ROLE OF EMERGENCY-MEDICINE RESIDENCY PROGRAMS IN DETERMINING EMERGENCY-MEDICINE CAREER CHOICE AMONG MEDICAL-STUDENTS

Study objective: To characterize the role of emergency medicine reside ncy programs in determining emergency medicine career choice among med ical students. Design: Observational, cross-sectional, descriptive stu dy. Information on student career choice was obtained through a target ed query of the National Resident Matching Program data base, simultan eously stratified by specialty and school, and adjusted for class size . Participants: All accredited emergency medicine residency programs a nd four-year allopathic medical schools. Results: Fifty-two schools (4 2%) had a closely affiliated emergency medicine residency program, ie, one based primarily at the institution's main teaching hospital(s). T his configuration was associated with a 70% increase in the median pro portion of students choosing emergency medicine as a career when compa red to the 73 schools with no closely affiliated emergency medicine re sidency (5.1 % vs 3.0%, P<.0001). When institutions were stratified by overall commitment to emergency medicine, the median proportion of st udents choosing emergency medicine as a career was 2.9% for institutio ns with a minimal commitment to emergency medicine (neither an academi c 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 institution s with a substantial commitment to emergency medicine (a department of emergency medicine and an emergency medicine residency) (P<.0001). Wh en institutional commitment to emergency medicine was examined in a si mple multivariate model, only the presence of an emergency medicine re sidency was associated independently with student career choice (P<.00 1). Conclusion: An emergency medicine residency program that is closel y affiliated with a medical school is strongly and independently assoc iated with a quantitatively and statistically significant increase in the proportion of students from that school who choose a career in eme rgency medicine. These data support the proposition that, if emergency medicine is to meet national manpower shortage needs by attracting st udents to the specialty, it must establish residency programs within t he primary teaching hospital(s) of medical schools. Such a configurati on does not currently exist in the majority of schools.