The effect of emergency medicine residency format on pursuit of fellowship training and an academic career.

Objectives: To determine the association between emergency medicine (EM) program format (postgraduate year [PGY] 1–3, 2–4, or 1–4) and two dependent variables: fellowship training and academic career. Methods: The authors conducted a mailed survey of 122 program directors (PDs) of U.S. EM residencies regarding the number of graduates from 1995 to 2000 who pursued fellowships, community practice, academics, or an advanced degree. The survey asked for initial postresidency position, as well as position three to five years later. Results: Of those contacted, 67.2% of the programs responded regarding 3,521 graduates (70.4% of all graduates); 18.6% of 1–3-year program graduates chose academics versus 28.5% for 2–4 and 34.2% for 1–4. A greater proportion of four-year-format graduates pursued academics (PGY 2–4 vs. PGY 1–3, odds ratio [OR] = 1.74; 95% confidence interval [95% CI] = 1.44 to 2.11, PGY 1–4 vs. PGY 1–3, OR = 2.28; 95% CI = 1.81 to 2.85). The PGY 1–4 format was associated with academic practice versus the PGY 2–4 format (OR = 1.31; 95% CI = 1.02 to 1.67). The aggregate of the PGY 2–4 and 1–4 formats was associated with initial academics versus PGY 1–3 programs (OR = 1.92; 95% CI = 1.63 to 2.26). Of PGY 1–3 residents, 4.3% pursued fellowships versus 5.6% of 2–4 and 8.6% of 1–4. The PGY 1–4 format was associated with more common fellowship pursuit versus both 2–4 (OR = 1.59; 95% CI = 1.01 to 2.51) and 1–3 (OR = 2.08; 95% CI = 1.41 to 3.10). For 1995–1997 graduates, 74.2% (271/365) who started out in academics remained there three to five years later. Of all graduates, 5.2% pursued fellowships and 23.1% pursued academics initially. Sixty-seven of 271 (24.7%) academic physicians from the 1995–1997 classes were fellowshiptrained. Conclusions: Four-year formats, especially 1–4, were associated with more common pursuit of fellowships and academics than the 1–3 format. Fellowship pursuit was uncommon (4% to 9% of graduates), whereas 18% to 34% initially chose academics. Key words: residency format; fellowship; academic career. ACADEMIC EMERGENCY MEDICINE 2004; 11:938–943. Emergency medicine (EM) is unique among the medical specialties in that it offers three training options for board preparation: postgraduate year (PGY) 1–3, PGY 2–4, and PGY 1–4. Academicians have debated which residency format favors fellowship training or an academic career. Some view the PGY 4 year as a ‘‘minifellowship’’ that better prepares residents for an academic career, whereas others view it as time for more focused training. Proponents of four-year programs argue that graduates are more clinically mature and confident, and better able to mentor junior residents and medical students. 1 Critics counter that the fourth year is less valuable, and that residents are used as junior attending physicians at low wages, while faculty supervision is more lax. We hypothesized that residents would be more likely to pursue further training after three years of EM residency versus four. Medical student career advising would be aided by determining whether format of training has an influence on career path. To the best of our knowledge, this is the first study to test the relationship between EM residency format and pursuit of fellowship training and/or an academic career.