General Pediatrics Resident Perspectives on Training Decisions and Career Choice

Abstract

OBJECTIVE. Little is known regarding at what point during the training period residents in pediatrics make decisions on their future career choices. As part of a dedicated process of reexamining the structure of residency training in pediatrics, the American Board of Pediatrics sought information to better understand the influences, process, and sequencing of both residency program selection and career decision-making among residents.METHODS. All pediatrics resident physicians in all training programs in the United States and Canada (N ϭ 8290) received the survey as part of the general pediatrics in-training examination. The survey focused on exploring how and when pediatrics residents make career choices and assessed perceived flexibility of their individual pediatrics residency program.RESULTS. The response rate was 95%. Location was the most important factor in selecting a residency program for 42% of all residents. Almost half of the pediatrics residents planned to pursue fellowship training after residency, a proportion that changed little across the 3 training years (level 1: 47%; level 2: 49%; level 3: 47%). Those who planned to pursue a general pediatrics career (either with or without inpatient care) were more likely than those who intended to pursue fellowship training to report that lifestyle was the most important factor in their career choice (63% vs 21%).CONCLUSIONS. Not surprisingly, different priorities motivate pediatricians to pursue specific programs for training and specific career options. The finding that those with the highest priority regarding lifestyle are more likely to pursue generalist training has implications for the generalist workforce, because those persons may also be more likely to seek part-time employment. Lifestyle concerns may need to be addressed in subspecialty training and subsequent subspecialty careers to ensure a continued flow of residents into fellowship training. Pediatrics 2009;123:S26-S30 T HE DECISION-MAKING PROCESS of residents regarding their future career paths is believed to be associated with a variety of factors. Little is known regarding at what point during the training period residents in pediatrics make decisions on their future career choices. Previous studies have attempted to examine potential predictors during medical school through residency. [1][2][3] It is likely that there are particular subgroups of residents for whom specific influences and experiences have greater influence than others.It is also unknown whether residents choose specific training programs because of their perceived flexibility, whether they desire additional flexibility in their training experiences, and whether such flexibility would have an affect on career choice and the decision to pursue subspecialty fellowship training.Residency training, with respect to duty hours, has changed considerably with the advent of the 80-hour workweek requirements. However, the fundamental structure of pediatrics programs, their mix of inpatient and outpatient care, and their degre...

Validating objectives and training in Canadian paediatrics residency training programmes

“…These findings are similar to those of previous Canadian studies (Macnab et al 1998;Veale et al 1999 Validating paediatric objectives and training e141 multiple other US studies (Camp et al 1997;Roberts et al 1997;Mulvey et al 2000;Blumenthal et al 2001;Blendon et al 2002;Garfunkel et al 2005;Freed et al 2009aFreed et al , 2009bFreed et al , 2009cFreed et al , 2009dLeslie 2009). Lieberman and Hilliard (2006) found that paediatricians certified in Canada between 1999 and 2003 had received excellent training in most paediatric subspecialties and felt adequately prepared for their careers.…”

Innovation in Residency Education and Evolving Pediatric Health Needs

“…Only 29% of third-year residents who intend to practice general pediatrics, just 13% of all third-year residents, plan to practice general pediatrics in both ambulatory and hospital settings. 5 This is a different situation from the one for which residency education was intended.…”

“…10 It must come to terms with increasing dichotomization of care and careers. 4,5 It must embrace the paradox of accommodating both breadth and career-specific learning. Residents who have made career choices should have access to concentrated, longitudinal learning opportunities that go well beyond continuity clinics.…”

Early Career Experiences of Pediatricians Pursuing or Not Pursuing Fellowship Training

“…Males, international medical school graduates (IMGs), and residents from larger residency programs are more likely to undertake subspecialty training. [1][2][3][4] Other related factors include market forces, indebtedness, mentor specialty, and work hours or the availability of part-time positions. [3][4][5][6] Published research has directly asked pediatricians what led them to pursue or not pursue subspecialty training.…”

“…Surveys of pediatric residents and early career pediatricians found structured hours and lifestyle were important factors to those who planned to pursue a career in general pediatrics. 2,7 Interest in specific diseases and patient populations remained the most important factor in post-residency career choice for those residents planning to pursue fellowships. 8,9 In the current study, our goal is to learn more about what happens in the work and life of pediatricians after fellowship.…”