• Colin P West, Carol Popkave, Henry J Schultz, Steven E Weinberger, and Joseph C Kolars.
• Department of Internal Medicine, Mayo Clinic, College of Medicine, Rochester, Minnesota 55905, USA. west.colin@mayo.edu
• Ann. Intern. Med. 2006 Nov 21; 145 (10): 774-9.

BackgroundLittle is known about the timing and stability of internal medicine resident career decisions during the course of residency training.ObjectiveTo assess changes in reported career plans among internal medicine trainees during their training.DesignObservational cohort using data collected as part of the annual Internal Medicine In-Training Examination (IM-ITE) survey.Setting411 internal medicine residency programs in North America participating in the annual IM-ITE.Participants2638 internal medicine residents who took the IM-ITE and responded to career plan questions on the test survey in all 3 years of training (2002-2004).MeasurementsSelf-reported career plans for individual residents during their postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2), and postgraduate year 3 (PGY-3) of training.Results2281 of 2638 residents (86.5%) identified a specific career plan in internal medicine during PGY-3. Of these 2281 residents, 1417 (62.1%) changed career plans at least once during the study period. Career plans reported by PGY-1 and PGY-2 residents matched subsequent PGY-3 plans for 55.1% and 68.4%, respectively. Six hundred eighty-six (26.0%) PGY-1, 278 (10.5%) PGY-2, and 205 (7.8%) PGY-3 residents remained undecided about their career plans at the time of the IM-ITE. Only 25.0% of graduating residents reported plans for a general internal medicine career.LimitationsThe study cohort represents a convenience sample and is restricted to the subset of residents sitting for the IM-ITE and responding to career plan questions in all 3 years of postgraduate training. Career plans were assessed by self-report, and it is possible that residents who responded in all years of training differed from those who did not.ConclusionsIn a subset of internal medicine residents in the class of 2004, career decisions changed late into residency training and enthusiasm for careers in general internal medicine remained low.

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