Determinants of internal medicine residents' choice in the canadian R4 Fellowship Match: A qualitative study

Background: There is currently a discrepancy between Internal Medicine residents' decisions in the Canadian subspecialty fellowship match (known as the R4 match) and societal need. Some studies have been published examining factors that influence career choices. However, these were either demographic factors or factors predetermined by the authors' opinion as possibly being important to incorporate into a survey. Methods: A qualitative study was undertaken to identify factors that determine the residents choice in the subspecialty (R4) fellowship match using focus group discussions involving third and fourth year internal medicine residents Results: Based on content analysis of the discussion data, we identified five themes: 1) Practice environment including acuity of practice, ability to do procedures, lifestyle, job prospects and income 2) Exposure in rotations and to role models 3) Interest in subspecialty's patient population and common diseases 4) Prestige and respect of subspecialty 5) Fellowship training environment including fellowship program resources and length of training Conclusions: There are a variety of factors that contribute to Internal Medicine residents' fellowship choice in Canada, many of which have been identified in previous survey studies. However, we found additional factors such as the resources available in a fellowship program, the prestige and respect of a subspecialty/career, and the recent trend towards a two-year General Internal Medicine fellowship in our country.