Characterizing the Availability and Impact of Career-Planning Resources for Internal Medicine Residents

Abstract

Purpose: Although many resources help residents develop post-residency, we hypothesize current resources are variably useful and that there is some degree of mismatch between the resources and support provided by residency programs and those desired by residents. Method: This is a mixed-methods study that uses a sequential explanatory study design that consists of a cross sectional survey of postgraduate year three (PGY-3) internal medicine senior residents and internal medicine program directors followed by semi- structured interviews with program directors. Results: Eight internal medicine residencies participated. Of the 201 PGY-3 residents who completed the survey, 42% (n=85) changed their plans. At the end of residency, significantly fewer residents planned to pursue a fellowship immediately afterward (74% v.59%, p < 0.01) and significantly more residents intended to pursue hospitalist medicine immediately after residency (10% v 29%, p<0.01). Residents disagreed with their program directors about the availability and value of mentorship and research supports and there were notable differences in the perception of resources based on gender and interest in academic medicine. Female residents were less likely to received guidance on apply to academic (54% v. 71%, p=0.01) and non- academic (32% v. 47%, p=0.04) practice-based positions and were less aware of research funds (38% v. 58%, p<0.01) despite equally valuing mentorship opportunity and research supports. Residents strongly interested in a career in academic medicine were more likely to pursue hospitalist medicine as a bridge to fellowship, to identify career mentors, strongly value mentorship experiences and research supports. While program directors aid in the development of these plans, they face challenges with 1.) negotiating competing demands amongst stakeholders, 2.) developing resources deliberately, 3.) maximizing the value of limited resources, and 4.) cultivating social capital. Conclusions: Residents actively change their plans during training. Training programs facilitated post-residency plan development by providing residents with clinical, mentorship, and paraclinical resources. Notable disagreement between residents and program directors and differences in the perception of resources based on gender and interest in academic medicine suggests that future initiatives should rigorously evaluate the efficacy of developed resources with explicit attention to difference in outcome based on residents’ identities and/or interests.