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Abstract Background There is currently a discrepancy between Internal Medicine residents' decisions in the Canadian subspecialty fellowship Gen200 r4 careers known as the R4 match and societal need.
Some studies have been published examining factors that influence career choices. However, these were either demographic factors or factors pre-determined by the authors' opinion as possibly being important to incorporate into a survey.
Methods A qualitative study was undertaken to identify factors that determine the residents choice in the subspecialty R4 fellowship match using focus group discussions involving third and fourth year internal medicine residents Results Based on content analysis of the discussion data, we identified five themes: Background There is a discrepancy between Internal Medicine residents' career choice in the subspecialties and societal need [ 1 ].
Specifically, there has been a declining interest in General Internal Medicine since Fifty-four percent of American third year Internal Medicine residents planned to practice General Internal Medicine in [ 2 ]. Gen200 r4 careers similar problem exists in Canada where the number of Internal Medicine residents pursuing General Internal Medicine is similar to that of the United States.
Canadian physician resource studies predict a critical shortage of generalists over the next five years given that to general internists will retire with only half being replaced by new graduates [ 4 ]. This concern regarding career choice and manpower in General Internal Medicine is not just localized to North America [ 5 - 8 ] and is in fact a global problem.
The reasons why residents choose their fellowship are not completely clear. Some survey studies have been published examining factors that influence career choices in Internal Medicine [ 129 - 13 ].
One particular issue with these studies is that the factors investigated are either demographic or pre-determined by the authors' opinions as possibly being important to incorporate into a survey.
Also, these studies almost exclusively involve American residents only.
One study by Horn et al. However, we are not aware of any purely qualitative studies that have used unprompted residents' opinions to establish important factors that influence Canadian Internal Medicine residents' choice in the R4 match. Methods Ethics We obtained ethics approval for this project through our university's Health Research Ethics Board prior to commencement of recruitment and data collection and we obtained informed consent from all participants.
Recruitment In Canada, all Internal Medicine residents must complete three years of core Internal Medicine training and then they decide whether they are going to subspecialize an additional two or three years of training or continue in General Internal Medicine mandatory one year, optional second year of training.
This decision is made five months into the third year of core training. We wanted to include residents who had already matched to their R4 program. Thus, our recruitment pool consisted of the 18 fourth year Internal Medicine residents i.
Adequate time was set aside for questions or concerns about the study before each focus group session began. Data collection The same person [V. We used the interview guide approach [ 14 ] in which the two authors specified ahead of time the topics to be covered, but we were not rigid in the exact wording and sequence of the questions.
Thus, the focus group discussions remained to some extent conversational. The discussions ran between minutes and began with open-ended questions such as "Why did you choose to pursue the subspecialty to which you matched?GEN Foundations General Education and Professional Success COURSE INFORMATION 1 From your student Web site, how do you access your reading assignments for this course?-From the Homepage, you would click on the “Classroom” tab.
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