Resident career planning needs in internal medicine: a qualitative assessment

A national virtual job search series for neonatal-perinatal medicine fellows

BACKGROUND

A standardized approach to prepare trainees for the job search has not been described. The objective of this study was to describe and evaluate an educational series on the job search for Neonatal-Perinatal Medicine (NPM) fellows and identify participants' job search knowledge gaps.

METHODS

During the 2020-2021 academic year, we created a virtual, seven-part job search series for NPM fellows that required no funding. The series has been repeated annually. We use REDCap surveys to register participants, collect baseline/demographic information, and evaluate the series' impact at the beginning and end of the job search timeline.

RESULTS

In the 2021-2022 academic year, 290 individuals registered for the series, and 89% completed the baseline/demographic survey. The majority were NPM fellows (89%). Early career neonatologists, NPM hospitalists, and pediatric residents also utilized the series (11%). Less than 25% reported being "knowledgeable" or "very knowledgeable" of core job search components, including the timeline of the job search, contract negotiation, and the general roles and responsibilities of junior faculty. Of those who completed the final job search survey and underwent a job search (60%, 97 of 162), the majority (86%) felt that career planning during training was stressful and believed that job search preparation should be structured into the NPM fellowship curriculum (81%). Many felt that the Job Search Series was helpful in elucidating components of the job search.

CONCLUSIONS

We identified several knowledge gaps in NPM fellows' understanding of how to find, prepare for, and negotiate their first post-training job. We strongly believe these knowledge gaps are not unique to NPM fellows and that all graduate medical education trainees would benefit from a similar, easy-to-implement, no-cost series.

A Qualitative Study of Internal Medicine Subspecialty Fellowship Program Directors' Perspectives on Short-Term Hospitalist Employment Prior to Fellowship

Background Some internal medicine (IM) residents pursuing subspecialty training choose short-term hospitalist employment prior to fellowship, or "pre-fellowship hospitalist years." Residency and fellowship program directors (PDs) advise residents on this decision, but PD experience with fellows pursuing pre-fellowship hospitalist years and the impact on fellowship applications is unknown. Objective We aimed to explore perceptions of fellowship PDs regarding experience with fellows who pursued pre-fellowship hospitalist years, including perceived effects on how such years affect fellowship application candidacy. Methods A purposive sample of 20 fellowship PDs in the most highly competitive and commonly selected IM fellowships (cardiology, pulmonology/critical care medicine, hematology/oncology, gastroenterology) from 5 academic institutions were approached for participation in fall 2021. Interviews included semi-structured questions about pre-fellowship hospitalist employment. Utilizing rapid qualitative analysis, interview transcripts were summarized and reviewed to identify themes and subthemes describing fellowship PDs' perspectives of pre-fellowship hospitalist years. Results Sixteen fellowship PDs (80%) participated. PDs identified 4 major themes as important for trainees considering pre-fellowship hospitalist years: (1) Explain the "Why"-why the year was pursued; (2) Characteristics of the Hospitalist Position-what type of employment; (3) The Challenges-potential concerns faced with pre-fellowship hospitalist years; and (4) Describe the "What"-the experience's contribution to resident professional development. Conclusions Fellowship PDs in 4 competitive IM subspecialities placed a strong emphasis on explaining a clear, logical reason for seeking short-term hospitalist employment prior to fellowship, describing how it fits into the overall career trajectory, and selecting activities that demonstrate continued commitment to the subspecialty.

Career selection trends among recent gastroenterology fellowship graduates

Various career paths exist for gastroenterology (GI) fellowship graduates across the country. These include further training, clinical or nonclinical job opportunities. Clinical career paths for those seeking jobs include academic positions or nonacademic positions (nonacademic hospital employed and private practice jobs). Data regarding career placement trends are limited. This study aims to explore temporal trends in career selection among new GI graduates. This is an observational cohort study. A list of GI fellowship programs was obtained from the FREIDA American Medical Association database. Programs with sufficient information on past graduate or alumni career placement after fellowship between 2017 and 2022 were included. Baseline characteristics and relevant information were collected. A Chi-square test was performed to assess the relationship between the categorical variables. A total of 203 GI fellowship programs were reviewed, among which only 21% (43/203) reported sufficient graduate career information. Across the 43 programs, 636 graduates were included. Thirty-three percent (210/636) of graduates were female. Forty-eight percent (308/636) of the graduates pursued nonacademic positions (nonacademic hospital employed and private practice jobs), 34% (216/636) into academic positions, and 17% (112/636) elected to do additional fellowship training. Both males and females were more likely to be employed in private practice (X2 = 12.8, df = 2, P = .002). Navigating through the decision-making process of selecting the first job after fellowship can be challenging. Our study reveals higher preference for nonacademic roles among graduates, consistent over 5 years, suggesting need to explore obstacles for academic positions or further training.

The role of different educational programs in specialty preference among Chinese medical students: a cross-sectional study

BACKGROUND

The imbalanced supply of physicians in different specialties and the decreasing number of young doctors in China have made it important to understand specialty preference and influencing factors and to evaluate the role of different programs in specialty choice and career planning among Chinese medical students to help shape the social healthcare system and ensure adequate medical practitioners in each specialty.

METHOD

A cross-sectional study comprising medical students from 5-year and 8-year program was conducted online. Demographics, specialty preferences and influencing factors, and career planning situations were collected and analysed by the chi-square test. Binary logistic regression analysis was performed in each program to identify the association between influencing factors and each specialty.

RESULTS

A total of 128 students (57.03% 5-year, 42.97% 8-year) responded to our survey. More 8-year students had a doctor in their household than 5-year students (25.45% vs. 10.96%, p < 0.05). The most preferred specialty among 5-year students was surgery, followed by others and internal medicine, while that most preferred by 8-year students was surgery, followed by internal medicine, obstetrics/gynecology and anesthesiology. Compared with 5-year students, more 8-year students considered 'personal competencies' (66.67% vs. 40.85%, p < 0.05), 'the reputation of the specialty' (18.52% vs. 7.04%, p ≤ 0.05), 'fewer doctor‒patient disputes' (27.78% vs. 11.27%, p < 0.05) and 'advice from family members' (24.07% vs. 7.04%, p < 0.05) influential. Among 5-year students, 'personal competencies' was positively associated with preference for surgery and 'work-life balance' was negatively associated. Among 8-year students, 'personal competencies' and 'work-life balance' were positively associated with internal medicine, while 'interests in the specialty' and 'broad career prospects' were negatively related. Many students need further career guidance, and personalized tutoring was the most wanted method.

CONCLUSIONS

There was no difference between 5-year and 8-year students regarding specialty preference, but bias existed, possibly due to the influence of the real-world situation. Improving the working environment and welfare might be beneficial for developing a balanced distribution of the workforce among different medical departments. It is necessary for medical schools to develop programs accordingly to help them better plan their future careers.

Development and Evaluation of a Five-Component Toolkit for Internal Medicine Residents Applying for Subspecialty Fellowships

INTRODUCTION

Subspecialty fellowship is a common career path for internal medicine (IM) residents, but little is published on residency program curricula for guiding residents through the process of applying to subspecialty fellowships. We describe a toolkit to guide IM residents through this process.

METHODS

We developed and implemented the Fellowship Application Toolkit for IM residents at the University of California, San Francisco, from 2018 to 2020. Educational strategies included live workshops, written resources, and one-to-one coaching, consisting of five components: fellowship application guidebook, Fellowship Application Information Night, alumni contact list, personal statement resources and coaches, and virtual interview workshop and mock interviews. Residents were surveyed both pre- and postintervention to evaluate these resources' use and efficacy.

RESULTS

Survey response rates were 21 of 41 (51%) in 2018, 25 of 41 (61%) in 2019, and 24 of 43 (56%) in 2020. Most respondents indicated the resources were extremely or very effective, including 30 of 36 (83%) who used the guidebook, 31 of 37 (84%) who attended the Fellowship Application Information Night, 10 of 15 (67%) who used the alumni contact list, nine of 10 (90%) who used the personal statement resources, and 12 of 14 (86%) who attended the virtual interview workshop. Respondents strongly or somewhat agreed that the overall efficacy of the residency's fellowship advising improved from pre- to postintervention (four of 17 [24%] in 2018 vs. 17 of 21 [81%] in 2020, p < .001).

DISCUSSION

Our Fellowship Application Toolkit was effective at supporting IM residents applying to fellowships.

Internal Medicine-Paediatrics residents' application of life design principles to career decisions

BACKGROUND

Residency is an important time for career planning. Little is known about how trainees make career decisions during this formative period.

OBJECTIVE

The objective of this study was to understand whether 'design thinking' activities help to inform Internal Medicine-Paediatrics (Med-Peds) residents' career decisions.

METHODS

We performed a cross-sectional survey of a national sample of fourth-year Med-Peds residents in May-July 2019 covering intended career, helpfulness of 'life design' strategies used to inform career decision and confidence with intended career plans. Bivariate analyses were performed to evaluate associations between used strategies and confidence with career plans.

RESULTS

A total of 86/145 (59%) of residents responded to the survey. The most helpful activities for clarifying career decisions were immersive exposure to the career during residency, and reflecting on compatibility of careers with their views of life and work. Finding the right mentor was associated with higher confidence in one's intended career path (p<0.05). There were no significant differences with confidence in intended career plan by gender or career path. Career decisions made during the first 2 years of residency were associated with higher confidence than those made prior to or in the second half of residency (p=0.01 and p=0.004).

CONCLUSION

This national survey of graduating Med-Peds residents reveals that proactive life design strategies were helpful in bringing clarity to their decision and were associated with higher confidence in intended career plans. These data should be of interest to residency training programmes in their efforts to support trainees with their career decisions.

Self-Assessment of Preparedness among Critical Care Trainees Transitioning from Fellowship to Practice

This study evaluated the subjective assessment of preparedness needs of critical care trainees and recent graduates between 2013 and 2014. A questionnaire was developed and validated by the subcommittee of the In-Training Section of Society of Critical Care Medicine (SCCM). The survey was deployed twice between December 2013 and January 2014 via email to any trainee or individual graduated from a critical care fellowship within the previous three years. Six percent (180) of all individuals completed the survey, and 67% of respondents had recently interviewed for a job. Northeast was the preferred location for a job (47%), and academia was favored over private practice (80% vs. 15%). Of the respondents that secured an interview, 55% felt prepared for the interview, 67% felt prepared to build an adequate job portfolio, 33% received formal guidance from their mentor/training program. 89% of total respondents agreed it is important to participate in a formal training course in job search, portfolio development, and interviewing process. The preferred sources of training were equally distributed between their home institution, webinars, and SCCM. There is an ongoing need in education regarding the transition period from fellowship to practice.

Career panel for pathology residents: going beyond the core curriculum

OBJECTIVES

To increase awareness in pathology residents of different career choices and familiarize them with the job market.

METHODS

For 3 years, community pathologists and faculty members participated in half-day panels that residents attended voluntarily. Panelists presented their professional life experiences and shared advice. We showcase the implementation and resident evaluation of these panels.

RESULTS

Panelists were rated as outstanding or excellent for relevance. Residents chose the following themes as most useful: visualizing the array of practices (community, part-time, public health, and others), careers that follow unexpected courses and people taking advantage of opportunities as they happen, knowing that not having a definitive direction is frequent, and finding out what different practices look for when they are hiring.

CONCLUSIONS

Career planning is a neglected aspect of pathology residency training, and panels in which pathologists present their experiences are helpful to prepare residents for what lies ahead.