The American Board of Anesthesiology, Raleigh, NC, USA.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
J Clin Anesth. 2023 Oct;89:111155. doi: 10.1016/j.jclinane.2023.111155. Epub 2023 Jun 6.
This study sought to understand the timing and important factors identified by residents regarding their decision to pursue a career in anesthesiology, training areas deemed important to their future success, perceived greatest challenges facing the profession of anesthesiology, and their post-residency plans.
The American Board of Anesthesiology administered voluntary, anonymous, repeated cross-sectional surveys to residents who began clinical anesthesia training in the U.S. from 2013 to 2016 and were subsequently followed up yearly until the completion of their residency. The analyses included data from 12 surveys (4 cohorts from clinical anesthesia years 1 to 3), including multiple-choice questions, rankings, Likert scales, and free text responses. Free responses were analyzed using an iterative inductive coding process to determine the main themes.
The overall response rate was 36% (6480 responses to 17,793 invitations). Forty-five percent of residents chose anesthesiology during the 3rd year of medical school. "Nature of the clinical practice of anesthesiology" was the most important factor influencing their decision (average ranking of 5.93 out of 8 factors, 1 [least important] to 8 [most important]), followed by "ability to use pharmacology to acutely manipulate physiology" (5.75) and "favorable lifestyle" (5.22). "Practice management" and "political advocacy for anesthesiologists" (average rating 4.46 and 4.42, respectively, on a scale of 1 [very unimportant] to 5 [very important]) were considered the most important non-traditional training areas, followed by "anesthesiologists as leaders of the perioperative surgical home" (4.32), "structure and financing of the healthcare system" (4.27), and "principles of quality improvement" (4.26). Three out of 5 residents desired to pursue a fellowship; pain medicine, pediatric anesthesiology, and cardiac anesthesiology were the most popular choices, each accounting for approximately 20% of prospective fellows. Perceived greatest challenges facing the profession of anesthesiology included workforce competition from non-physician anesthesia providers and lack of advocacy for anesthesiologist values (referenced by 96% of respondents), changes and uncertainty in healthcare systems (30%), and personal challenges such as psychological well-being (3%).
Most residents identified anesthesiology as their career choice during medical school. Interest in non-traditional subjects and fellowship training was common. Competition from non-physician providers, healthcare system changes, and compromised psychological well-being were perceived concerns.
本研究旨在了解住院医师选择从事麻醉学职业的时间和重要因素、他们认为对未来成功至关重要的培训领域、麻醉学专业面临的最大挑战，以及他们的住院后计划。
美国麻醉学委员会对 2013 年至 2016 年期间开始在美国接受临床麻醉培训的住院医师进行了自愿、匿名、重复的横断面调查，并随后每年进行随访，直到完成住院医师培训。分析包括来自 12 项调查（4 个来自临床麻醉 1 至 3 年的队列）的数据，包括多项选择题、排名、李克特量表和自由文本回答。使用迭代归纳编码过程对自由回答进行分析，以确定主要主题。
总体回复率为 36%（17793 份邀请共收到 6480 份回复）。45%的住院医师在医学院的第 3 年选择了麻醉学。“麻醉学临床实践的性质”是影响他们决策的最重要因素（在 8 个因素中排名第 5.93 位，1[最不重要]至 8[最重要]），其次是“使用药理学急性调节生理学的能力”（5.75）和“有利的生活方式”（5.22）。“实践管理”和“为麻醉师进行政治宣传”（分别在 1[非常不重要]至 5[非常重要]的量表上评分 4.46 和 4.42）被认为是最重要的非传统培训领域，其次是“作为围手术期手术之家的领导者的麻醉师”（4.32）、“医疗保健系统的结构和融资”（4.27）和“质量改进原则”（4.26）。五分之三的住院医师希望攻读专科医师培训；疼痛医学、儿科麻醉学和心脏麻醉学是最受欢迎的选择，每个专业各占未来专科医师的约 20%。麻醉学专业面临的最大挑战包括非医师麻醉提供者的劳动力竞争和缺乏对麻醉师价值观的倡导（96%的受访者提到）、医疗保健系统的变化和不确定性（30%）以及个人挑战，如心理健康（3%）。
大多数住院医师在医学院期间就将麻醉学作为自己的职业选择。对非传统学科和专科医师培训的兴趣很普遍。非医师提供者的竞争、医疗保健系统的变化和心理健康受损被认为是令人担忧的问题。
