Minter Daniel J, Levy Sean D, Rao Sowmya R, Currier Paul F
School of Medicine, University of California San Francisco, San Francisco, CA, USA.
Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Crit Care Res Pract. 2018 Mar 6;2018:9496241. doi: 10.1155/2018/9496241. eCollection 2018.
The United States (US) is experiencing a growing shortage of critical care medicine (CCM) trained physicians. Little is known about the exposures to CCM experienced by internal medicine (IM) residents or factors that may influence their decision to pursue a career in pulmonary/critical care medicine (PCCM).
We conducted a survey of US IM residency program directors (PDs) and then used multivariable logistic regression to identify factors that were predictive of residency programs with a higher percentage of graduates pursuing careers in PCCM.
Of the 249 PDs contacted, 107 (43%) completed our survey. University-sponsored programs more commonly had large ICUs (62.3% versus 42.2%, =0.05), primary medical ICUs (63.9% versus 41.3%, =0.03), and closed staffing models (88.5% versus 41.3%, < 0.001). Residents from university-sponsored programs were more likely to pursue specialty fellowship training ( < 0.001) overall but equally likely to pursue careers in PCCM as those from community-sponsored programs. Factors predictive of residencies with a higher percentage of graduates pursuing training in PCCM included larger ICUs (>20 beds), residents serving as code leaders, and greater proportion of graduates pursuing specialization.
While numerous differences exist between the ICU rotations at community- and university-sponsored IM residencies, the percentage of graduates specializing in PCCM was similar. Exposure to larger ICUs, serving as code leaders, and higher rates of specialization were predictive of a career choice in PCCM.
美国重症医学（CCM）专业培训医师的短缺情况日益严重。关于内科（IM）住院医师积累的重症医学经验，以及可能影响他们选择从事肺科/重症医学（PCCM）职业的因素，我们了解得还很少。
我们对美国内科住院医师培训项目主任（PD）进行了一项调查，然后使用多变量逻辑回归来确定哪些因素可预测毕业生从事PCCM职业比例较高的住院医师培训项目。
在联系的249位PD中，107位（43%）完成了我们的调查。大学主办的项目更常见的有大型重症监护病房（62.3%对42.2%，P = 0.05）、主要医疗重症监护病房（63.9%对41.3%，P = 0.03）和封闭式人员配置模式（88.5%对41.3%，P < 0.001）。总体而言，来自大学主办项目的住院医师更有可能寻求专科 fellowship培训（P < 0.001），但与来自社区主办项目的住院医师相比，他们从事PCCM职业的可能性相同。预测毕业生从事PCCM培训比例较高的住院医师培训项目的因素包括更大的重症监护病房（>20张床位）、担任急救负责人的住院医师以及追求专业化的毕业生比例更高。
虽然社区主办和大学主办的内科住院医师培训项目在重症监护病房轮转方面存在诸多差异，但从事PCCM专科的毕业生比例相似。接触大型重症监护病房、担任急救负责人以及更高的专业化率可预测PCCM职业选择。
