Blog | Thursday, October 9, 2014

Residency, team sports, and being a member of a team


In a recent medical education twitter chat, other medical educators and I were discussing success being tied to previous experience playing a team sport. It stemmed from this article, which suggested that success in residency (otolaryngology) may be more likely if one played a team sport earlier. This is a fascinating observation, and one that I hadn’t thought of when interviewing applicants. Others commented that there may be bias since in early schooling, boys are more likely to be members of team sports than girls.

It is interesting that residency program directors really struggle with trying to find the magic bullet that will determine success. What does “success” really mean? For program directors, I suppose it could mean having a resident who performed very well clinically, who was not a rabble rouser and thus “caused no trouble”, and who received excellent evaluations throughout training. It could mean impeccable surgical outcomes for procedurally-related fields (although there are other factors besides a resident involvement in surgery that might affect surgical outcomes). It could also mean getting a job and starting a practice after residency, or securing a fellowship after residency training. I really don’t think there is one thing that defines this success.

There may be success on a test (such as passing a board examination): that has been studied. The old adage: “past performance predicts future performance” is true with regards to tests, in my opinion. How this translates for programs directors is that those students who performed well on USMLE Step 1 and/or Step 2 are more likely to pass the board examinations after residency. While this is only one aspect of “being a doctor” (using competency language, it would be the competency of medical knowledge), residency programs are indeed being evaluated on this measure of board pass rate.

There may be success regarding professionalism. Some might take the reverse approach. When one is unprofessional, what factors predict that unprofessional behavior? This has been studied by Dr. M Papadakis, and basically, past “unprofessional” behavior in medical school predicts future disciplinary action by state medical boards.

There may be success in securing a match position. Many educators have published on this, such as this from plastic surgery.

There may be success in other domains as well. Here is a description that uses a surgical aptitude test. Here is another study looking at the utility of letters of recommendation to predict success.

I have heard many references over the years that medicine is a “team sport”. No one takes care of a patient by only herself/himself. We really need a team to help patients optimize their health. I believe that the field of geriatrics models this very well, and has described training on working in multidisciplinary teams. The importance of teams in medicine has also been outlined for patient-centered medical homes, such that teamwork competencies need to be defined.

One of my mentors (a female) has mentioned “I love seeing applicants who were Eagle Scouts.” I have heard others who get excited seeing certain extracurricular activities, such as volunteerism, on a written application. Like others, I certainly enjoy reading some things on an application more than others, but I really haven’t found any one thing that predicts success.

To me, it is not just the application that is important. The application gets you in the door [for the job interview], but the interview gets you the job. As for defining success: well, we in medical education have a long way to go before we are able to pinpoint that one down.

Alexander M. Djuricich, MD, FACP, is Associate Dean for Continuing Medical Education and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis. This post originally appeared at Mired in MedEd, where he blogs about medical education.