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.
Highlights
Since their advent during the polio epidemic of the midtwentieth century, intensive care units (ICUs) and the specialty of critical care medicine (CCM) have become fundamental pillars in the care of critically ill patients [1]
Residents in university-sponsored programs are exposed to a higher percentage of ICUs with greater than 20 beds (62.3% versus 42.2%, p 0.05), pure medical ICUs (63.9% versus 41.3%, p 0.03), and a closed ICU staffing model (88.5% versus 41.3%, p < 0.001)
University- and community-sponsored residencies utilized similar educational methods and did not di er in the percentage of graduates specializing in pulmonary/critical care medicine (PCCM)
Summary
Since their advent during the polio epidemic of the midtwentieth century, intensive care units (ICUs) and the specialty of critical care medicine (CCM) have become fundamental pillars in the care of critically ill patients [1]. Intensivists in the US have largely been internal medicine (IM) residency graduates with subsequent training in pulmonary/critical care medicine (PCCM), along with surgeons and anesthesiologists [4]. Trainees from other residencies ( emergency medicine and neurology), as well as IM graduates pursuing CCM fellowships without pulmonary training (IM-CCM), have begun entering the field in increasing numbers, with. Critical Care Research and Practice expanded board certification opportunities partially directed at increasing the supply of intensivists [3, 5, 6]. E Accreditation Council for Graduate Medical Education (ACGME) requires all graduates of IM residency programs to experience three to six months of dedicated critical care rotations during the 36 months of training but does not provide further guidance on how to structure such rotations [8]. Other studies of CCM education have largely focused on specific changes related to duty-hours or educational interventions [10,11,12]
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