CONCEPTS
academic emergency medicine
Fctors Influencing Resident CareerChoices in Emergency Medicine I
From the Societyfor Academic Emergency Medicine, Lansing, Michigan.
Arthur B Sanders, MD, FACEP John V Fulginiti, MA Donald B Witzke, PhD
Receivedfor publication April 9, 1991. Revision receivedJuly 22, 1991. Acceptedfor publication August 25, 1991.
Objective: To assess the attitudes of residents in emergency medicine regarding a career in academics. Design: A 22-item questionnaire was administered to residents in conjunction with the yearly American Board of Emergency Medicine inservice examination. Demographic information and factors influencing career intent were elicited. Respondents were classified by intent on a career in emergency medicine. A three-way analysis of variance was used to address group differences for eight specific factors impacting on career decision. Chi-square analysis was used to address questions involving relationships among variables with dichotomous or categorical responses. Results: The survey was distributed to 1,654 residents, and 1,238 (75%) completed the questionnaire. Motivating factors demonstrating significant differences between those residents planning an academic career and those not interested in academe were a desire to do research, desire to teach, desire to make a contribution to medicine, and exposure to role models, with less emphasis on the need for free time for other interests and less concern regarding practice location. More than 80% of those not going into academic emergency medicine believed they were adequately exposed to research in residency compared with 65% of those intent on a career in academe (P< .01). Research in medical school, residency, and authorship of a research paper were significantly more prevalent for those residents desiring a career in academe (P< .01 ). Twenty-six percent of residents responded that their role models for research were less than adequate. Seventeen percent of residents intend to take fellowship training. The most popular fields for fellowships were toxicology (25%), emergency medical services (21%), pediatrics (15%), and research (9%). Conclusion: The results of this survey address attitudes among
residents toward a career in academic emergency medicine. Factors such as motivation, role models, and exposure to research may help academicians plan strategies to meet the future needs of academic emergency medicine. [Sanders AB, Fulginiti JV, Witzke DB: Factors influencing resident career choices in emergency medicine. Ann Emerg Med January 1992;21:47-52.]
JANUARY1992 21:1 ANNALS OF EMERGENCY MEDJCINE
47/59 l
RESIDENT CAREER CHOICES
Sanders, Fulginiti & Witzke
INTRODUCTION Little is known about factors that influence decisions of residents toward a career in academic medicine. Recent surveys in the radiology literature have indicated that exposure to a research environment during residency training may be an important factor in influencing radiology residents toward a career in academe. 1-3 There is presently a shortage of board-certified emergency physicians in the United States. ¢ This manpower shortage is projected to continue for at least another decade despite a steady increase in the number of residency training programs in emergency medicine. The growth of emergency medicine and need for additional training programs has produced a shortage of wellqualified faculty for academic positions in emergency medicine. ¢-7 Tile Society for Academic Emergency Medicine (SAEM) undertook a survey to assess the attitudes of residents in emergency medicine regarding their career choices. The survey attempted to determine characteristics that correlate with the choices of a career in emergency medicine.
M A T E R I A L S AND M E T H O D S A 22-item questionnaire developed by SAEM was administered by the residency directors in emergency medicine. The survey was timed to coordinate with the American Board of Emergency Medicine's (ABEM) in-service examination, which all residents complete. The help of residency directors was solicited through direct contact by SAEM. ABEM cooperated with the mailing and coordination of the survey. However, it was made clear to the residents and residency directors that the smvey was optional and independent from the ABEM in-service examination. The questionnaire contained 19 checklist-type items soliciting residents' attitudes toward a career in academic emergency medicine. Residents were asked to rate on a scale of I (unimportant) to 5 (very important) factors influencing their career decisions. In additionl factors such as exposure to academics (research and teaching) during medical school and residency and role models were specifically elicited. The questionnaire also included three demographic items addressing the postgraduate year status, type of residency training program, and SAEM involvement of the respondent. The questionnaire was anonymous and required approximately five minutes to complete. Questionnaires were collected and sent to SAEM by the residency program.
~0/48
The initial item on the questionnaire asked, "Do you plan a career in academic emergency medicine?" Respondents indicated on a five-point scale (no, probably not, maybe, probably yes, yes) whether they planned a career in academic emergency medicine. Based on their response, subjects were classified into three groups. Those residents responding "no" or "probably not" comprised the group '!not interested in a career in academic emergency medicine." Those responding "maybe" were classed as the "undecided" group, and those who indicated "yes" or "probably yes" were included in the group "interested in a career in academic emergency medicine." A three-way analysis of variance was used to address group differences for eight specific ~ontinuous variables impacting career decision (financial compensation, location, role models, mobility, desire to do research, desire to te/~ch, desire to contribute to medicine, and free time for other pursuits). Respondents were classified by intent on a career in emergency medicine, postgraduate year level, and type of residency program (university based, university-affiliated community hospital, or nonuniversity). Chi-square analysis (contingency tables) was used to address questions involving relationships among variables with dichotomous or categorical responses (exposure to research, author of an original paper, postgraduate year status). Two items on the questionnaire pertained to role models for teaching and research. A repeated measures analysis of variance was used to relate mentorship hypotheses to career intent. Due to the potential for chance significant effects because of the relatively large nmnber of dependent variables and large sample size, a more stringent significance level o f P < .01 was selected. The Student-Ncwman-Keuls procedure to test the significance of pairs of means was used when a significant higher order effect was obtained. Data were entered in a spreadsheet and statistical analysis performed using the SPSS/PC program.
RESULTS The survey was distributed to 1,654 residents, and 1,238 (75%) anonymously completed the questionnaire. Thirty-five percent of respondents (434) said they probably or definitely planned a career in academic emergency medicine. Forty percent (491) were uncertain, and 24% (293) did not or probably did not want a career in academe. Factors influencing a career decision included financial cornpensation, location, role models, mobility, desire to do
ANNALS OF EMERGENCY MEDICfNE 21:1 JANUARY1992
RESIDENT
CAREER CHOICES
Sanders, Fulginiti & Witzke
research, desire to teach, contribution to medicine, and free time to pursue other interests. Differences in the three groups of career intent are shown (Table). Motivating factors demonstrating significant differences between those residents planning an academic career and those not interested in academics were desire to do research, desire to teach, desire to make a contribution to medicine, exposure to role models, the need for free time for other interests and location. Mobility was the only factor that showed a significant difference by postgraduate year level or type of residency program. Seventy-one percent of the subjects (821) said they had been adequately exposed to research during residency training, while 29% (333) did not believe they had adequate research exposure. Answers to this question varied significantly by career intent (Figure 1). Only 65% of residents interested in an academic career said they were adequately exposed to research compared with 80% of residents choosing a clinical career (P < .0001). Sixty-four percent of respondents (768) said they had been adequately taught teaching skills, while 36% (424) believed that they were not adequately taught teaching skills. Forty-one percent of residents (495) had done research in medical school. Research in medical school was significantly more prevalent for those residents desiring a career in academe compared with
those preferring a clinical career (Figure 2). Forty-six percent of those planning to go !ntq academe had done research in medical school compared with 35.5% of residents interested in clinical practice (P < .007). Those residents planning a career in academic emergency medicine have done research (58.7%, 428) or plan to do research (92.1%, 411) in residency, significantly more than those residents planning a clinical career (Figures 3 and 4). Forty percent of respondents planning an academic career (429) have authored an original research paper, compared • Figure 1. 6O.2,%;
284
Residents interested in an academic
71.0%;
career (yes AEM) reported significantly less adequate exposure to research during residency compared with undecided residents (maybe AEM) or those not interested in academe (not AEM).
Figure 2. 9O 80 70
Table. Factors influencing career deci.~ionz
Interested in Academic Emergency Medicine (Group A)
Not Interested in Academic EmerUncertain gency Medicine (Group B) (Group C)
Significance
Desire to do research
3.02*
2.43
1.90
P < .6001 (A vs B + C)
Desire to teach
4.27
3.70
2.89
P < .001
Contribution to medicine
3.90
3.55
3.15
P < .OOl (A vs B + C)
Role models
3.76
3.52
3.20
P < .6001
Residents doing research in medical school are sign~cantly more likely to desire a career in academe (yes AEM)
6o #-5o ~40 3O 2o
46.2%;
academic career (not AEM).
10
0
Not AEM
(A vs B + C)
Maybe Yes AEM AEM Career Group P < .007
Figure 3.
(A vs B + C) Free time for other
3.99
4.16
4.22
interests Mobility
3.45
3.40
3.62
(Junior residents)
P < .01 (6roup C,
Mobility
3.37
3.33
3.10
(Senior residents)
junior vs senior)
Location
4.02
4.29
4.28
P < .0OOl
Financial
3.27
3.55
3.40
P < .0001
(A vs B + C) compensation *Mean scores
Residents who have done research daring
P < .004 (A vs C)
{8 vs A+C)
compared with thoae not interested in an
residency are siga~cantly more likely to
7O 6O
58.7%;
compared with those not interested in an
~6O ~40 30 20 10 O
desire a career in academe (yes AEM) academic career (not AEM).
Not AEM
Maybe Yes AEM AEM Career Group P < .0001
1, unimportant; 5, very important.
JANUARY 1992
21:1
ANNALS OF EMERGENCY MEDICINE
49/01
I
RESIDENT
CAREER
Sanders, Fulginiti
CHOICES
& Wit.&
with 29.3% of residents not interested in academe (P < .OOZ, Figure 5). Authorship of a nonresearch paper such as case report or review article was not correlated with intent on an academic career (Figure 6). Residents were asked to rate their role models for teaching and research in emergency medicine on a scale of 1 to 5 (1, poor; 3, adequate; 5 excellent). While role models for teaching were generally regarded as good to excellent (35% reported excellent and 1% poor), the role models for research have been less exemplary. Twenty-six percent of residents responded that their role models were poor or less than adequate for research (Figure 7).
Figure 4.
1W 90 80 70 60
Residents who plan to do research in residency are sign$icantly
more likely to
desire a career in academe (yes AEM) compared with those not interested in an
8 >50 SW
academic career (not AEM).
30 20 10 0
Not AEM
TEV+$
Yes AEM
Attitudes of emergency medicine residents regarding an academic career are not well known. Data from this survey representing 75% of residents in emergency medicine help to characterize their attitudes regarding career choices. It appears that a substantial proportion of residents (35%) would like a career in academic emergency medicine. Even if all of the nonresponders were not interested in academe, 26% of residents responded that they were probably or definitely interested in a career in academics. Historically, a much smaller proportion of residents actually go into academe each year. Our study did not track how many of these residents actually chose academic ) Figure 7.
P
academic emergency medicine
Fctors Influencing Resident CareerChoices in Emergency Medicine I
From the Societyfor Academic Emergency Medicine, Lansing, Michigan.
Arthur B Sanders, MD, FACEP John V Fulginiti, MA Donald B Witzke, PhD
Receivedfor publication April 9, 1991. Revision receivedJuly 22, 1991. Acceptedfor publication August 25, 1991.
Objective: To assess the attitudes of residents in emergency medicine regarding a career in academics. Design: A 22-item questionnaire was administered to residents in conjunction with the yearly American Board of Emergency Medicine inservice examination. Demographic information and factors influencing career intent were elicited. Respondents were classified by intent on a career in emergency medicine. A three-way analysis of variance was used to address group differences for eight specific factors impacting on career decision. Chi-square analysis was used to address questions involving relationships among variables with dichotomous or categorical responses. Results: The survey was distributed to 1,654 residents, and 1,238 (75%) completed the questionnaire. Motivating factors demonstrating significant differences between those residents planning an academic career and those not interested in academe were a desire to do research, desire to teach, desire to make a contribution to medicine, and exposure to role models, with less emphasis on the need for free time for other interests and less concern regarding practice location. More than 80% of those not going into academic emergency medicine believed they were adequately exposed to research in residency compared with 65% of those intent on a career in academe (P< .01). Research in medical school, residency, and authorship of a research paper were significantly more prevalent for those residents desiring a career in academe (P< .01 ). Twenty-six percent of residents responded that their role models for research were less than adequate. Seventeen percent of residents intend to take fellowship training. The most popular fields for fellowships were toxicology (25%), emergency medical services (21%), pediatrics (15%), and research (9%). Conclusion: The results of this survey address attitudes among
residents toward a career in academic emergency medicine. Factors such as motivation, role models, and exposure to research may help academicians plan strategies to meet the future needs of academic emergency medicine. [Sanders AB, Fulginiti JV, Witzke DB: Factors influencing resident career choices in emergency medicine. Ann Emerg Med January 1992;21:47-52.]
JANUARY1992 21:1 ANNALS OF EMERGENCY MEDJCINE
47/59 l
RESIDENT CAREER CHOICES
Sanders, Fulginiti & Witzke
INTRODUCTION Little is known about factors that influence decisions of residents toward a career in academic medicine. Recent surveys in the radiology literature have indicated that exposure to a research environment during residency training may be an important factor in influencing radiology residents toward a career in academe. 1-3 There is presently a shortage of board-certified emergency physicians in the United States. ¢ This manpower shortage is projected to continue for at least another decade despite a steady increase in the number of residency training programs in emergency medicine. The growth of emergency medicine and need for additional training programs has produced a shortage of wellqualified faculty for academic positions in emergency medicine. ¢-7 Tile Society for Academic Emergency Medicine (SAEM) undertook a survey to assess the attitudes of residents in emergency medicine regarding their career choices. The survey attempted to determine characteristics that correlate with the choices of a career in emergency medicine.
M A T E R I A L S AND M E T H O D S A 22-item questionnaire developed by SAEM was administered by the residency directors in emergency medicine. The survey was timed to coordinate with the American Board of Emergency Medicine's (ABEM) in-service examination, which all residents complete. The help of residency directors was solicited through direct contact by SAEM. ABEM cooperated with the mailing and coordination of the survey. However, it was made clear to the residents and residency directors that the smvey was optional and independent from the ABEM in-service examination. The questionnaire contained 19 checklist-type items soliciting residents' attitudes toward a career in academic emergency medicine. Residents were asked to rate on a scale of I (unimportant) to 5 (very important) factors influencing their career decisions. In additionl factors such as exposure to academics (research and teaching) during medical school and residency and role models were specifically elicited. The questionnaire also included three demographic items addressing the postgraduate year status, type of residency training program, and SAEM involvement of the respondent. The questionnaire was anonymous and required approximately five minutes to complete. Questionnaires were collected and sent to SAEM by the residency program.
~0/48
The initial item on the questionnaire asked, "Do you plan a career in academic emergency medicine?" Respondents indicated on a five-point scale (no, probably not, maybe, probably yes, yes) whether they planned a career in academic emergency medicine. Based on their response, subjects were classified into three groups. Those residents responding "no" or "probably not" comprised the group '!not interested in a career in academic emergency medicine." Those responding "maybe" were classed as the "undecided" group, and those who indicated "yes" or "probably yes" were included in the group "interested in a career in academic emergency medicine." A three-way analysis of variance was used to address group differences for eight specific ~ontinuous variables impacting career decision (financial compensation, location, role models, mobility, desire to do research, desire to te/~ch, desire to contribute to medicine, and free time for other pursuits). Respondents were classified by intent on a career in emergency medicine, postgraduate year level, and type of residency program (university based, university-affiliated community hospital, or nonuniversity). Chi-square analysis (contingency tables) was used to address questions involving relationships among variables with dichotomous or categorical responses (exposure to research, author of an original paper, postgraduate year status). Two items on the questionnaire pertained to role models for teaching and research. A repeated measures analysis of variance was used to relate mentorship hypotheses to career intent. Due to the potential for chance significant effects because of the relatively large nmnber of dependent variables and large sample size, a more stringent significance level o f P < .01 was selected. The Student-Ncwman-Keuls procedure to test the significance of pairs of means was used when a significant higher order effect was obtained. Data were entered in a spreadsheet and statistical analysis performed using the SPSS/PC program.
RESULTS The survey was distributed to 1,654 residents, and 1,238 (75%) anonymously completed the questionnaire. Thirty-five percent of respondents (434) said they probably or definitely planned a career in academic emergency medicine. Forty percent (491) were uncertain, and 24% (293) did not or probably did not want a career in academe. Factors influencing a career decision included financial cornpensation, location, role models, mobility, desire to do
ANNALS OF EMERGENCY MEDICfNE 21:1 JANUARY1992
RESIDENT
CAREER CHOICES
Sanders, Fulginiti & Witzke
research, desire to teach, contribution to medicine, and free time to pursue other interests. Differences in the three groups of career intent are shown (Table). Motivating factors demonstrating significant differences between those residents planning an academic career and those not interested in academics were desire to do research, desire to teach, desire to make a contribution to medicine, exposure to role models, the need for free time for other interests and location. Mobility was the only factor that showed a significant difference by postgraduate year level or type of residency program. Seventy-one percent of the subjects (821) said they had been adequately exposed to research during residency training, while 29% (333) did not believe they had adequate research exposure. Answers to this question varied significantly by career intent (Figure 1). Only 65% of residents interested in an academic career said they were adequately exposed to research compared with 80% of residents choosing a clinical career (P < .0001). Sixty-four percent of respondents (768) said they had been adequately taught teaching skills, while 36% (424) believed that they were not adequately taught teaching skills. Forty-one percent of residents (495) had done research in medical school. Research in medical school was significantly more prevalent for those residents desiring a career in academe compared with
those preferring a clinical career (Figure 2). Forty-six percent of those planning to go !ntq academe had done research in medical school compared with 35.5% of residents interested in clinical practice (P < .007). Those residents planning a career in academic emergency medicine have done research (58.7%, 428) or plan to do research (92.1%, 411) in residency, significantly more than those residents planning a clinical career (Figures 3 and 4). Forty percent of respondents planning an academic career (429) have authored an original research paper, compared • Figure 1. 6O.2,%;
284
Residents interested in an academic
71.0%;
career (yes AEM) reported significantly less adequate exposure to research during residency compared with undecided residents (maybe AEM) or those not interested in academe (not AEM).
Figure 2. 9O 80 70
Table. Factors influencing career deci.~ionz
Interested in Academic Emergency Medicine (Group A)
Not Interested in Academic EmerUncertain gency Medicine (Group B) (Group C)
Significance
Desire to do research
3.02*
2.43
1.90
P < .6001 (A vs B + C)
Desire to teach
4.27
3.70
2.89
P < .001
Contribution to medicine
3.90
3.55
3.15
P < .OOl (A vs B + C)
Role models
3.76
3.52
3.20
P < .6001
Residents doing research in medical school are sign~cantly more likely to desire a career in academe (yes AEM)
6o #-5o ~40 3O 2o
46.2%;
academic career (not AEM).
10
0
Not AEM
(A vs B + C)
Maybe Yes AEM AEM Career Group P < .007
Figure 3.
(A vs B + C) Free time for other
3.99
4.16
4.22
interests Mobility
3.45
3.40
3.62
(Junior residents)
P < .01 (6roup C,
Mobility
3.37
3.33
3.10
(Senior residents)
junior vs senior)
Location
4.02
4.29
4.28
P < .0OOl
Financial
3.27
3.55
3.40
P < .0001
(A vs B + C) compensation *Mean scores
Residents who have done research daring
P < .004 (A vs C)
{8 vs A+C)
compared with thoae not interested in an
residency are siga~cantly more likely to
7O 6O
58.7%;
compared with those not interested in an
~6O ~40 30 20 10 O
desire a career in academe (yes AEM) academic career (not AEM).
Not AEM
Maybe Yes AEM AEM Career Group P < .0001
1, unimportant; 5, very important.
JANUARY 1992
21:1
ANNALS OF EMERGENCY MEDICINE
49/01
I
RESIDENT
CAREER
Sanders, Fulginiti
CHOICES
& Wit.&
with 29.3% of residents not interested in academe (P < .OOZ, Figure 5). Authorship of a nonresearch paper such as case report or review article was not correlated with intent on an academic career (Figure 6). Residents were asked to rate their role models for teaching and research in emergency medicine on a scale of 1 to 5 (1, poor; 3, adequate; 5 excellent). While role models for teaching were generally regarded as good to excellent (35% reported excellent and 1% poor), the role models for research have been less exemplary. Twenty-six percent of residents responded that their role models were poor or less than adequate for research (Figure 7).
Figure 4.
1W 90 80 70 60
Residents who plan to do research in residency are sign$icantly
more likely to
desire a career in academe (yes AEM) compared with those not interested in an
8 >50 SW
academic career (not AEM).
30 20 10 0
Not AEM
TEV+$
Yes AEM
Attitudes of emergency medicine residents regarding an academic career are not well known. Data from this survey representing 75% of residents in emergency medicine help to characterize their attitudes regarding career choices. It appears that a substantial proportion of residents (35%) would like a career in academic emergency medicine. Even if all of the nonresponders were not interested in academe, 26% of residents responded that they were probably or definitely interested in a career in academics. Historically, a much smaller proportion of residents actually go into academe each year. Our study did not track how many of these residents actually chose academic ) Figure 7.
P
