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To the Editor.—
The article by Englander et al in the September issue of Pediatrics represents a wonderful collaboration between 2 important pediatric organizations dedicated to education: the Association of Pediatric Program Directors and the Council on Medical Student Education in Pediatrics.1 In fact, it was comforting to read that PL-1s were satisfied with the advising they received prior to entering residency. The study begins to address a research gap in an important area that has been neglected: the career-development path from the undergraduate through postgraduate continuum. More attention has been devoted to this topic at the residency level, as evidenced in a recent publication.2 Career satisfaction would be another important variable here.3
The purpose of this letter is to raise a couple of issues about the study design and address the bigger picture of career development, lest we get complacent about the work we need to do.
As the authors pointed out, the study did have some limitations. Not mentioned was how questions used in the survey were assessed for validity, assuming they were established de novo. It would have been appropriate to pilot the questionnaire, using a small sample, to try to establish some validity. Another point for discussion was using PL-1 residents as the cohort. One could argue that surveying residents at the end of their PL-3 year or 3 to 5 years postresidency would perhaps be more reflective of whether their training was appropriate for their career choice.
The survey implies, and perhaps assumes, that faculty were successful in their advising. I am skeptical on this point, because we in the educational community have done very little to train faculty how to be better counselors/advisers. Maybe there are some intuitive cognitive and skills issues that are learned on the job. However, there is a body of literature on coaching, mentoring, and counseling from which we as advisers of students and residents would all benefit. The authors did address this point, and I urge this to be a top priority of these 2 organizations.
I am not aware of any national, systematic ratings of training programs to allow faculty advisers to access this information to help students match their needs with programs’ emphasis. So how do faculty on the East Coast really know West-Coast programs and vice versa? If we had a consistent rating scale, students visiting programs could complete their evaluations on each program and submit them to a central clearinghouse for data entry and analysis. This would be subjective but perhaps better than what we have now, which is minimal at best.
On a positive note, hopefully this study will stimulate leaders in pediatric education to combine resources and efforts to fix a problem that is in need of repair.
REFERENCES
In Reply.—
I appreciate both the comments of Greenberg and the opportunity to respond. Regarding the issue of validity of our survey, I must admit to being unclear on which survey questions Greenberg believes would have been more useful after a "pilot" questionnaire and which conclusions he is considering invalid. The survey was divided into 7 demographic questions, 4 satisfaction questions, and 3 open-ended, qualitatively evaluated questions on aspects of the match process.
The overall survey and its components certainly possessed face validity, as evidenced by the input of a number of "experts" in the field as well as medical students going through the match and residents who recently graduated from medical school. The demographic data should have both excellent validity and reliability, particularly because the survey was anonymous and voluntary. The satisfaction questions are subject to skewness, as are all scale-based satisfaction questions. This, however, does not suggest they are invalid in providing an overall impression of the respondents. The correlation between rank of program matched and satisfaction with both the overall process and its component parts suggests construct validity to the satisfaction questions. Finally, we tried to be mindful of not overinterpreting the qualitative data, given both the response rate of 42% and the inherent bias of a survey of this nature.
Regarding the use of PL-1s rather than PL-3s or residency graduates as our respondents, our intent was to "evaluate the current status of advice and counseling for students going through the match, and to elicit suggestions for improvement." I submit that the best population to evaluate the process is the group who engaged in it most recently. I agree with Greenberg, however, that as a field we need to continue to evaluate our successes and failures as career planners throughout the spectrum of medical education, from undergraduate to continuing medical education.
Finally, the study neither implies nor assumes that faculty advisors were "successful in their advising." Rather, the study suggests that students were satisfied with the advice they received from faculty advisors. Taking comfort in the satisfaction of our respondents in no way obviates the need for improvements in the system. Far from encouraging complacency, our article calls for specific action targeted at the perceived needs of the respondents.
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