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      Associations between hematology/oncology fellows’ training and mentorship experiences and hematology-only career plans

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          Key Points

          Clinical, research and mentorship experiences in hematology are positively associated with fellows' plans to pursue hematology-only careers.

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          Most cited references 18

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          The role of medical school culture in primary care career choice.

          To examine individual-level and medical-school-level factors, including the school's primary care culture, that are associated with medical students' likelihood of practicing primary care.
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            Attitudes and perceptions of internal medicine residents regarding pulmonary and critical care subspecialty training.

            To evaluate the attitudes and perceptions of internal medicine residents regarding pulmonary and critical care medicine (PCCM) training. Prospective study. Three university hospitals. 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. 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%). 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.
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              Graduate Medical Education, 2017-2018

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                Author and article information

                Journal
                Blood Advances
                American Society of Hematology
                2473-9529
                2473-9537
                November 12 2019
                November 12 2019
                October 31 2019
                : 3
                : 21
                : 3278-3286
                Affiliations
                [1 ]Department of Health Policy and Management, Milken Institute School of Public Health, and
                [2 ]Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University, Washington, DC;
                [3 ]Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
                [4 ]Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA;
                [5 ]Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC;
                [6 ]Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN;
                [7 ]Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD;
                [8 ]Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL;
                [9 ]Jane Anne Nohl Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, CA;
                [10 ]Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL;
                [11 ]Transfusion Medicine Fellowship Program, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN;
                [12 ]Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY; and
                [13 ]Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
                Article
                10.1182/bloodadvances.2019000569
                © 2019

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