The number of Internal Medicine (IM) residents applying to Infectious Diseases (ID) fellowships has declined disproportionately compared to other subspecialties. The factors that influence residents’ career choices and the decision to pursue a career in ID are not known; however, understanding these factors might lead to interventions to enhance interest in ID.
We conducted a cross-sectional mixed methods study of graduating IM residents using a two-stage sampling strategy. We conducted 25 semi-structured interviews and qualitatively analyzed data for themes which we then applied to survey design. Participants identified as one of three categories (1) applied/plan to apply to ID fellowship; (2) interested in ID but did NOT apply; and (3) NEVER interested in ID. Although the design was self-weighting, all analyses were conducted using post-stratification adjustment weights with survey data analysis procedures.
Seventy-three of 160 IM residency programs participated with 590 IM residents surveyed. The number of participants who identified as categories 1, 2 and 3 was 42, 188 and 360 respectively. Among those in category 2, 26% chose IM, 16% chose hospital medicine and 10% chose pulmonary critical care over ID. Of all participants, 65% developed an interest in their chosen field before residency; however, in category 1, 72% developed an interest before residency.
More residents in category 1 (71%) rated their ID knowledge as good or very good at the end of medical school compared to 64% in category 2 and 45% in category 3. Of surveyed residents, 90% felt mentorship influenced career decisions and 80% in category 1 identified an ID mentor compared to 43% in category 2. Surveyed residents rated improved salary and early broad exposure to ID as the most likely factors to increase ID interest and 45% in category 2 would have chosen ID if salaries were equivalent to other specialties.
The majority of IM residents develop career interests before entering residency, making medical school ID interest groups and innovative high-quality microbiology curricula key in attracting trainees to ID. In residency, many who had considered ID ultimately chose other fields, citing factors such as mentorship, exposure to ID and salary. These data identify many potential interventions to address declining interest in ID.
K. Ramsey, None
W. Armstrong, None