Career Plans of Internal Medicine Residents From 2019 to 2021.
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ABSTRACT:
SUBMITTER: Paralkar N
PROVIDER: S-EPMC10463168 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
Publications
Career Plans of Internal Medicine Residents From 2019 to 2021.
Paralkar Neha N LaVine Nancy N Ryan Saoirse S Conigliaro Rosemarie R Ehrlich Jason J Khan Aisha A Block Lauren L
JAMA internal medicine 20231001 10
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Project description:BackgroundInterest in nephrology careers among internal medicine residents in the United States is declining. Our objective was to assess the impact of the presence of a nephrology fellowship training program on perceptions and career interest in nephrology among internal medicine residents. A secondary objective was to identify commonly endorsed negative perceptions of nephrology among internal medicine residents.MethodsThis was a repeated cross-sectional survey of internal medicine residents before (Group 1) and 3 years after (Group 2) the establishment of nephrology fellowship programs at two institutions. The primary outcome was the percentage of residents indicating nephrology as a career interest in Group 1 vs. Group 2. Secondary outcomes included the frequency that residents agreed with negative statements about nephrology.Results131 (80.9%) of 162 residents completed the survey. 19 (14.8%) residents indicated interest in a nephrology career, with 8 (6.3%) indicating nephrology as their first choice. There was no difference in career interest in nephrology between residents who were exposed to nephrology fellows during residency training (Group 2) and residents who were not (Group 1). The most commonly endorsed negative perceptions of nephrology were: nephrology fellows have long hours/burdensome call (36 [28.1%] of residents agreed or strongly agreed), practicing nephrologists must take frequent/difficult call (35 [27.6%] agreed or strongly agreed), and nephrology has few opportunities for procedures (35 [27.3%] agreed or strongly agreed). More residents in Group 2 agreed that nephrology is poorly paid (8.9% in Group 1 vs. 20.8% in Group 2, P = 0.04), whereas more residents in Group 1 agreed that nephrologists must take frequent/difficult call (40.0% in Group 1 vs. 18.1% in Group 2, P = 0.02).ConclusionsThe initiation of a nephrology fellowship program was not associated with an increase in internal medicine residents' interest in nephrology careers. Residents endorsed several negative perceptions of nephrology, which may affect career choice.
| S-EPMC5313227 | biostudies-literature
Project description:BackgroundInternal medicine residents face numerous career options after residency training. Little is known about when residents make their final career choice.ObjectiveWe assessed the timing and predictive factors of final career choices among internal medicine residents at graduation, including demographics, pre-residency career preferences, and rotation scheduling.MethodsWe conducted a retrospective study of graduates of an academic internal medicine residency program from 2014 to 2017. Main measures included demographics, rotation schedules, and self-reported career choices for residents at 5 time points: recruitment day, immediately after Match Day, end of postgraduate year 1 (PGY-1), end of PGY-2, and at graduation.ResultsOf the 138 residents eligible for the study, 5 were excluded based on participation in a fast-track program for an Accreditation Council for Graduate Medical Education subspecialty fellowship. Among the remaining 133 residents, 48 (36%) pursued general internal medicine fields and 78 (59%) pursued fellowship training. Career choices from recruitment day, Match Day, and PGY-1 were only weakly predictive of the career choice. Many choices demonstrated low concordance throughout training, and general medicine fields (primary care, hospital medicine) were frequently not decided until after PGY-2. Early clinical exposure to subspecialty rotations did not predict final career choice.ConclusionsEarly career choices before and during residency training may have low predictability toward final career choices upon graduation in internal medicine. These choices may continue to have low predictability beyond PGY-2 for many specialties. Early clinical exposure may not predict final career choice for subspecialties.
| S-EPMC7161324 | biostudies-literature
Project description:BackgroundResidents graduate from medical school with increasing levels of debt and also may possess poor financial knowledge and practices. Prior studies have assessed resident financial knowledge and interest in financial education, yet additional information regarding their attitudes about personal finance and financial planning could be essential for the development of relevant curricula.ObjectiveWe assessed baseline financial attitudes and planning behaviors of internal medicine and internal medicine-pediatrics residents in 3 geographically diverse academic programs.MethodsA modified version of the Financial Industry Regulatory Authority National Financial Capability survey was administered anonymously to residents in 3 programs in spring 2017. Outcomes included levels of educational debt, positive financial planning behaviors, perception of finances and debt, and education about personal finance.ResultsResponse rate was 62% (184 of 298). Rates of educational debt were high, with 81% (149 of 184) of respondents reporting educational debt, and the majority owing more than $100,000. Residents' financial practices were variable, and residents could be grouped into 1 of 3 categories-concerned-engaged, concerned-unengaged, and unconcerned-unengaged-based on their engagement with debt and financial management. Residents with high debt (> $250,000) had a bimodal distribution of respondents who strongly agreed and those who strongly disagreed they were concerned about debt.ConclusionsResident financial attitudes and practices are variable, ranging from highly engaged residents actively managing their financial wellness to unengaged residents who have low concern, despite high educational debt.
| S-EPMC6314372 | biostudies-literature
Project description:BackgroundIn some Western countries, the medical profession is continuously losing prestige, doctors are claiming of high demands, low rewards, and difficult structural working conditions. This study aimed to investigate the arguments given by Swiss residents for and against a career in medicine.MethodsAs part of a prospective cohort study of Swiss medical school graduates on career development, 567 fourth-year residents were asked to answer the free-response item of what arguments there still were in favour of or against a career in medicine. They also indicated whether they would choose the medical profession all over again (yes/no). The statements were transcribed, content categories inductively formulated, and their descriptions written down in a code manual. Arguments were encoded according to the code manual and assigned to eight content categories (Mayring's content analysis). Frequency distributions were given for categories and tested with Chi2-tests for differences in gender, speciality fields, and whether or not the respondent would again choose a career in medicine.ResultsThe 567 participants made 1,640 statements in favour of and 1,703 statements against a career in medicine. The content analysis of the residents' answers yielded eight categories with arguments both for and against a career in medicine. Of all "statements for" responses, 70% fell into the two top-ranking categories of Personal experiences in day-to-day working life (41.2%) and Interpersonal experiences in professional relationships (28.8%). The top-ranking category of the "statements against" arguments was General work-related structural conditions (32%), followed by Social prestige and health-policy aspects (21%). Main arguments in favour of a career in medicine were interdisciplinary challenge, combination of basic sciences and interpersonal concerns, helping suffering people, guarantee of a secure job; arguments against comprised high workload, time pressure, emotional stress, poorly structured continuing education, increasing bureaucracy, work-life imbalance, low income, and decreasing social prestige. The statements revealed few differences depending on gender, medical field, and attitude towards choosing the medical profession again; one out of five young doctors would not do so.ConclusionResidents' chief complaint is deteriorating structural working conditions, including unfavourable work-life balance. Making medicine an attractive profession again will require sustainable changes in health-policy framework and social reward.
| S-EPMC1564007 | biostudies-literature
Project description:BackgroundUnderstanding factors in internal medicine (IM) resident career choice may reveal important needed interventions for recruitment and diversity in IM primary care and its subspecialties. Self-reported learner confidence is higher in men than in women in certain areas of practicing medicine, but has never been explored as a factor in career choice.ObjectiveThe purpose of this study is to elucidate associations between confidence, gender, and career choice.DesignIM residents completed a 31-item survey rating confidence in procedural, clinical, and communication skills on a 9-point Likert scale. Residents also reported anticipated career choice and rated influence of factors. Associations between gender and confidence scale scores, gender and career choice, and confidence and career choice were analyzed using t tests, ANOVA, and multiple linear regression controlled for postgraduate year (PGY), institution, and specialty choice.Participants292 IM residents at Northwestern and University of Texas (UT) Southwestern MAIN MEASURES: Resident gender, self-reported confidence, career choice KEY RESULTS: Response rate was 79.6% (n = 292), of them 50.3% women. Overall self-reported confidence increased with training (PGY-1 4.9 (1.1); PGY-2 6.2 (1.0); PGY-3 7.4 (1.0); p < 0.001). Men had higher confidence than women (men 6.6 (1.5); women 6.3 (1.4), p = 0.06), with the greatest difference in procedures. High confidence in men was associated with choice of procedural careers, whereas there was no association between confidence and career in women.ConclusionsThis is the first study demonstrating a gender difference in self-reported confidence and career choice. There is a positive correlation in men: higher self-reported confidence with procedural specialties, lower with general internal medicine. Women's self-reported confidence had no association. Further investigation is needed to elucidate causative factors for differences in self-reported confidence by gender, and whether alterations in level of self-reported confidence produce a downstream effect on career choice.
| S-EPMC7947144 | biostudies-literature
Project description:BackgroundMany residents experience burnout, prompting national attention to well-being; however, well-being is not merely the absence of burnout. A recently developed measure of flourishing may provide insight on this important topic.ObjectiveWe investigated flourishing in a sample of medical residents.MethodsInternal medicine residents and psychiatry residents at 2 residency programs responded to a cross-sectional online survey (December 2017-February 2018), which focused on the Flourish Index (FI) and Secure Flourish Index (SFI). Both measures generate scores ranging from a low of 0 to a high of 10. Participants were queried about quality of life, burnout, work-life balance, empathic concern, and sociodemographic characteristics. Simple and multiple linear regressions were performed to examine the relationship between FI/SFI and other variables.ResultsThe response rate was 92% (92 of 101). Participants were found to have a mean FI score of 6.8 (SD = 1.6) and mean SFI score of 6.9 (SD = 1.6). Low quality of life, low work-life balance satisfaction, high emotional exhaustion, lower empathic concern, and having a pet were all significantly associated with lower FI scores (R2 = 0.59; F[14, 69] = 7.10; P < .0001), indicating lesser flourishing, controlling for other variables. Similarly, low quality of life, high emotional exhaustion, lower empathic concern, and having a pet were all significantly associated with lower SFI scores (R2 = 0.55; F[14, 69] = 6.06; P < .0001), controlling for other variables.ConclusionsIn this sample, the flourishing indices were associated with well-being and burnout metrics.
| S-EPMC7301920 | biostudies-literature
Project description:Background: Focused cardiac ultrasound (FCU) is a safe and efficient diagnostic intervention for internal medicine physicians. FCU is a highly teachable skill, but is used in routine cardiac assessment in only 20% of surveyed training programs.We developed an FCU curriculum for internal medicine residents and an assessment tool to evaluate the impact of the curriculum on trainee knowledge and confidence. Methods: Internal medicine residents rotating through clinical cardiology services underwent 30 minutes of didactic and 60 minutes of hands-on teaching on acquisition and interpretation of FCU. A 20 item pre and post-curriculum online survey was administered (November 2018-December 2019) to assess confidence and knowledge in FCU. Results: 79 of 116 (68%) residents completed the pre-survey and 50 completed the post-survey, of whom 34 received the curriculum. The mean change in confidence score in those who received versus did not receive the curriculum was 0.99 versus 0.39 (p=0.046) on a 5-point Likert scale. Among 33 residents who had paired pre- and post-surveys the mean change in confidence score was 1.2 versus 0.85 (p<0.001) in those who received versus did not receive the curriculum. The mean increase in knowledge score was 13% versus 7% respectively (p<0.0001). Conclusions: We instituted a novel curriculum for internal medicine residents to gain experience in image acquisition and interpretation. Both confidence and knowledge in FCU improved following the curriculum, indicating that this is a highly teachable skill. Additional analysis of the of the FCU study images will be useful for informing future interventions.
| S-EPMC9979930 | biostudies-literature
Project description:ImportanceFew data exist on internal medicine trainees' selection of cardiology training, although this is important for meeting future cardiology workforce needs.ObjectiveTo discover trainees' professional development preferences and perceptions of cardiology, and their relationship to trainees' career choice.Design, setting, and participantsWe surveyed trainees to discover their professional development preferences and perceptions of cardiology and the influence of those perceptions and preferences on the trainees' career choices. Participants rated 38 professional development needs and 19 perceptions of cardiology. Data collection took place from February 2009, through January 2010. Data analysis was conducted from May 2017 to December 2017.Main outcomes and measuresMultivariable models were used to determine the association of demographics and survey responses with prospective career choice.ResultsA total of 4850 trainees were contacted, and 1123 trainees (of whom 625 [55.7%] were men) in 198 residency programs completed surveys (23.1% response; mean [SD] age, 29.4 [3.5] years). Principal component analysis of survey responses resulted in 8-factor and 6-factor models. Professional development preferences in descending order of significance were stable hours, family friendliness, female friendliness, the availability of positive role models, financial benefits, professional challenges, patient focus, and the opportunity to have a stimulating career. The top perceptions of cardiology in descending order of significance were adverse job conditions, interference with family life, and a lack of diversity. Women and future noncardiologists valued work-life balance more highly and had more negative perceptions of cardiology than men or future cardiologists, who emphasized the professional advantages available in cardiology. Professional development factors and cardiology perceptions were strongly associated with a decision to pursue or avoid a career in cardiology in both men and women.Conclusions and relevanceAlignment of cardiology culture with trainees' preferences and perceptions may assist efforts to ensure the continued attractiveness of cardiology careers and increase the diversity of the cardiology workforce.
| S-EPMC6143073 | biostudies-literature
Project description:BACKGROUND: Increasing complexity of medical care, coupled with limits on resident work hours, has prompted consideration of extending Internal Medicine training. It is unclear whether further hour reductions and extension of training beyond the current duration of 3 years would be accepted by trainees. OBJECTIVE: We aimed to determine if further work-hour reductions and extension of training would be accepted by trainees and whether resident burnout affects their opinions. DESIGN: A postal survey was sent to all 143 Internal Medicine residents at the University of Colorado School of Medicine in May 2004. MEASUREMENTS: The survey contained questions related to opinions on work-hour limits using a 5-point Likert scale ranging from strongly agree to strongly disagree. Burnout was measured using the Maslach Burnout Inventory, organized into three subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment, with burnout defined as high EE or DP. RESULTS: Seventy-four percent (106/143) of residents returned the survey. The vast majority (84%) of residents disagreed or strongly disagreed with extending training to 4 or 5 years. Burnout residents were less averse to extending training (strongly agree or agree, 18.9% vs 4.3%, P = .04). The majority of residents (68.9%) disagreed or strongly disagreed with establishing a 60-hour/week limit. Residents who met the criteria for burnout were more likely to agree that a 60-hour limit would be better than an 80-hour limit (strongly agree or agree, 22% vs 8%, P = .02). CONCLUSIONS: In this program, most Internal Medicine residents are strongly opposed to extending their training to 4 or 5 years and would prefer the current 80 hours/week cap. A longer, less intense pace of Internal Medicine training seems to be less attractive in the eyes of current trainees.
| S-EPMC1824782 | biostudies-other
Project description:BackgroundLittle is known about factors contributing to the career decisions of internal medicine residents.ObjectiveTo evaluate factors self-reported by internal medicine residents nationally as important to their career decisions.DesignCross-sectional survey conducted in October of 2005, 2006, and 2007 as part of the national Internal Medicine In-Training Examination (IM-ITE).ParticipantsPostgraduate year 3 internal medicine residents taking the IM-ITE.MeasurementsResidents rated the importance of nine factors in their career decisions on 5-point Likert scales. Univariate statistics characterized the distribution of responses. Associations between variables were evaluated using Cochran-Mantel-Haenszel statistics for ordinal data. Multivariate analyses were conducted using logistic regression.ResultsOf 17,044 eligible residents taking the IM-ITE, 14,890 (87.4%) completed the career decision survey questions. Overall, time with family was the factor most commonly reported as of high or very high importance to career decisions (69.6%). Women were more likely to assign greatest importance to family time (OR 1.22, 95% confidence interval 1.12-1.31, p < 0.001) and long-term patient relationships (OR 1.34, 95% confidence interval 1.23-1.46, p < 0.001). Across debt levels, financial considerations were of greatest importance more often for residents owing >$150,000 (OR 1.33, 95% confidence interval 1.09-1.62, p < 0.001). Across specialties, mentor specialty was rated lowest in importance by residents pursuing hospitalist and general internal medicine careers.ConclusionsGreater attention to factors reported by residents as important to their career decisions may assist efforts to optimize the distribution of physicians across disciplines. In addition to lifestyle and practice considerations, these factors may include mentor specialty. As this factor is less commonly reported as important by residents planning careers in generalist fields, attention to effective mentoring may be an important element of efforts to increase interest in these areas.
| S-EPMC2710478 | biostudies-literature