Attracting top residency candidates: a survey of important program attributes
Education
*First-year resident, Internal Medicine Program, University of British Columbia, Vancouver, BC
†Third-year resident, Emergency Medicine Program, University of Western Ontario, London, Ont.
‡Children’s Health Research Institute, Children’s Hospital of Western Ontario, London, Ont.
§Associate Professor, Division of Emergency Medicine, University of Western Ontario, London, Ont.
CJEM 2005;7(6):411-414
Abstract
Objectives: Emergency medicine (EM) residents work intimately with emergency department staff, and many residents become staff at the institutions that train them. As such, it is in the interest of all training sites to attract the strongest candidates to their programs. The goal of this study was to determine what factors make programs most appealing to EM residency applicants.
Methods: A survey was developed to assess the relative importance of 20 factors used by EM residency applicants in selecting a Royal College of Physicians and Surgeons of Canada residency program. The survey was piloted on 17 University of Western Ontario EM residency candidates in 2003, and validated on 26 EM residency candidates applying to 8 sites across Canada in 2004.
Results: The 20 surveyed factors fell into 4 categories. The most important factors were those relating to interactions with the program (4.5 out of 5), followed by factors relating to the program itself (3.5), personal factors (3.4), and lastly, factors relating to the city/province (2.9).
Conclusions: These data suggest that the most important factors are "interactions with a program" and program characteristics. Both of these are largely within a program's control. By striving to make their curriculum, interview days and medical student electives more appealing a residency program can improve its ability to attract the strongest residency candidates.
Résumé
Objectifs : Les résidents de médecine d'urgence travaillent en étroite collaboration avec le personnel du département d'urgence et plusieurs d'entre eux se joignent à l'établissement qui les a formés. À ce titre, il est dans l'intérêt de tous les établissements de formation d'attirer les meilleurs candidats dans leurs programmes. La présente étude avait pour but de déterminer les facteurs qui rendent les programmes plus attirants pour les candidats à la résidence en MU.
Méthodes : Un sondage fut conçu pour évaluer l'importance relative de 20 facteurs utilisés par les candidats faisant une demande de résidence en MU lors de leur choix d'un programme de résidence du Collège Royal des médecins et chirurgiens du Canada. Le sondage fut mené auprès de 17 candidats à la résidence en MU de la Western Ontario University en 2003 et validé auprès de 26 candidats à la résidence en MU ayant posé leur candidature dans huit établissements partout au Canada en 2004.
Résultats : Les 20 facteurs du sondage s'inséraient dans quatre catégories. Les facteurs les plus importants étaient ceux qui avaient rapport aux interactions avec le programme (4,5 sur 5), suivis des facteurs liés au programme lui-même (3,5), des facteurs personnels (3,4) et finalement, des facteurs liés à la ville ou à la province (2,9).
Conclusions : Ces données suggèrent que les facteurs les plus importants sont «les interactions avec le programme» et les caractéristiques de ce dernier. Ces deux éléments sont en grande partie sous le contrôle du programme. En s'efforçant d'offrir un programme d'études, des journées d'entrevue et des choix de stages aux étudiants en médecine plus intéressants, un programme de résidence peut améliorer sa capacité à attirer les meilleurs candidats.
Introduction
Just as medical students compete for positions in top residency programs, training programs compete for the strongest trainees to join their resident pool. An understanding of what factors are important to residency applicants will help programs attract the best candidates. Previous studies have focused on factors that affect resident choice of specialty, rather than choice of specific program within a specialty.1,2 Although at least one previous study has assessed the reasons physicians choose careers in emergency medicine (EM),3 and other surveys have explored the reasons that residents in non-EM disciplines choose specific residency programs, there have been no studies addressing the reasons EM residency candidates select the specific programs they do.4,5
Our objective was to conduct a nation-wide survey of 4th-year medical students applying to Canadian EM residency programs, to determine what factors are most important as they decide between programs. The relevant factors were also characterized in terms of their susceptibility to modification by residency program directors.
Methods
Survey development and pilot testing
The investigators developed a pilot survey on a consensus basis, using input from junior EM residents and senior medical students. The survey asked respondents to rank the importance of 20 different factors influencing their decision-making process in choosing a residency program (Table 1). Each factor was rated on a scale of 1 (least important) to 5 (most important). The 20 factors fell into 2 major categories: those within a program's control, including "factors relating to the program itself" and "interactions with the program"; and those beyond a program's control, including "city/province factors" and "personal factors."
After the 2003 EM residency interview process, all of the candidates interviewed for the University of Western Ontario Royal College residency program were invited to participate. Consenting subjects completed the pilot survey on an anonymous basis, and the preliminary data suggested that a more extensive survey would be feasible and useful. The survey was based on results of the pilot study, and minor changes were made before distribution in Year 2.
Validation study
The survey process was repeated in 2004, this time distributing surveys to all candidates interviewed at Royal College EM program sites in London, Vancouver, Edmonton, Calgary, Winnipeg, Toronto, Kingston and Hamilton. All surveys were distributed by the same senior medical student to ensure lack of duplication. The goal for the validation phase was to survey every Royal College EM interviewee nation-wide, to minimize bias that may have occurred during the single-site pilot study.
Data analysis
The mean values and standard deviations (SDs) for each of the 20 variables were calculated for the pilot phase and the validation phase of the study. Mean values were also calculated for each of the categories described above. The mean values for the 2 main categories (factors within a program's control v. factors beyond a program's control) were compared using a Mann–Whitney test.
Results
All 17 eligible subjects participated in the 2003 (pilot) survey, and 26 of 31 eligible subjects participated in the 2004 (validation) phase. All surveys were complete, with no missing data. Table 1 summarizes mean values for the 20 factors studied, and Figure 1 shows grouped mean values for the 4 broad categories. The residency candidates indicated that interactions with the program were most important, followed by program factors.
Validation phase data (Fig. 2) suggested that factors within a program's control were significantly more important (mean score, 4.0; SD, 0.7) than factors beyond a program's control (mean score, 3.2; SD, 0.4; p = 0.033). Analysis of pilot phase data revealed the same trend, but differences were not statistically significant.
Discussion
Validation phase data suggested that the most important residency program selection factors are perceived happiness of current residents (mean score, 4.7), their fit with current residents (4.5), treatment during electives (4.5), interview day impression (4.2), strength of program director (4.1) and strength of didactic teaching program (4.0). The 4 most important factors fell within the category "interactions with the program." All of the above variables, and 9 of the top 10 fell within the classification "factors within a program's control." This is significant because all of these key variables can be modified by a residency program. Focused improvements in areas such as the interview day and quality of medical student electives could result in improved ratings in this important category.
Fig. 1. Mean importance of surveyed factors, by category
Fig. 2. Factors within versus factors beyond control.
The next most important category, factors relating to characteristics of the residency program itself (or "program factors"), also contains easily modifiable variables. Respondents indicated that a strong program director, good didactic teaching, large amounts of elective time, and flexible rotations all weighed heavily in their evaluation of a residency program.
Notably, many of the factors that are beyond a program's control were considered less important by the applicants. These less important variables included size of city, salary, and proximity of family and friends.
Table 1 shows that pilot-phase data were strikingly similar, also suggesting that "interactions with the program" and "program factors" were most important, and that "factors within a program's control" dominated those "beyond a program's control."
| Factors within a program’s control | ||
| 1. Program Factors | Year 1 | Year 2 |
| Overall program reputation | 4.1 (0.7) | 3.9 (0.6) |
| Large number of hospitals | 2.9 (0.9) | 3.0 (1.0) |
| Large number of residents | 3.3 (0.8) | 2.8 (0.8) |
| Research opportunities | 3.6 (0.9) | 2.9 (1.0) |
| Large amount of elective time | 4.4 (0.7) | 3.9 (0.7) |
| Very flexible rotations | 4.4 (0.5) | 3.8 (0.7) |
| Strong fellowship exam record | 4.0 (0.9) | 3.6 (1.0) |
| Strength of program director | 4.5 (0.6) | 4.1 (0.9) |
| Strength of teaching program | 4.0 (0.7) | 4.0 (0.8) |
| Amount of off-service time | 2.9 (1.0) | 2.8 (1.0) |
| Mean score | 3.8 (0.6) | 3.5 (0.5) |
| 2. Interactions with Program | Year 1 | Year 2 |
| Interview day impression | 4.7 (0.5) | 4.2 (0.8) |
| Treatment during electives | 4.0 (0.6) | 4.5 (0.7) |
| Your “fit” with current residents | 4.6 (0.6) | 4.5 (0.8) |
| Perceived happiness of residents | 4.9 (0.2) | 4.7 (0.6) |
| Mean score | 4.6 (0.4) | 4.5 (0.2) |
| Factors beyond a program’s control | ||
| 3. City Factors | Year 1 | Year 2 |
| Large city | 3.1 (1.1) | 3.3 (1.1) |
| Cost of living | 4.1 (0.7) | 3.0 (1.0) |
| Salary | 3.1 (0.9) | 2.7 (0.8) |
| Ability to supplement income | 3.0 (1.3) | 2.7 (1.2) |
| Mean score | 3.3 (0.5) | 2.9 (0.3) |
| 4. Personal Factors | Year 1 | Year 2 |
| Proximity of family/friends | 3.5 (1.3) | 3.6 (1.0) |
| Significant other’s wishes | 2.9 (1.1) | 3.3 (1.4) |
| Mean score | 3.2 (0.4) | 3.4 (0.2) |
These findings are similar to those of a 1993 paper that focused on Internal Medicine applicants, where "program reputation" and "perception of current residents" were found to be highly important.4 Conversely, a similar US study of Radiology applicants found that 4 of the 5 factors most important to incoming residents were beyond a program's control.5 The reason for this inconsistency is unclear, but may relate to differences between the fields of Radiology and EM, between Canadian and US applicants, or between study methodologies.
The principal strength of this study lies in the fact that 2 separate cohorts of EM candidates arrived at a near-identical results, supporting its validity.
Limitations
This survey and scoring system have not been previously validated, and the relatively small sample size limits statistical power, but the strength of our findings is bolstered by the fact that we surveyed most of the eligible subjects interviewing at 8 different sites across Canada, and that data from 2 study cohorts in 2 consecutive years were strikingly similar. Although the differences in scores assigned to the various surveyed factors were statistically significant, it is unclear whether they are clinically important. Finally, we specifically studied applicants to Royal College EM programs and we do not know whether the results of this study can be generalized to CCFP-EM applicants or applicants to other medical and surgical disciplines.
Conclusions
These data suggest that the most important factors are "interactions with a program" and program characteristics. Both of these are largely within a program's control. By striving to make their curriculum, interview days and medical student electives more appealing, a residency program can improve its ability to attract the strongest residency candidates.
References
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- Robbins B, Ostrovsky DA, Melgar T. Factors in medical students' selection and ranking of combined medicine-pediatrics programs. Acad Med 2005;80:199.
- Kazzi AA, Langdorf MI, Ghadishah D, Handly N. Motivations for a career in emergency medicine: a profile of the 1996 US applicant pool. Can J Emerg Med 2001;3:99-105.
- Flynn TC, Gerrity MS, Berkowitz LR. What do applicants look for when selecting internal medicine residency programs? A comparison of rating scale and open-ended responses. J Gen Intern Med 1993;8:249-54.
- Pretorius ES, Hrung J. Factors that affect national residency matching program rankings of medical students applying for radiology residency. Acad Radiol 2002;9:75-81.
