Education Columns

by Melissa Bradner, MD, MSHA, Associate Professor, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine

Family physicians serve as advisors to medical students who have expressed an interest in family medicine as a career. It can seem like our role is to “sell” family medicine and struggle against the misconceptions about family medicine in academic medical centers. Rather than take the defensive, salesperson stance, we offer an inquiry model (similar to motivational interviewing) that poses significant questions for the student to consider and then seek more information.

The advisor/student interview is conceptualized into five discussion topics:

I. The Self Knowledge approach explores the students’ personal interests, abilities, and career values.¹

• What makes you want to go to work every day?
• What energized you?
• What drains you?
• What really matters to you?

II. The advisor’s role is to help students examine the perceptions they encounter from others about family medicine. The Perception questions reflect on the information a student might hear about family medicine.²

• On what information was the statement based?
• What information would you need to make your own judgments?

III. Organizational Voice addresses student concerns in the context of academic medical centers and the social peer influence of a medical school class.³ The advisor helps the student see how group perspective, especially a small vocal group or one politically connected individual, can influence perception.

• How widely is this view held and by whom?

IV. Early on in their medical training, students with an interest in family medicine experience a state of Cognitive Dissonance: they believe family medicine is a fulfilling career choice but are confronted with beliefs that suggest otherwise.⁴ When students experience negative comments about family medicine, they are left with a decision to believe the statements or dismiss them as untrue. They are in a state of dissonance.

• In what ways is ___________ (any community setting quality) different from ________ (academic center culture)?
• In what way do you think practicing in a community setting might be different than an academic medical center?

V. Within every medical school class there are informal and formal leaders who have a pivotal role in their social groups.⁵ Anticipatory Advising fosters student awareness of negative statements about family medicine and prepares students for how they might react.

How might you respond to faculty who actively criticize your career choice?
What kinds of attitudes about family medicine might you expect to hear from other students, faculty, family, or friends?

The core message of the framework is that any student statements or questions need to be viewed as a starting point—a bridge—to exploring in further depth the student’s knowledge and interests. The key role for the family medicine advisor is to ask the right questions.

References

1. Reed V, Jernstedt C, Reber E. Literature review: understanding and improving medical student specialty choice: a synthesis of the literature using decision theory as a referent. Teach Learn Med 2001;13(2):117-29.

2. Holmes D, Tumiel-Berhalter L, Zayas L, Watkins R. “Bashing” of medical specialties: students’ experiences and recommendations. Fam Med 2008;40(6):400-6.

3. Haidet P, Kelly A, Chou C. Characterizing the patient centeredness of hidden curricula in medical schools: development and validation of a new measure. Acad Med 2005;80:44-7.

4. Ryckman R. Theories of personality. Monterey, CA: Brooks Cole Publishing Company, 1982:8.

5. Ivers N. Galil-Abdel R. Marketing family medicine: challenging misconceptions. Can Fam Physician 2007;53:793-4.