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Due to a variety of factors, there was a recent redistribution of graduating American medical students toward primary care specialties and a decline in the number of applicants seeking training positions in anesthesiology. In the present study, factors responsible for Mayo house staff (i.e., residents and clinical fellows) selecting anesthesiology as a career, and Mayo Clinic as their training program, were identified. We also evaluated their level of satisfaction with their choice of career and training program, and their perceptions of the future for anesthesiology trainees. A cross sectional analysis was conducted using a questionnaire to survey 67 house staff enrolled in the anesthesiology training program at Mayo Clinic, Rochester, MN during the 1995-1996 academic year. All responses were anonymous. Data were analyzed using the chi-square and Mann-Whitney rank sum tests. P ? 0.05 was considered statistically significant. Forty-eight (72%) of those surveyed responded to the questionnaire. The most frequently cited reasons for selecting anesthesiology as a career included it: is a “hands-on“ specialty, involves clinical application of physiology and pharmacology, and provides immediate gratification in one’s work. The most frequently cited reasons for selecting our training program were the diversity of training experience, prestige associated with Mayo Clinic, and employment opportunities following training. Forty-four (92%) felt downsizing of anesthesiology training programs was a national trend, 26 (54%) anticipated difficulty obtaining a job following training, and 16 (33%) felt they had future job security. Overall, 47 (98%) were happy with their career choice, and 40 (83%) would choose anesthesiology as a career if they were now graduating from medical school. Our data indicate that selection of a career in anesthesiology and training program are strongly associated with concerns regarding educational experiences and postgraduate employment opportunities. More than half anticipated difficulty obtaining postgraduate employment; however, this skepticism was overshadowed by two findings: the trainees reported a very high level of satisfaction in their choice of career and training program, and the vast majority reported they would seek a career in anesthesiology if they were now selecting a medical specialty. Additionally, all 1996 graduates found suitable employment without difficulty.
Due to a variety of factors, there was a recent redistribution of graduating American medical students toward primary care medicine and a decline in the number of applicants seeking training positions in anesthesiology.1-7 Aware of the changing political and postgraduate employment climates, medical students became less interested in selecting anesthesiology as a career.7 This was characterized by a decline in the number of graduating American medical students entering anesthesiology.7-10 For example, in 1995, 44% of Clinical Anesthesia year 1 (CA1) training positions offered through the National Resident Matching Program (NRMP) filled.8 Of these, 83% were occupied by U.S. seniors.8 At the nadir in 1996, only 30% of these positions filled, of which only about one-third were American medical school graduates.8 In contrast, results of the 1997 NRMP showed signs of improvement. That is, the percentage of CA1 training positions that filled increased to 44% with little change in the distribution between American and International medical graduates.8 It is important for programs to identify key issues affecting recruitment so they can be effectively addressed. Programs could use this information to showcase their strengths and improve areas identified as weak.
The purpose of this study was to identify factors responsible for Mayo anesthesiology trainees selecting anesthesiology as a career and Mayo Clinic as their training program. We also evaluated their current level of satisfaction with their choice of career and training program, and their perceptions of the future for anesthesiology trainees.
Following approval from the Institutional Review Board, a cross sectional analysis was conducted using a questionnaire to survey 67 house staff (residents in their clinical base, CA1, CA2, or CA3 year of training, and clinical fellows) enrolled in the anesthesiology training program at Mayo Clinic, Rochester, MN during the 1995-1996 academic year.
Before initiating the survey, five trainees were randomly selected to perform a pilot study in which we sought feedback regarding individual questions and corresponding answer sets. Subsequently, all residents were sent the questionnaire (Appendix 1) via campus mail. In order to optimize our response rate, all trainees were sent a reminder/thank you post card two weeks after initial survey mailing. A second survey was sent to individuals indicating they had misplaced, lost, or did not receive the initial questionnaire. Completed questionnaires were returned to the Mayo Survey Research Center for analysis. All responses were anonymous.
Factors important in selecting anesthesiology as a career, and Mayo as a training program, were rank-ordered. Age, gender, and other demographic features affecting satisfaction ratings were analyzed using the chi-square and Mann-Whitney rank sum tests. All tests were two-tailed with p ? 0.05 considered statistically significant.
Forty-eight (72%) of those surveyed responded to the questionnaire. Of the respondents, females and males represented 10% and 77%, respectively. This ratio is consistent with the distribution of females and males in our training program. The chronologic ages of the respondents were as follows: ? 30 y (42%), 31 to 40 y (42%), 3 41 y (4%). Thirteen percent elected not to disclose their gender or age. The respondents’ level of training was distributed as follows: 23% clinical base, 25% CA1, 23% CA2, 21% CA3, and 8% postgraduate clinical fellow.
The top five reasons cited for selecting anesthesiology as a career were: a) it is a “hands-on” specialty, b) it involves the clinical application of physiology and pharmacology, c) it provides immediate gratification in one’s work, d) it enables the clinician to perform invasive procedures, and e) there is no ongoing patient management to contend with (Table 1). Of interest, immediate earning potential and prestige were among the lowest ranking features.
The top five reasons cited for selecting Mayo’s anesthesiology training program were: a) diversity of training experience, b) prestige associated with the institution, c) employment opportunities following training, d) general impression at the interview, and e) house staff satisfaction (i.e., morale) observed at the time of interview (Table 2). Of note, a patient population with a low incidence of AIDS and trainee stipend were low ranking features. With the exception of males citing prestige of training program as an important feature more often than females (p < 0.05) neither gender nor age significantly affected their responses.
Forty-seven (98%) reported being satisfied with their career choice. Additionally, when surveyed on their current level of satisfaction with the training program, 32 (87%) and 36 (97%) house staff at or beyond the CA1 level of training (n=37) were satisfied with their educational and clinical experiences, respectively (Table 3).
When surveyed on their perceptions of the future for anesthesiology trainees, 44 (92%) felt that downsizing of anesthesiology training programs was a national trend, 26 (54%) anticipated difficulty obtaining a job following training, only 16 (33%) felt they would have job security as an anesthesiologist, and 60% would advise graduating medical students to consider a career in anesthesiology. However, despite their concerns, 40 (83%) would choose anesthesiology as a career if they were now graduating from medical school.
To our knowledge, this is the first study evaluating factors responsible for house staff selecting anesthesiology as a career, house staff satisfaction with various educational aspects of a training program, and house staff perceptions of the future for graduating anesthesiology trainees. We recognize that the educational opportunities at Mayo may not be similar to those at other teaching institutions. However, such information may be useful to identify factors of importance in recruiting high-quality graduating medical students into anesthesiology and individual training programs.
When evaluating factors important to senior medical students in selecting a training program, two groups of investigators reported findings similar to the results of our study. Lebovits et al.11 surveyed 226 seniors graduating from State University of New York Health Science Center at Brooklyn School of Medicine. When stratified to those selecting anesthesiology, the top five factors were: diversity of training experience, conference/didactic teaching, opportunities for post-residency training, house office satisfaction, and general impression at the interview.11 Similarly, Simmonds et al.12 surveyed medical students graduating from Tulane University. They reported house officer satisfaction, general impression at the interview, diversity of training experience, geographic location, and conference/didactic teaching were important issues when selecting a residency program.12 Taken together, trainees from each of these geographic regions (i.e., northeast, southeast, and midwest) indicated similar reasons for selecting a residency program.
In all three of the above-cited studies (including ours), diversity of training experience, general impression at the interview, and house staff satisfaction were consistently among the top responses (Table 2).11,12 However, the previous two studies11,12 evaluated graduating medical students only, and thus, were unable to assess anesthesiology house staff satisfaction. Our respondents reported a high level of satisfaction with their choice of career, and clinical and educational experiences (Table 3).
When asked about their perceptions of the future, greater than half anticipated difficulty obtaining a job following training and only one-third felt they had job security (i.e., the ability to obtain full-time gainful employment as an anesthesiologist). We anticipate these negative perceptions may have an adverse affect on the ability of anesthesiology training programs to recruit high-quality American seniors in the future. In support of this concern, 83% of our house staff indicated they would choose anesthesiology as a career if they were now graduating from medical school, yet only 60% would advise graduating medical students to do so.
In summary, our data indicate selection of a career and training program in anesthesiology is strongly associated with concerns regarding the educational experience and postgraduate job opportunities.
As observed in our study and others15,16, maintaining a high level of satisfaction is an important factor in the recruitment of high-quality graduating medical school seniors into anesthesiology and individual training programs. “Although many factors influence the establishment and maintenance of quality in a specialty, it begins with the recruitment and education of the best students”.7
Ms. Tischa Agnessi for her contribution to data analysis and presentation.