction	and	the	importance	of	developing	long-term,	strong	relationships	with	patients”	Theme	2	-	Although	all	experiences,	including	this	program,	help	students	guide	their	career	choices,	other	experiences	are	more	influential	in	this	respect	• Goal	of	the	FPP	was	to	assist	in	career	selection	not	recognized	by	students	“I	don’t	think	that	the	FPP’s	goal	nor	its	outcome	was	to	assist	in	career	selection”	• Students	had	mixed	reactions	about	the	usefulness	of	FPP	interactions	in	influencing	their	own	future	career	direction	“Attending	 such	 appointment	 are	 very	 educational,	 but	 do	 not	 generally	 give	 direction	 regarding	 the	 differences	 between	 different	specialties”	• Experiences	with	clerkship	and	observership	was	more	influential	with	career	selection	“I	think	my	decision	to	pursue	family	medicine	is	more	so	influenced	by	my	core	rotation	and	speaking	to	other	family	physicians”	Canadian	Medical	Education	Journal	2017,	8(1)		 e105	learning	 objectives,	 requiring	 students	 to	 attend	more	 appointments,	 and	 incorporating	 students’	personal	 interest	 when	 assigning	 patients	 and	physicians	 may	 help	 future	 students	 derive	 career	direction	from	such	a	program.			Conflicts	of	interest:	There	are	no	conflicts	of	interest	for	any	of	the	authors.			References	1. Frank	 JR,	 Snell	 LS,	 Sherbino	 J,	 et	 al.	 Draft	 CanMEDS	2015	 Physician	 Competency	 Framework	 –	 Series	 II.	Change	 record.	 Ottawa:	 The	 Royal	 College	 of	Physicians	and	Surgeons	of	Canada;	2014	May.	2. Hochberg	MS,	Billig	J,	Berman	RS,	Kalet	AL,	Zabar	SR,	Fox	JR,	Pachter	HL. When	surgeons	decide	to	become	surgeons:	 new	 opportunities	 for	 surgical	education. Am	J	Surg.	2014	Feb;207(2):194-200.	3. Zeldow	PB,	Preston	RC,	Daugherty	SR. The	decision	to	enter	 a	 medical	 specialty:	 timing	 and	 stability. Med	Educ.	1992	Jul;26(4):327-32.	PubMed	PMID:	1630336.	4. Wright	 B,	 Scott	 I,	 Woloschuk	W,	 Brenneis	 F.	 Career	choice	 of	 new	 medical	 students	 at	 three	 Canadian	universities:	 family	 medicine	 versus	 specialty	medicine.	 Can	 Med	 Assoc	 Journal.	 2004	 Jun	22;170(13):1920–4.		5. Allen	SS,	Sherman	MB,	Bland	CJ,	Fiola	JA.	Effect	of	early	exposure	 to	 family	 medicine	 on	 students’	 attitudes	toward	the	specialty.	J	Med	Educ.	1987;62:911-7.		6. Geertsma	 RH,	 Romano	 J.	 Relationship	 between	expected	 indebtedness	and	career	 choice	of	medical	students.	J	Med	Educ.	1986;61:555-9.	7. Rosenthal	MP,	Diamond	JJ,	Rabinowitz	HK,	Bauer	LC,	Jones	RL,	Kearl	GW,	et	al.	 Influence	of	income,	hours	worked,	 and	 loan	 repayment	 on	medical	 stu-	 dents’	decision	 to	 pursue	 a	 primary	 care	 career.	 JAMA.	1994;271:914-7.	8. Pinchin	 S,	 Bowes	 K,	 Sanfilippo	 AJ.	 The	 First	 Patient	Program:	 Improving	 Early	 Medical	 Student’s	Experience	of	Patients	and	Diseases.	Poster	presented	at:	 Canadian	 Conference	 on	 Medical	 Education;	Quebec	City,	QC;	2013	April	20-23.	9. O'Donoghue	 S,	 McGrath	 D,	 Cullen	 W.	 How	 do	longitudinal	 clerkships	 in	 general	 practice/primary	care	 impact	 on	 student	 experience	 and	 career	intention?	 A	 cross-sectional	 study	 of	 student	experience.	Educ	Prim	Care.	2015	May;26(3):166-75.	10. Norris	 TE,	 Schaad	 DC,	 DeWitt	 D,	 Ogur	 B,	 Hunt	 DD.	Longitudinal	 Integrated	 Clerkships	 for	 Medical	Students:	An	Innovation	Adopted	by	Medical	Schools	in	 Australia,	 Canada,	 South	 Africa,	 and	 the	 United	States.	Acad	Med.	2009	Jul;84(7):902-7.	11. Elnicki	 DM,	 Halbritter	 KA,	 Antonelli	 MA,	 et	 al.	Educational	 and	 career	 outcomes	 of	 an	 internal	medicine	 preceptorship	 for	 first-year	 medical	students.	J	Gen	Intern	Med.	1999;14:341-6.	12. Penciner	 R.	 Emergency	 medicine	 preclerkship	observerships:	evaluation	of	a	structured	experience.	CJEM. 2009	May;11(3):235-9.					

https://journalhosting.ucalgary.ca/index.php/cmej/article/download/36752/pdf

Examining the impact of early longitudinal patient exposure on medical students’ career choices

Abstract

Similar works

Full text

Available Versions

Directory of Open Access Journals

University of Calgary Journal Hosting