title: Attitudes and perceptions of internal medicine residents regarding pulmonary and critical care subspecialty training.
abstract: OBJECTIVE
  To evaluate the attitudes and perceptions of internal medicine residents regarding pulmonary and critical care medicine (PCCM) training.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Three university hospitals.
  
  
  METHODS
  An eight-page survey was distributed and collected between March 1, 2002, and June 30, 2002. All internal medicine or internal medicine/pediatric residents training at the three institutions were eligible for the study.
  
  
  RESULTS
  One hundred seventy-eight residents in internal medicine from an eligible pool of 297 residents returned the survey (61% response rate). PCCM accounted for only 3.4% of the career choices. Forty-one percent of the residents seriously considered a pulmonary and/or critical care fellowship during their residency. Of these residents, 23.5% found the combination of programs the more attractive option, while 2.8% found pulmonary alone and 14.5% found critical care alone more attractive. Key factors associated with a higher resident interest in PCCM subspecialty training included more weeks in the ICU (p = 0.008), more role models in PCCM (3.02 +/- 0.78 vs 3.45 +/- 0.78, p = 0.0004), and resident observations of a greater sense of satisfaction among PCCM faculty (3.07 +/- 0.82 vs 3.33 +/- 0.82, p = 0.04) and fellows (3.05 +/- 0.69 vs 3.31 +/- 0.86, p = 0.03) [mean +/- SD]. The five most commonly cited attributes of PCCM fellowship that would attract residents to the field included intellectual stimulation (69%), opportunities to manage critically ill patients (51%), application of complex physiologic principles (45%), number of procedures performed (31%), and academically challenging rounds (29%). The five most commonly cited attributes of PCCM that would dissuade residents from the field included overly demanding responsibilities with lack of leisure time (54%), stress among faculty and fellows (45%), management responsibilities for chronically ill patients (30%), poor match of career with resident personality (24%), and treatment of pulmonary diseases (16%).
  
  
  CONCLUSIONS
  Internal medicine residents have serious reservations about PCCM as a career choice. Our survey demonstrated that a minority of US medical graduates actually would choose PCCM as a career, which suggests that efforts to expand PCCM training capacity might result in vacant fellowship slots. To promote greater interest in PCCM training, efforts are needed to improve the attractiveness of PCCM and address the negative lifestyle perceptions of residents.
authors.affiliation: The Mount Sinai Medical Center, Box 1232, One Gustave L. Levy Place, New York, NY 10029-6574, USA. scott.lorin@mountsinai.org
authors.forename: Scott
authors.initials: S
authors.lastname: Lorin
authors.forename: John
authors.initials: J
authors.lastname: Heffner
authors.forename: Shannon
authors.initials: S
authors.lastname: Carson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002321:Career Choice; D003422:Critical Care; D003479:Curriculum; D003625:Data Collection; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D010372:Pediatrics / Q000193:education; D015272:Pulmonary Medicine / Q000193:education*; D013038:Specialization; D014481:United States