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      Factors influencing decisions about a career in hepatology: A survey of gastroenterology fellows

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          Abstract

          Despite an unmet need for hepatologists in the United States, every year transplant hepatology (TH) fellowship positions remain unfilled. To address this, we investigated factors that influence trainee decisions about pursuing a career in hepatology. We invited current gastroenterology (GI) and TH fellows from all Accreditation Council for Graduate Medical Education‐accredited programs for the academic year 2014‐2015 to participate in an online survey about factors influencing decisions to train in hepatology. The same paper‐based survey was distributed at a nationally recognized GI board review course. The survey was completed by 180 participants of which 91% were current GI or TH fellows and 24% were not aware of the pilot 3‐year combined GI and TH training program. A majority of respondents (57%) reported that a shorter time (3 versus 4 years) to become board certification eligible would influence their decisions to pursue TH. The most common reasons for not pursuing hepatology were less endoscopy time (67%), additional length of training (64%), and lack of financial compensation (44%). Personal satisfaction (66%), management of complex multisystem disease (60%), and long‐term relationships with patients (57%) were the most attractive factors. Sixty‐one percent of participants reported having a mentor, and 94% of those with mentors reported that their mentors influenced their career decisions. Conclusion: We have identified several factors that affect fellows' decision to pursue TH. Shorter training, increased financial compensation, and increased endoscopy time are potentially modifiable factors that may increase the number of trainees seeking careers in hepatology and help alleviate the deficit of hepatologists. ( Hepatology Communications 2017;1:347–353)

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          Most cited references 14

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          Mentoring matters. Mentoring and career preparation in internal medicine residency training.

          Mentoring during the early stages of a career has been associated with high career satisfaction and may guide development of professional expertise. Little is known about mentoring experiences during residency training. Our purpose was to describe mentoring relationships among internal medicine residents, and to examine the relationship between mentoring and perceived career preparation. We designed and administered a mailed survey to all interns and residents enrolled in the five independent Internal Medicine Residency Training Programs affiliated with Harvard Medical School. We examined the development of mentoring relationships during residency training, and measured satisfaction with mentoring and with perceived career preparation. Of the 329 respondents (65% response rate), 93% reported that it is important to have a mentor during residency, but only half identified a current or past mentor. Interns [adjusted odds ratio (AOR) 0.3 (95% confidence interval (CI) 0.2, 0.5)] and underrepresented minority residents [0.3 (0.1, 0.7)] were significantly less likely to establish a mentoring relationship than their peers. Mentored residents were nearly twice as likely to describe excellent career preparation [1.8 (1.1, 3.1)]. Our findings demonstrate the importance of mentoring to medical residents, and identify a relationship between mentoring and perceived career preparation. We also identify a relative lack of mentoring among interns and underrepresented minority residents.
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            Payback time: the associations of debt and income with medical student career choice.

            With impending health care reform in the USA, there is an imperative to increase the number of students choosing primary care (PC) careers. Research is needed to better understand the roles of economic factors in medical student career choice. The objective of this study was to examine the relationships among debt, income and career choice by comparing students planning PC careers with those aspiring to one of the 12 non-PC fields in which median income exceeds US$300 000 ('high-paying non-primary care' [HPNPC]). Surveys (response rate = 81%) were administered to Year 1 students scheduled to graduate between 1996 and 2012, and Year 4 students graduating between 1993 and 2010. Respondents were students at New York Medical College and East Carolina University's Brody School of Medicine. Analyses focused on the 2674 Year 1 respondents choosing a PC (n = 1437, 54%) or HPNPC (n = 1237, 46%) career, and the 2307 Year 4 respondents intending to pursue PC (n = 992, 43%) or HPNPC (n = 1315, 57%). Longitudinal analyses examining changes in career goals during medical school were based on students who completed surveys in both Years 1 and 4. The outcome measures studied were self-reported debt, anticipated income and self-rated value placed on income. Relative to their PC counterparts, students intending to pursue HPNPC careers anticipated an average of US$24 904 (Year 4 students) or US$29 237 (Year 1 students) greater debt, placed a higher importance value on income, and anticipated earning an average of US$58 463 (Year 1 students) and US$89 909 (Year 4 students) more in annual income after graduation. Debt was associated with the value placed on income in the choice of career and the amount of future income anticipated. Students who valued income highly were especially inclined to switch from PC during medical school. The switch away from PC was associated with debt, as well as with a marked increase in anticipated income. Debt and anticipated income are important concerns which may shape future supplies of PC doctors. © Blackwell Publishing Ltd 2012.
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              The Increasing Burden of Imported Chronic Hepatitis B — United States, 1974–2008

              Background Without intervention, up to 25% of individuals chronically infected with hepatitis B virus (HBV) die of late complications, including cirrhosis and liver cancer. The United States, which in 1991 implemented a strategy to eliminate HBV transmission through universal immunization, is a country of low prevalence. Approximately 3,000–5,000 U.S.-acquired cases of chronic hepatitis B have occurred annually since 2001. Many more chronically infected persons migrate to the United States yearly from countries of higher prevalence. Although early identification of chronic HBV infection can reduce the likelihood of transmission and late complications, immigrants are not routinely screened for HBV infection during or after immigration. Methods To estimate the number of imported cases of chronic hepatitis B, we multiplied country-specific prevalence estimates by the yearly number of immigrants from each country during 1974–2008. Results During 1974–2008, 27.9 million immigrants entered the U.S. Sixty-three percent were born in countries of intermediate or high chronic hepatitis B prevalence (range 2%–31%). On average, an estimated 53,800 chronic hepatitis B cases were imported to the U.S. yearly from 2004 through 2008. The Philippines, China, and Vietnam contributed the most imported cases (13.4%, 12.5%, and 11.0%, respectively). Imported cases increased from an estimated low of 105,750 during the period 1974–1977 to a high of 268,800 in 2004–2008. Conclusions Imported chronic hepatitis B cases account for approximately 95% of new U.S. cases. Earlier case identification and management of infected immigrants would strengthen the U.S. strategy to eliminate HBV transmission, and could delay disease progression and prevent some deaths among new Americans.
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                Author and article information

                Contributors
                sarah.m.ordway.mil@mail.mil
                Journal
                Hepatol Commun
                Hepatol Commun
                10.1002/(ISSN)2471-254X
                HEP4
                Hepatology Communications
                John Wiley and Sons Inc. (Hoboken )
                2471-254X
                12 May 2017
                June 2017
                : 1
                : 4 ( doiID: 10.1002/hep4.v1.4 )
                : 347-353
                Affiliations
                [ 1 ] Department of Internal Medicine Walter Reed National Military Medical Center Bethesda MD
                [ 2 ] Division of Gastroenterology/Hepatology, Department of Internal Medicine Walter Reed National Military Medical Center Bethesda MD
                [ 3 ] Medstar Georgetown Transplant Institute Medstar Georgetown University Washington DC
                Author notes
                [* ] ADDRESS CORRESPONDENCE AND REPRINT REQUESTS TO:

                Sarah M. Ordway, M.D.

                Internal Medicine, Building 19, Room 3607

                Walter Reed National Military Medical Center

                8901 Wisconsin Ave

                Bethesda, MD 20889

                E‐mail: sarah.m.ordway.mil@ 123456mail.mil

                Tel.: +1‐301‐295‐0196

                Article
                HEP41040
                10.1002/hep4.1040
                5721393
                © 2017 The Authors. Hepatology Communications published by Wiley Periodicals, Inc., on behalf of the American Association for the Study of Liver Diseases.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                Page count
                Figures: 2, Tables: 4, Pages: 7, Words: 3244
                Product
                Categories
                Special Article
                Special Article
                Custom metadata
                2.0
                hep41040
                June 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.7 mode:remove_FC converted:08.12.2017

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