To evaluate the attitudes and perceptions of internal medicine (IM) residents regarding Pulmonary and Critical Care Medicine (PCCM) training.
Prospective study. Three university hospitals. An 8-page survey was distributed and collected between March 1st and June 30th, 2002. All IM or IM/pediatric residents training at the three institutions were eligible for the study.
178 residents in IM from an eligible pool of 297 returned the survey (61% response rate). PCCM accounted for only 3.4% of the career choices. Forty-one percent (41.0%) seriously considered a pulmonary and/or critical care fellowship during their residency. Of these residents, 23.5% found the combination of programs the more attractive option, while 2.8% found pulmonary alone and 14.5% found critical care alone more attractive. Key factors associated with a higher resident interest in PCCM sub-specialty training included more ICU weeks (p=.008), more role models in PCCM (p=.0004), and resident observations of a greater sense of satisfaction among PCCM faculty (p=.04) and fellows (p=.03). The five most commonly cited attributes of PCCM fellowship that would attract residents to the field included intellectual stimulation (69%), opportunities to manage critically ill patients (51%), application of complex physiologic principles (45%), number of procedures performed (31%), and academically challenging rounds (29%). The five most commonly cited attributes of PCCM that would dissuade residents from the field included overly demanding responsibilities with lack of leisure time (54%), stress among faculty and fellows (45%), management responsibilities for chronically ill patients (30%), poor match of career with resident personality (24%), and treatment of pulmonary diseases (16%).
Internal medicine residents have serious reservations about PCCM as a career choice. Our survey demonstrated that a minority of U.S. medical graduates actually would choose PCCM as a career, which suggests that efforts to expand PCCM training capacity might result in vacant fellowship slots.
To promote greater interest in PCCM training, efforts are needed to improve the attractiveness of PCCM and address the negative “lifestyle” perceptions of residents.
S.M. Lorin, None.