Changes in career decisions of internal medicine residents during training

Background: Little is known about the timing and stability of internal medicine resident career decisions during the course of residency training. Objective: To assess changes in reported career plans among internal medicine trainees during their training. Design: Observational cohort using data collected as part of the annual Internal Medicine In-Training Examination (IM-ITE) survey. Setting: 411 internal medicine residency programs in North America participating in the annual IM-ITE. Participants: 2638 internal medicine residents who took the IM-ITE and responded to career plan questions on the test survey in all 3 years of training (2002-2004). Measurements: Self-reported career plans for individual residents during their postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2), and postgraduate year 3 (PGY-3) of training. Results: 2281 of 2638 residents (86.5%) identified a specific career plan in internal medicine during PGY-3. Of these 2281 residents, 1417 (62.1%) changed career plans at least once during the study period. Career plans reported by PGY-1 and PGY-2 residents matched subsequent PGY-3 plans for 55.1% and 68.4%, respectively. Six hundred eighty-six (26.0%) PGY-1, 278 (10.5%) PGY-2, and 205 (7.8%) PGY-3 residents remained undecided about their career plans at the time of the IM-ITE. Only 25.0% of graduating residents reported plans for a general internal medicine career. Limitations: The study cohort represents a convenience sample and is restricted to the subset of residents sitting for the IM-ITE and responding to career plan questions in all 3 years of postgraduate training. Career plans were assessed by self-report, and it is possible that residents who responded in all years of training differed from those who did not. Conclusions: In a subset of internal medicine residents in the class of 2004, career decisions changed late into residency training and enthusiasm for careers in general internal medicine remained low.