Graduating pediatric residents have varied career goals, including primary care, subspecialty, and hospitalist practice. Past American Academy of Pediatrics (AAP) research revealed that between 1997 and 2014, the majority of graduating residents felt prepared for primary care practice (56%–69%),1 –3 fellowship training (53%–72%),1 –3 and hospitalist practice (81%).3 Additionally, satisfaction with training was consistently high from 2003 to 2015, with 9 in 10 graduating residents reporting they would choose a pediatrics residency again.2 –4 Our study objective was to determine if pediatric residents’ self-reported preparedness for career activities and satisfaction with training has changed in recent years.
Methods
We used data from the 2015 to 2022 AAP Annual Survey of Graduating Residents. Surveys were mailed and e-mailed (up to 8 times in total) to national random samples of 1000 graduating residents from all US categorical pediatric residency programs (approximately one-third of eligible residents were sampled each year). The AAP Institutional Review Board approved all surveys as exempt.
Residents reported a future career goal (primary care practice, subspecialty practice, or hospitalist practice). They also rated how well their program prepared them (on a 5-point scale, from “poor” to “excellent”) for 6 career activities: primary care pediatric practice, pediatric fellowship training, hospitalist practice or fellowship, child advocacy, research, and using telemedicine strategies and techniques (added in 2019). To assess training satisfaction, respondents reported whether they would choose to do a pediatrics residency again (yes/no). We pooled cross-sectional survey responses and assessed nonresponse bias using a t test for age and χ2 test for sex and US region of residency program. We used χ2 linear-by-linear tests to examine preparedness for career activities and satisfaction across the 8 years for residents overall and separately for each career goal.
Results
The overall response was 49.3% (3910/7932), with annual rates decreasing from 55.7% (2015) to 43.2% (2022), dropping to <40% in only 1 year (2021 = 38.3%). Compared with the random sample invited to participate, respondents did not differ by age, sex, or US region of residency program.
Across the 8-year study period, 38.1% of respondents reported a primary care career goal, 49.5% reported a subspecialty career goal, and 12.4% reported a hospitalist career goal. Overall, 68.6% rated their program as very good or excellent at preparing them for primary care practice in 2015, decreasing to 42.1% by 2022 (P < .001; Fig 1, Supplemental Table 2). Preparedness for fellowship training, hospitalist practice, child advocacy, and research also significantly declined across years. The percentage reporting very good or excellent preparedness for using telemedicine increased from 15.8% in 2019 to 29.4% in 2022 (P < .001). Nine in 10 residents would choose a pediatrics residency again, with no significant change across time (Supplemental Fig 2).
Percentage of pediatric residents rating their program as very good or excellent at preparing them for various career activities by graduation year.
Percentage of pediatric residents rating their program as very good or excellent at preparing them for various career activities by graduation year.
The differences in preparedness across years remained when examined by residents’ career goals (Table 1). For example, the decline in primary care preparedness was significant among those with primary care (71.4%–46.4%), subspecialty (70.2%–41.0%), and hospitalist (53.7%–28.9%) goals (all P < .001).
Percentage of Pediatric Residents Rating Their Program as Very Good or Excellent at Preparing Them for Career Activities by Graduation Year and Career Goal
. | 2015 . | 2016 . | 2017 . | 2018 . | 2019 . | 2020 . | 2021 . | 2022 . | P* . |
---|---|---|---|---|---|---|---|---|---|
Primary care career goal | |||||||||
Primary care pediatric practice | 71.4 | 66.2 | 61.3 | 60.9 | 62.5 | 49.4 | 54.0 | 46.4 | <.001 |
Pediatric fellowship training | 75.0 | 72.3 | 70.4 | 63.4 | 67.9 | 57.8 | 60.4 | 60.0 | <.001 |
Hospitalist practice or fellowshipa | 84.0 | 84.1 | 87.9 | 76.4 | 82.7 | 79.6 | 80.6 | 78.3 | <.05 |
Child advocacy | 53.4 | 60.1 | 48.2 | 54.7 | 47.6 | 44.6 | 56.1 | 37.3 | <.01 |
Research | 28.4 | 33.7 | 24.2 | 27.3 | 25.1 | 18.6 | 19.4 | 25.9 | <.05 |
Using telemedicine strategies and techniques | — | — | — | — | 13.7 | 17.3 | 34.5 | 31.5 | <.001 |
Subspecialtyb career goal | |||||||||
Primary care pediatric practice | 70.2 | 68.2 | 62.5 | 57.0 | 58.9 | 50.2 | 53.8 | 41.0 | <.001 |
Pediatric fellowship training | 80.2 | 80.7 | 75.9 | 69.5 | 77.1 | 71.7 | 74.6 | 69.3 | <.01 |
Hospitalist practice or fellowshipa | 87.9 | 85.3 | 80.8 | 82.2 | 84.5 | 81.3 | 81.8 | 77.9 | <.05 |
Child advocacy | 50.4 | 54.9 | 55.4 | 51.7 | 53.9 | 41.4 | 47.3 | 41.2 | <.01 |
Research | 37.5 | 33.6 | 34.4 | 30.5 | 38.0 | 27.9 | 32.1 | 28.4 | <.05 |
Using telemedicine strategies and techniques | — | — | — | — | 17.8 | 20.3 | 31.6 | 28.8 | <.001 |
Hospitalist career goal | |||||||||
Primary care pediatric practice | 53.7 | 55.8 | 45.3 | 45.9 | 41.7 | 46.4 | 28.6 | 28.9 | <.001 |
Pediatric fellowship training | 88.9 | 79.2 | 68.8 | 77.0 | 73.3 | 76.8 | 56.1 | 71.1 | <.01 |
Hospitalist practice or fellowshipa | 94.4 | 87.0 | 89.1 | 95.1 | 88.3 | 91.1 | 71.4 | 86.7 | <.05 |
Child advocacy | 66.7 | 54.5 | 46.9 | 47.5 | 48.3 | 44.6 | 36.6 | 42.2 | <.01 |
Research | 40.7 | 45.5 | 20.3 | 24.6 | 28.3 | 30.4 | 21.4 | 17.8 | <.01 |
Using telemedicine strategies and techniques | — | — | — | — | 11.9 | 16.1 | 36.6 | 25.0 | <.05 |
. | 2015 . | 2016 . | 2017 . | 2018 . | 2019 . | 2020 . | 2021 . | 2022 . | P* . |
---|---|---|---|---|---|---|---|---|---|
Primary care career goal | |||||||||
Primary care pediatric practice | 71.4 | 66.2 | 61.3 | 60.9 | 62.5 | 49.4 | 54.0 | 46.4 | <.001 |
Pediatric fellowship training | 75.0 | 72.3 | 70.4 | 63.4 | 67.9 | 57.8 | 60.4 | 60.0 | <.001 |
Hospitalist practice or fellowshipa | 84.0 | 84.1 | 87.9 | 76.4 | 82.7 | 79.6 | 80.6 | 78.3 | <.05 |
Child advocacy | 53.4 | 60.1 | 48.2 | 54.7 | 47.6 | 44.6 | 56.1 | 37.3 | <.01 |
Research | 28.4 | 33.7 | 24.2 | 27.3 | 25.1 | 18.6 | 19.4 | 25.9 | <.05 |
Using telemedicine strategies and techniques | — | — | — | — | 13.7 | 17.3 | 34.5 | 31.5 | <.001 |
Subspecialtyb career goal | |||||||||
Primary care pediatric practice | 70.2 | 68.2 | 62.5 | 57.0 | 58.9 | 50.2 | 53.8 | 41.0 | <.001 |
Pediatric fellowship training | 80.2 | 80.7 | 75.9 | 69.5 | 77.1 | 71.7 | 74.6 | 69.3 | <.01 |
Hospitalist practice or fellowshipa | 87.9 | 85.3 | 80.8 | 82.2 | 84.5 | 81.3 | 81.8 | 77.9 | <.05 |
Child advocacy | 50.4 | 54.9 | 55.4 | 51.7 | 53.9 | 41.4 | 47.3 | 41.2 | <.01 |
Research | 37.5 | 33.6 | 34.4 | 30.5 | 38.0 | 27.9 | 32.1 | 28.4 | <.05 |
Using telemedicine strategies and techniques | — | — | — | — | 17.8 | 20.3 | 31.6 | 28.8 | <.001 |
Hospitalist career goal | |||||||||
Primary care pediatric practice | 53.7 | 55.8 | 45.3 | 45.9 | 41.7 | 46.4 | 28.6 | 28.9 | <.001 |
Pediatric fellowship training | 88.9 | 79.2 | 68.8 | 77.0 | 73.3 | 76.8 | 56.1 | 71.1 | <.01 |
Hospitalist practice or fellowshipa | 94.4 | 87.0 | 89.1 | 95.1 | 88.3 | 91.1 | 71.4 | 86.7 | <.05 |
Child advocacy | 66.7 | 54.5 | 46.9 | 47.5 | 48.3 | 44.6 | 36.6 | 42.2 | <.01 |
Research | 40.7 | 45.5 | 20.3 | 24.6 | 28.3 | 30.4 | 21.4 | 17.8 | <.01 |
Using telemedicine strategies and techniques | — | — | — | — | 11.9 | 16.1 | 36.6 | 25.0 | <.05 |
—, not added to the survey until 2019.
P value in χ-square linear-by-linear association test examining variation across the 8 years.
From 2019 onward, wording changed from “Hospitalist practice” to “Hospitalist practice or fellowship” because of Pediatric Hospital Medicine being added as a new American Board of Pediatrics (ABP) subspecialty certification.
Subspecialty career goal includes those who selected the “subspecialty practice” and “both primary care and subspecialty practice” responses.
Discussion
Our analysis of cross-sectional survey data from national samples of pediatric residents graduating from 2015 to 2022 revealed declines in self-reported preparedness for 5 of 6 career activities. Among all respondents, we saw a 39% relative decrease in primary care preparedness across years. The only career activity for which preparedness increased was telemedicine. These changes held true for residents with primary care, subspecialty, and hospitalist career goals. Across years and career goals, nearly all residents would choose a pediatrics residency again.
Our results reveal that residents are less prepared for primary care than for fellowship training and hospitalist practice. Unpreparedness in primary care may have higher stakes relative to fellowship training, which has built-in supervision. Targeted interventions to increase preparedness based on career goals may be needed, especially for primary care. Pediatric residency curriculum changes proposed in 2023, which increase outpatient experiences,5 may help residents feel more prepared for their careers.
Despite our study limitations, which include self-reported, cross-sectional data limited to third-year pediatric residents and potential nonresponse bias, our findings suggest fewer than one-half of graduating residents, including those with primary care goals, feel prepared for primary care practice. Although residency program disruptions from the 2019 severe acute respiratory syndrome coronavirus 2 pandemic6 –10 likely contributed to the decreases in resident-reported preparedness, our data suggest the decline in some career activities, including primary care, started before 2020. The ongoing monitoring of these trends will be important.
Ms Gottschlich conceptualized the study, coordinated and supervised data collection, conducted the analyses, participated in the drafting of the manuscript, and revised the manuscript; Ms Frintner conceptualized the study, designed the data collection instrument, reviewed the analyses, participated in the drafting of the manuscript, and critically reviewed the manuscript; Mr Kist coordinated data collection, reviewed the analyses, participated in the drafting of the manuscript, and critically reviewed the manuscript; Dr Haftel conceptualized the study, participated in the drafting of the manuscript, and critically reviewed the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
FUNDING: The American Academy of Pediatrics (AAP) supported this project. The research presented in this paper is that of the authors and does not reflect the official policy of the AAP.
CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest relevant to this article to disclose.
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