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. 2018 Mar 6:2018:9496241.
doi: 10.1155/2018/9496241. eCollection 2018.

Intensive Care Unit Rotations and Predictors of Career Choice in Pulmonary/Critical Care Medicine: A Survey of Internal Medicine Residency Directors

Daniel J Minter  1 , Sean D Levy  2 , Sowmya R Rao  3 , Paul F Currier  4
Affiliations

Intensive Care Unit Rotations and Predictors of Career Choice in Pulmonary/Critical Care Medicine: A Survey of Internal Medicine Residency Directors

Daniel J Minter et al. Crit Care Res Pract. .

Abstract

Background: The United States (US) is experiencing a growing shortage of critical care medicine (CCM) trained physicians. Little is known about the exposures to CCM experienced by internal medicine (IM) residents or factors that may influence their decision to pursue a career in pulmonary/critical care medicine (PCCM).

Methods: We conducted a survey of US IM residency program directors (PDs) and then used multivariable logistic regression to identify factors that were predictive of residency programs with a higher percentage of graduates pursuing careers in PCCM.

Results: Of the 249 PDs contacted, 107 (43%) completed our survey. University-sponsored programs more commonly had large ICUs (62.3% versus 42.2%, p=0.05), primary medical ICUs (63.9% versus 41.3%, p=0.03), and closed staffing models (88.5% versus 41.3%, p < 0.001). Residents from university-sponsored programs were more likely to pursue specialty fellowship training (p < 0.001) overall but equally likely to pursue careers in PCCM as those from community-sponsored programs. Factors predictive of residencies with a higher percentage of graduates pursuing training in PCCM included larger ICUs (>20 beds), residents serving as code leaders, and greater proportion of graduates pursuing specialization.

Conclusions: While numerous differences exist between the ICU rotations at community- and university-sponsored IM residencies, the percentage of graduates specializing in PCCM was similar. Exposure to larger ICUs, serving as code leaders, and higher rates of specialization were predictive of a career choice in PCCM.

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Figures

Figure 1
Figure 1
Bar graphs showing the percentage of residency programs reporting the presence of intensivists from different specialties on the ICU teaching service by residency sponsorship. In both groups, the most common intensivist specialty was PCCM, with the other base specialties variably represented in university- and community-sponsored programs. There was not a significant difference in the presence of non-PCCM attendings between the two types of residencies.
Figure 2
Figure 2
Box and whisker plots depicting the percentage of graduating IM residency classes pursuing any fellowship training (a) and PCCM (b) by residency sponsorship. A significantly higher median percentage of graduates from university-sponsored programs pursued any fellowship (60 (50–75) versus 40 (30–60), p < 0.001), but the class percentages pursuing PCCM specifically did not differ between residency types (10 (10–15) versus 10 (10–20), p < 0.64).
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