Impact of personal goals on the internal medicine R4 subspecialty match: a Q methodology study

Abstract

BackgroundThere has been a decline in interest in general internal medicine that has resulted in a discrepancy between internal medicine residents’ choice in the R4 subspecialty match and societal need. Few studies have focused on the relative importance of personal goals and their impact on residents’ choice. The purpose of this study was to assess if internal medicine residents can be grouped based on their personal goals and how each group prioritizes these goals compared to each other. A secondary objective was to explore whether we could predict a resident’s desired subspecialty choice based on their constellation of personal goals.MethodsWe used Q methodology to examine how postgraduate year 1–3 internal medicine residents could be grouped based on their rankings of 36 statements (derived from our previous qualitative study). Using each groups’ defining and distinguishing statements, we predicted their subspecialties of interest. We also collected the residents’ first choice in the subspecialty match and used a kappa test to compare our predicted subspecialty group to the residents’ self-reported first choice.ResultsFifty-nine internal medicine residents at the University of Alberta participated between 2009 and 2010 with 46 Q sorts suitable for analysis. The residents loaded onto four factors (groups) based on how they ranked statements. Our prediction of each groups’ desired subspecialties with their defining and/or distinguishing statements are as follows: group 1 – general internal medicine (variety in practice); group 2 – gastroenterology, nephrology, and respirology (higher income); group 3 – cardiology and critical care (procedural, willing to entertain longer training); group 4 – rest of subspecialties (non-procedural, focused practice, and valuing more time for personal life). There was moderate agreement (kappa = 0.57) between our predicted desired subspecialty group and residents’ self-reported first choice (p < 0.001).ConclusionThis study suggests that most residents fall into four groups based on a constellation of personal goals when choosing an internal medicine subspecialty. The key goals that define and/or distinguish between these groups are breadth of practice, lifestyle, desire to do procedures, length of training, and future income potential. Using these groups, we were able to predict residents’ first subspecialty group with moderate success.

Undergraduate nursing students' subjective attitudes to curriculum for Simulation-based objective structured clinical examination

“…The greatest benefit of the Q methodology is that it forces a quasinormal distribution, so participants cannot choose the same response for every item (Daniels and Kassam, 2013). Study participants are asked to rank the order of the Q samples by using a grid referred to as the Q sort table.…”

Addressing the Nationwide Shortage of Child and Adolescent Psychiatrists: Determining Factors that Influence the Decision for Psychiatry Residents to Pursue Child and Adolescent Psychiatry Training

“…A systematic evaluation of how these factors may affect recruitment into child psychiatry could help guide recruitment efforts. Empirical studies have been conducted within the field of internal medicine by Daniels et al to determine factors that affect residents' choices of fellowship [12,13]. Thus far, multiple proposals have been put forth to try to increase recruitment within child psychiatry including shortening the length of training, creating child psychiatry mentorships on the medical student level, and providing clinical experiences in inpatient child psychiatry in medical schools [14][15][16].…”

A scoping review of Q-methodology in healthcare research

“…This was in part due to the forced-choice nature of the method. Some studies reported using Q-methodology as it requires participants to sort cards in relation to each other [ 60 ]. This meant that participants were not able to select the same response for each item, which was reasoned to more accurately portray real-life situations in which decision-making is constrained and must consider multiple factors [ 61 ].…”