CRA Forum: English Version

Background:

Rheumatology manpower in Canadian academic units needed to fulfill responsibilities in delivery of clinical services and academic programs is inadequate.
Enrollment in rheumatology training programs is falling and is insufficient to meet the present and future manpower needs for patients with rheumatic diseases in Canada. The Canadian Council of Academic Rheumatologists predicts that Canada will require a rheumatology manpower increase of 64% by the year 2026 to meet recently recommended targets for provision.
J Rheumatol 2001,28:1944-1951; 2004,31:1200-5.
GIM residents usually commit to a subspecialty early in their PGY2 yr
Many residents make choices before this time to permit scheduling of clinical rotations, research experiences etc thought necessary for success
Little is known about the stability of the decisions about career choice

Methods:

Subjects

The Internal Medicine in-training evaluation (IM-ITE) serves as a self evaluation of medical knowledge by IM residents. Although it is directed to PGY-2 residents it is taken by residents at every level annually and usually approximately 19,500 residents (80% of all GIM residents) participate annually.
After the exam residents are asked to complete a survey included in exam booklet which includes questions on career trajectories

Survey

The survey addresses questions regarding career choices including General internal Medicine, hospitalist, subspecialty, other, and undecided. The subpecialties included cardiology, GI, pulmonary/Critical care, nephrology, hematology-oncology, Infectious diseases, endocrinology, rheumatology, geriatrics. The “Other” choice included allergy/immunology and sports medicine.
GIM residents who completed survey in each of 2002, 2003, 2004 are the study sample (2638 residents). Differences by sex were also evaluated.

Results:

Study Cohort (No.) & amp; amp; nbsp; 2638
male &a mp;a mp;n bsp; No. (%) 1648 (62.5%)
Women more likely to be undecided as PGY1 (31%vs 23% p<0.001)
Rheumatology (& endocrinology) were preferred by females (p<0.001)
Only 1.9% of GIM residents chose rheumatology in PGY1
Prospective concordance of PGY1 & PGY3 was 55.1%(47.2-63.6)
For rheumatology of 84 in PGY3 only 51% ie 42 had that preference in PGY1 and therefore 42 acquired that preference along the way
Among undecided trainees only 3.5% chose rheumatology
Prospective concordance of PGY2 & PGY3 was 68.4%(60.7-75.3)
For rheumatology of 84 in PGY3 only 61.9% ie 52 had that preference in PGY2 and therefore 32 acquired that preference along the way
Among undecided only 2.2% chose rheumatology
23/84 (27.4%) of rheumatology residents in PGY3 had the same career path for all 3 years

Summary:

26% of PGY1’s are undecided re careers, women more so than men
Rheumatology is more popular among female PGY3’s
Prospective concordance PGY1 to 3 was only 55.1%
Among undecided only 3.5% chose rheumatology
Prospective concordance PGY2 to 3 was only 68.4%
Among undecided only 2.2% chose rheumatology
Of those choosing rheumatology at PGY1, only 27% stayed to PGY3

Limitations:

No follow-up data to confirm that self-reported career plans reflect actual career plans.
- However since subspecialty positions are allocated during the PGY3 year the PGY3 reported plans are probably correct
- Subspecialty certification numbers are similar to the PGY3 career announced plans
It is possible that residents who participated in the survey in all 3 years are not representative.
- However this distribution of career choices and sex was similar to that of the entire group of residents

Conclusions:

Action items for Educators

Focus on undergrads as 1 in 4 students are undecided at PGY1, esp females
Females are more interested in rheumatology than males. Capitalize on this or focus on males???
Almost 50% of PGY1’s change career goals. Therefore work hard on PGY1’s
Even in PGY2’s 1 in 3 change career goals. Seek out the undecided
Only 27% of those choosing rheum in PGY1 remain. Focus on retention

CRA Journal Club review by Dr. Murray Urowitz - English and French versions
CRA Forum : CRA Journal Club review by Dr. Murray Urowitz - English and French versions