Recruitment of house staff into anesthesiology: a re-evaluation of factors responsible for house staff selecting anesthesiology as a career and individual training program

doi:10.1016/S0952-8180(03)00087-4

Journal of Clinical Anesthesia

Volume 15, Issue 4, June 2003, Pages 289-294

https://doi.org/10.1016/S0952-8180(03)00087-4 Get rights and content

Abstract

Study objective

To reexamine, in a follow-up to our first study, those factors responsible for house staff (i.e., residents and clinical fellows) selecting anesthesiology as a career and a specific training program, as well as house staff satisfaction with various educational aspects of our training program, and their perceptions of the future for graduating anesthesiology trainees.

Design

Survey questionnaire of 77 house staff at the Mayo Clinic during the 2000 to 2001 academic year.

Setting

Academic medical center.

Measurements

A cross-sectional analysis was conducted using a questionnaire to survey 77 house staff enrolled in the anesthesiology training program at Mayo Clinic, Rochester, MN during the 2000 to 01 academic year. All responses were anonymous. Data were compared between time epochs using an f-exact test. A p-value ≤0.05 was considered statistically significant.

Main results

Forty-five (58%) of those surveyed responded to the questionnaire. Responses were similar to those obtained in the original study that we conducted in 1995 to 96. The most frequently cited reasons for selecting anesthesiology as a career were: it is a “hands-on” specialty, it involves the clinical application of physiology and pharmacology, and there is adequate time off. The most frequently cited reasons for selecting our training program were: diversity of training experience, prestige associated with the institution, and house staff satisfaction (i.e., morale) observed at the time of interview. House staff continued to report a very high level of satisfaction with the training program (education, clinical practice, and research opportunities). Only 58% of respondents (vs. 92% in 1995-1996) felt that downsizing of anesthesiology training programs was a national trend, none (vs. 54% in 1995-1996) anticipated difficulty obtaining a job following training, and 91% (vs. 33% in 1995-1996) felt that they had future job security. Overall, 98% (vs. 98% in 1995-1996) were pleased with their career choice, and 93% (vs. 83% in 1995-1996) would choose anesthesiology as a career if they were now graduating from medical school.

Conclusion

Data from one institution indicate that selection of an anesthesiology career and training program remain strongly associated with concerns regarding educational experiences and postgraduate employment opportunities. In contrast to our results from our 1995-1996 study, significantly fewer house staff had concerns about securing employment following training. Our observations—coupled with favorable National Resident Matching Program results during the past few years—bode well for the future recruitment of graduating American medical students into anesthesiology.

Introduction

In the 1990s, the specialty of anesthesiology experienced dramatic fluctuations in the number of American Medical Graduates (AMGs; Table 1) applying for residency positions in the United States.* † ‡ ,§ 1, 2, 3, 4, 5 At the same time, there were substantial changes in perceived postgraduate employment opportunities and job security.*, †, ‡, § 1, 2, 3, 4, 5 During the mid-1990s, the number of graduating American medical students entering anesthesiology decreased dramatically.∥ # ** †† 4, 5 At the nadir in 1996, only 30% of positions offered through the National Resident Matching Program (NMRP) were filled, of which less than two thirds were American medical school seniors.5 Since 1996, the annual NRMP match results have improved steadily.5

As the number of trainees entering anesthesiology fluctuates, it is important that existing programs identify factors responsible for successful recruitment of applicants into anesthesiology and individual training programs. Accordingly, we conducted a study in 1995–96 that identified factors responsible for house staff (ie, residents and clinical fellows) selecting anesthesiology as a career and a specific training program, as well as house staff satisfaction with various educational aspects of our training program, and their perceptions of the future for graduating anesthesiology trainees.1 With renewed interest in the field of anesthesiology5 and improved postgraduate employment opportunities, we elected to reexamine these issues five years after the nadir.

Section snippets

Materials and methods

Following approval from the Mayo Clinic Institutional Review Board, we conducted a cross-sectional analysis of 77 house staff, including residents in their clinical base, CA1, CA2, or CA3 year, and clinical fellows, who were enrolled in the anesthesiology training program at Mayo Clinic, Rochester, MN during the 2000 to 2001 academic year. We used the same questionnaire instrument that we used in our 1995 to 1996 study.1

Respondents were asked if various factors were a major positive, minor

Results

Forty-five (58%) of those surveyed responded to the questionnaire. Of the respondents, females and males represented 16% and 73%, respectively. This ratio is consistent with the distribution of females and males in our training program. The age distribution of the respondents was as follows: ≤30 years (44%), 31 to 40 years (40%), and ≥41 years (2%). Eleven percent did not disclose their gender and 13% elected not to disclose their age. The respondents level of training was distributed as

Discussion

To our knowledge, this is the first study to reevaluate factors responsible for house staff selecting anesthesiology as a career and a specific training program, as well as house staff satisfaction with various educational aspects of our training program, and their perceptions of the future for graduating anesthesiology trainees. Although most of these factors remained relatively constant between the 1995-1996 and 2000-2001 study periods, there were some interesting differences observed between

Summary

To date, ours is the first study to reevaluate factors responsible for house staff selecting anesthesiology as a career and a specific training program, as well as house staff satisfaction and their perceptions of future employment prospects. Although most of these factors remained relatively constant between the 1995-1996 and 2000-2001 study epochs, there were some interesting differences. As observed in our study and others,6, 7 maintaining a high level of satisfaction is an important factor

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Cited by (25)

Recruitment of house staff into anesthesiology: A longitudinal evaluation of factors responsible for selecting a career in anesthesiology and an individual training program
2014, Journal of Clinical Anesthesia
Citation Excerpt :
A request to participate in an anonymous web-based survey (SurveyMonkey, Portland, OR, USA) was sent via email to all 63 residents enrolled in their clinical base, CA1, CA2, and CA3 years. Survey questions were identical to those used in previous studies conducted in 1995-96 and 2000-01 [2,3] with the exception of several new duty hour-related questions (Appendix A). Survey questions were previously validated utilizing test residents [2].
To re-evaluate factors responsible for selecting a career in anesthesiology and for selecting an anesthesiology training program. The perceptions of anesthesiology residents about employment opportunities and future job security were also re-examined. Novel data on the impact of duty hour restrictions on residency training were obtained.
Survey instrument.
Academic medical center.
63 residents enrolled in the anesthesiology residency at Mayo Clinic in Rochester, MN (clinical base year and clinical anesthesia years 1-3) during the 2010-11 academic year. All responses were anonymous.
Current study data were compared to data from two similar studies published by the authors (1995-96 and 2000-01) using an f-exact test. A P-value ≤ 0.05 was considered significant.
55 of 63 (87%) residents responded to the survey. The most frequently cited reasons for selecting a career in anesthesiology were: anesthesiology is a “hands-on” specialty (49%), critical care medicine is included in the scope of training/practice (33%), anesthesiology provides opportunities to perform invasive procedures (31%), and the work is immediately gratifying (31%). When current data were compared with data from the 1995-96 survey, respondents reported significant decreases in interest in physiology/pharmacology (42% vs 21%; P = 0.03), opportunities to conduct research (13% vs 2%; P = 0.05) and opportunities to train in pain medicine (13% vs 0%; P = 0.01) as reasons for selecting anesthesiology. When current data were compared with data from the 2000-2001 survey, respondents reported a significant increase in critical care medicine (7% vs 33%, P = 0.01), significant decreases in time off (36% vs 11%; P = 0.01) and work time mostly devoted to patient care (20% vs 2%; P = 0.01) as factors in selecting anesthesiology as a career. Nearly all (94%) respondents reported a high level of satisfaction with their specialty choice and would choose anesthesiology again if currently graduating medical school. When current data were compared with those from the 2000-2001 survey, a significant increase in respondents who anticipated difficulty securing employment (0% vs 14%; P = 0.01) was noted. However, anticipation of difficulty in securing employment remained significantly lower than what was reported on the 1995-96 survey (54% vs 14%; P = 0.01). Thirty-eight percent of residents reported that implementation of duty hour restrictions had a positive impact on resident education, and 43% of residents reported that duty hour restrictions improved their quality of life. However, most respondents (69%) did not support further duty hour restrictions, and many (43%) expected to work longer hours after graduation.
Residents in this study remain highly satisfied with anesthesiology as a career choice and with their training program. However, a resurgence of concern about employment after program completion and about future job security is apparent. The impact of critical care medicine training has significantly increased as a factor in selecting anesthesiology as a career, and the impact of training in pain medicine has significantly decreased. Although work hour restrictions were viewed as having a positive impact on training and well-being by 48% of residents, a majority of respondents in this study (76%) disagreed with further duty hour restrictions.
Reasons residents choose to specialize in anesthesiology and postoperative critical care in the autonomous community of Madrid
2011, Revista Espanola de Anestesiologia y Reanimacion
El objetivo principal fue conocer las motivaciones que han determinado la elección de la especialidad en Anestesiología y Reanimación en la Comunidad de Madrid y determinar si el conocimiento o contacto previo con la especialidad contribuía a la elección de la misma, ver si existían diferencias en las motivaciones principales del grupo que elige la especialidad por primera vez, con respecto a los que lo hacen como segunda especialidad y saber cuáles eran sus expectativas y si éstas se habían cumplido, además de conocer el grado de satisfacción global.
Encuesta dirigida a todos los residentes de Anestesiología y Reanimación de la Comunidad de Madrid entre noviembre de 2008 y febrero de 2010. La encuesta incluía datos demográficos, especialidad previa, contacto pregraduado, motivos de elección (técnicos, sociales, laborales, satisfacción obtenida y expectativas cumplidas).
Se obtuvieron 89 encuestas válidas (35% de repuestas). Los aspectos más frecuentemente valorados fueron: el desarrollo y realización de técnicas (97,8%), el concepto de especialidad dinámica y con amplio contenido teórico práctico (98,9%), la valoración y el tratamiento del paciente crítico (93,3%). Asimismo estas tres razones las consideraron entre importantes y muy importantes en la valoración cuantitativa por la mayoría de los encuestados, siendo lo más importante para el 55,8% la realización y desarrollo de técnicas. El 100% de los que tenían especialidad previa, se definieron insatisfechos. El conocimiento previo de la especialidad establece diferencias en las motivaciones e intereses, como el interés por el dolor (p = 0,037) o el modelo profesional a emular (p = 0,014).
Lo que más atrae a los residentes es el contenido teórico práctico, la posibilidad de realizar técnicas y la valoración y tratamiento del paciente crítico. Los residentes con otra especialidad están menos satisfechos y sus expectativas menos cumplidas que el resto.
Our main objective was to determine the reasons why residents chose to specialize in anesthesiology and postoperative critical care in the autonomous community of Madrid. We also wished to know if prior contact with this specialty influenced their choice, if those who chose it as a second specialization differed from those who were doing a first residency, what expectations the residents had and if they had been met, and if they were satisfied with their training.
Survey of all residents in anesthesiology and postoperative critical care medicine in the community of Madrid between November 2008 and February 2010. The questionnaire items covered demographic data, prior specialty training, undergraduate contact with the specialty, reasons for choosing this specialty (technical, social, or employment-related interests), satisfaction, and expectations met.
We received 89 valid questionnaires, a sample that represented 35% of the residents. The reasons expressed most often were learning and performing techniques (97.8%); that the specialty was dynamic, with broad theoretical and practical content (98.9%), and an interest in providing critical care (93.3%). These 3 reasons were considered important or very important by most of the respondents; 55.8% considered that learning and carrying out techniques was the most important reason. All the respondents who had previously done specialty training said they were dissatisfied. Prior contact with the specialty was associated with having different reasons and interests, such as an interest in pain (P = .037) or emulating a role model (P = .014).
The specialty’s mix of theoretical and practical content and the chance to perform techniques and provide critical care are the features the residents find most attractive. Residents who already have another specialty are less satisfied and their expectations are not as well met.
Pharmacy students' motivational beliefs regarding pursuance of graduate school after completion of the PharmD program
2010, Currents in Pharmacy Teaching and Learning
Citation Excerpt :
Intrinsic value is similar to intrinsic motivational beliefs and assesses value associated with interest and enjoyment in performing a task; attainment value encompasses beliefs about the importance of performing a task; utility value is similar to extrinsic motivational beliefs in that it assesses the usefulness of performing a task; and cost belief takes into consideration factors that must be sacrificed to perform a task. Research has been conducted outside of the pharmacy profession that studied relationships between motivational beliefs and course enrollment, choice of college major, course goals, career choice, and perceptions of student abilities.21–31 Additional research has also been conducted that has specifically examined reasons for pursuing graduate school; however, none of the studies was developed within a theoretical framework related to motivational beliefs.32–34
The primary objective of the study was to develop and validate an instrument, within an expectancy-value framework, to assess student motivational beliefs regarding pursuance of graduate school after obtaining a PharmD degree. A secondary objective of the study was to examine additional student perceptions regarding graduate school.
Using a web-based survey instrument, information was obtained from samples of 2^nd and 3^rd professional year pharmacy students regarding motivational beliefs, graduate school, and other post-PharmD options.
The developed instrument demonstrated acceptable reliability and validity. Differences in motivational beliefs were discovered across student demographic variables. Furthermore, intrinsic value and attainment/utility value motivational beliefs were significant predictors of likelihood of students pursuing graduate school in a pharmacy-related area. Faculty encouragement was positively associated with increased likelihood of pursuing graduate school and increases in intrinsic value and attainment/utility value motivational beliefs.
Student value beliefs of graduate school influence the likelihood of pursuing graduate school. Student motivational beliefs should be considered when determining effective methods of recruiting students to post-PharmD graduate education.
French national survey on evaluation by residents in anesthesiology and critical care of choice's motivations of the specialty and their practical and theoretical training
2010, Annales Francaises d'Anesthesie et de Reanimation
La durée de l’internat d’anesthésie-réanimation (AR) est passée de quatre à cinq ans en 2002 en France. L’AR est une spécialité de mieux en mieux choisie par rapport aux spécialités médicales et chirurgicales. Nous avons réalisé une enquête nationale par questionnaire sur l’évaluation de leur formation théorique et pratique de l’internat par les internes d’AR français.
Un questionnaire (données démographiques, motivations du choix, cursus) a été envoyé aux 1422 internes inscrits depuis 2002 dans chaque inter-région.
Au total, 562 questionnaires (40 %) ont été renvoyés. Les internes sont âgés en moyenne de 28 ± 2 ans, 46 % sont des femmes, en moyenne en sixième semestre [extrêmes : 1–10]. La spécialité AR était le premier choix de spécialité pour 90 % et la ville d’internat obtenue était le premier choix de ville pour 73 %. Les internes déclarent que leur lieu d’installation sera choisi principalement sur des critères de qualité de vie. Ainsi, 97 % referaient le même choix de spécialité. La formation en anesthésie locorégionale (ALR) et la prise en charge de l’intubation difficile a été estimée bonne ou correcte par 53 et 62 % des internes. La formation théorique a été jugée correcte par 31 % et bonne par 53 % des répondeurs et la formation pratique a été estimée correcte par 25 % et bonne par 61 % des internes.
L’AR est désormais une spécialité qui répond à un choix positif. Le choix de l’AR par les étudiants en fin de cursus médical est conforté par l’enseignement et l’exercice de la spécialité au cours de l’internat. La formation globale est jugée satisfaisante dans l’ensemble. Les internes souhaiteraient un approfondissement dans certains domaines (échographie, ALR, lecture critique d’articles, rédaction médicale) et une évaluation de cette formation pratique par des simulations.
Les internes d’AR semblent dans l’ensemble satisfaits de leur parcours de formation et referaient le même choix de spécialité.
The duration of Anesthesiology and Intensive Care (AIC) residency increased from four to five years in 2002 in France. AIC is a specialty increasingly chosen in relation to medical and surgical specialties. We conducted a national survey by questionnaire on the evaluation of their theoretical and practical training by the French residents.
A questionnaire (demographics, motivations for the choice, training) was sent to 1422 residents, enrolled since 2002, in each province.
In total, 562 questionnaires (40 %) were returned. The mean age of residents is 28 ± 2 years, 46 % are women, on average in 6th semester [1–10th]. The obtained specialty was their first choice for 90 % and of the obtained city home for 73 %. Residents declare that the place of their definitive installation will be chosen depending on the quality of life mainly. So, 97 % referred the same choice of specialty. Training in locoregional anaesthesia (LRA) was evaluated correct or good by 53 % of residents and in the management of difficult intubation correct or good by 62 %. Theoretical training was assessed correct by 31 % of responders and good by 53 % and practical training correct by 25 % and good by 61 %.
The AIC is now a specialty of positive choice by students. This choice is reinforced by teaching and practice during the residency. The global training is as good as a whole. Residents wish to deepen in some areas (ultrasound, LRA, critical reading, medical redaction) and an evaluation of their practical training with simulations.
French AIC residents seem satisfied with almost all their training and referred the same choice of specialty.
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Part-time clinical practice in anesthesia is increasing due to the feminization and the aging of the medical workforce, as well as the arrival of generations X and Y to the health care workforce. Recruiting the best and brightest physicians requires accommodating their needs and interests, as well as retaining older workers who wish to reduce their hours as they approach retirement. This article discusses steps to help departments or groups optimally manage the part-time anesthesia workforce.
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2005, Journal of Clinical Anesthesia
Citation Excerpt :
Clearly, there was an issue. Current house staff satisfaction is a well-known issue for successful recruiting of future house staff [1]. Simultaneously (and coincidentally), the political climate of anesthesiology changed [2].
To allow for growth in our anesthesiology residency, we assumed control of the clinical base year (postgraduate year 1[PGY-1]) and adjusted the curriculum to accommodate the expanded size. With this opportunity to change the curriculum, we created a clinical base year to prepare PGY-1 for clinical anesthesia training in PGY-2 to PGY-4 using, for this purpose, the best resources of our clinical site. We describe the process and preliminary results of the change.

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^*: Associate Professor of Anesthesiology

^†: Assistant Professor of Anesthesiology

^‡: Professor of Anesthesiology

^§: Statistician, Section of Biostatistics

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JEPM original contributionRecruitment of house staff into anesthesiology: a re-evaluation of factors responsible for house staff selecting anesthesiology as a career and individual training program