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

Abstract

Purpose: Although internal medicine residency programs provide many resources to aid residents in developing post-residency plans, we hypothesize many residents change their post-residency plans during residency and that current resources are variably useful and that there is some degree of mismatch between the resources and supports provided by residency programs and those desired by residents. Methods: This is a mixed-methods study using a sequential explanatory study design consisting of a cross-sectional survey of postgraduate year three (PGY-3) internal medicine residents and internal medicine program directors ascertaining the availability and value of resources for post-residency planning. We conducted semi-structured interviews of program directors thereafter to identify barriers to providing resources. We generated descriptive statistics of survey results and performed pairwise comparisons of responses by residents’ gender and their interest in a career in academic medicine. We used qualitative content analysis on interview responses to identify thematic barriers programs experience in developing resources. 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 and program directors reported that training programs provided clinical, mentorship, and enrichment (e.g. pathways and research support) resources to aid residents’ post-residency plan development. Residents’ perceptions of about the availability and value of mentorship and research supports differed from their program directors’ responses, and residents’ perception of resources differed by gender and career interests. Compared to male residents, female residents were less likely to receive guidance on applying 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. Compared to their colleagues, residents strongly interested in a career in academic medicine were more likely to identify career mentors (73% v. 58%, p=0.02) and to strongly value mentorship experiences and research supports (p<0.01 on all items). 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: Nearly half of residents changed their plans during residency. Training programs facilitated post-residency plan development by providing residents with clinical, mentorship, and enrichment resources. Perceptions about available resources differ notably between residents and program directors, and between residents according to gender and interest in academic medicine. Future initiatives should rigorously evaluate the efficacy of developed resources with explicit attention to difference in outcome based on residents’ identities and/or interests.