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

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. 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. 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 fellowship-trained. 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.