Gallagher E J, Goldfrank L R, Anderson G V, Barsan W G, Levy R C, Sanders A B, Strange G R, Trott A T
Albert Einstein College of Medicine, Bronx, New York.
Ann Emerg Med. 1994 May;23(5):1062-7. doi: 10.1016/s0196-0644(94)70104-0.
To characterize the role of emergency medicine residency programs in determining emergency medicine career choice among medical students.
Observational, cross-sectional, descriptive study. Information on student career choice was obtained through a targeted query of the National Resident Matching Program data base, simultaneously stratified by specialty and school, and adjusted for class size.
All accredited emergency medicine residency programs and four-year allopathic medical schools.
Fifty-two schools (42%) had a closely affiliated emergency medicine residency program, ie, one based primarily at the institution's main teaching hospital(s). This configuration was associated with a 70% increase in the median proportion of students choosing emergency medicine as a career when compared to the 73 schools with no closely affiliated emergency medicine residency (5.1% vs 3.0%, P < .0001). When institutions were stratified by overall commitment to emergency medicine, the median proportion of students choosing emergency medicine as a career was 2.9% for institutions with a minimal commitment to emergency medicine (neither an academic department of emergency medicine nor a closely affiliated emergency medicine residency), 4.1% for institutions with a moderate commitment to emergency medicine (either a department of emergency medicine or an emergency medicine residency, but not both), and 5.7% for institutions with a substantial commitment to emergency medicine (a department of emergency medicine and an emergency medicine residency) (P < .0001). When institutional commitment to emergency medicine was examined in a simple multivariate model, only the presence of an emergency medicine residency was associated independently with student career choice (P < .001).
An emergency medicine residency program that is closely affiliated with a medical school is strongly and independently associated with a quantitatively and statistically significant increase in the proportion of students from that school who choose a career in emergency medicine. These data support the proposition that, if emergency medicine is to meet national manpower shortage needs by attracting students to the specialty, it must establish residency programs within the primary teaching hospital(s) of medical schools. Such a configuration does not currently exist in the majority of schools.
明确急诊医学住院医师培训项目在医学生选择急诊医学职业过程中所起的作用。
观察性、横断面、描述性研究。通过对全国住院医师匹配项目数据库进行有针对性的查询获取学生职业选择信息，同时按专业和学校进行分层，并根据班级规模进行调整。
所有经认可的急诊医学住院医师培训项目以及四年制的全科医学院校。
52所学校（42%）设有紧密附属的急诊医学住院医师培训项目，即主要设在该机构主要教学医院的项目。与73所没有紧密附属急诊医学住院医师培训项目的学校相比，这种配置使选择急诊医学作为职业的学生中位数比例增加了70%（5.1%对3.0%，P <.0001）。当按对急诊医学的总体投入对机构进行分层时，对急诊医学投入最少的机构（既没有急诊医学学术部门也没有紧密附属的急诊医学住院医师培训项目）中选择急诊医学作为职业的学生中位数比例为2.9%，对急诊医学投入中等的机构（有急诊医学系或急诊医学住院医师培训项目，但不是两者都有）为4.1%，对急诊医学投入大量的机构（有急诊医学系和急诊医学住院医师培训项目）为5.7%（P <.0001）。在一个简单的多变量模型中检查机构对急诊医学的投入时，只有急诊医学住院医师培训项目的存在与学生职业选择独立相关（P <.001）。
与医学院紧密附属的急诊医学住院医师培训项目与该校选择急诊医学职业的学生比例在数量和统计学上的显著增加密切且独立相关。这些数据支持这样一种观点，即如果急诊医学要通过吸引学生投身该专业来满足国家人力短缺需求，就必须在医学院的主要教学医院内设立住院医师培训项目。目前大多数学校不存在这种配置。
