Impact of the continuity clinic experience on resident career choice has been difficult to characterize because there are no prior studies demonstrating an association between satisfaction with the experience and career choice. Our study is novel in that it assesses resident interest in GIM, based on the continuity clinic experience. Most residents feel the experience influences career choice and that higher satisfaction with learning, patient diversity, clinic operations, and personal experience is associated with increased interest in a GIM career. Additionally, when residents are stratified by interest in GIM before their continuity experience, almost no associations emerge. This further suggests that there is a relationship between continuity clinic experience and future GIM interest.
The largest difference in mean satisfaction scores among the 3 resident groups (more likely to pursue, less likely to pursue, or no impact on pursuit of a GIM career) was in the personal experience domain. This domain captured personal/professional satisfaction (patient relationships/continuity, support from colleagues/attending physicians, and personal reward) and level of work/life balance (fatigue, stress, work enjoyment, and personal balance). This suggests that finding the experience rewarding, enjoyable, and in balance with personal pursuits is likely critical when choosing a GIM career. Optimizing mechanisms to minimize and reduce burnout, providing a positive professional environment, and emphasizing resident impact on patient outcomes are important factors in structuring the continuity clinic experience.
The learning and clinical environments were also important. Two key subscales suggested that a poor learning environment is associated with lower GIM interest: learning processes (eg, ensuring adequate time for teaching while providing quality didactics/conferences and educational resources that address future clinical and business practices) and patient diversity (eg, ensuring residents are exposed to a diverse group of patients). Although all clinics are limited in the spectrum of patients they serve (insurance status, geography, etc), efforts can be made to adjust patient panels to include a broader range of patient illnesses and limit redundancy.14
Experiencing a functional clinic (patient volume, workflow, etc) with an appropriate patient load 5 influence interest. Models maximizing use of physician-specific knowledge and skills that minimize physician completion of tasks that can be performed by other members of the health care team 5 lead to improved recruitment.
Our findings help support a framework for understanding future GIM career interest as it relates to continuity clinic. The survey tool and our factor analysis emphasize trainee satisfaction with clinical experiences in the context of personal satisfaction. Social Cognitive Career Theory posits that career decisions stem from experiences yielding personal success, positive affective reactions while completing tasks, and exposure to successful role models.15
If continuity clinic influences resident career choice, then the results support such a model. Understanding the mediators of satisfaction within the clinical environment and their relative importance is an important future direction of research. Similarly, satisfaction in the personal experience domain is likely informed by personal success and positive affective reactions from colleagues, patients, and preceptors. The degree to which each has a role and in what context is another important area of future research.
Our study has several limitations. First, we captured cross-sectional data allowing us to generate correlative but not causal relationships. There 5 have been factors beyond continuity clinic that influenced GIM interest (including prior interest in GIM), and prospectively assessing residents is an important next step. Additionally, we were unable to capture actual resident career choice, making it difficult to assess if resident perception of impact is correlated with future career choice. Also, our response rate was moderate, leaving the possibility that those who completed the survey 5 have been systematically different from those who did not. Although the percentage of residents interested in the various career paths is representative of national career paths, there 5 have been other unmeasured differences. While we used a validated survey, we did not validate our researcher-designed questions and cannot ensure that there was consistent interpretation of the questions regarding career choice. We collected data from a single training program and our results 5 not be applicable to other programs. Additionally, most of our residents choose their continuity site and this 5 have influenced their responses. Finally, we collected data over multiple years and during that time, various clinic innovations occurred that likely altered resident perceptions of the continuity clinic experience.