Oh, the places you'll go! A qualitative study of resident career decisions in emergency medicine

Postresidency career choices are complex decisions that involve personal, professional, and financial preferences and may be influenced by training programs. It is unknown how residents navigate these decisions during emergency medicine (EM) residency. We explored EM residents' perspectives on career decision making and how residency programs can support career planning. We conducted semistructured interviews at seven accredited EM residency programs from diverse locations and training formats. We used purposive sampling to reflect the diversity of trainees with regard to gender, level of training, and career plans. Two researchers independently coded the transcripts. We used a constructivist-interpretivist paradigm to guide our thematic analysis. We interviewed 11 residents and identified major themes in three categories. Residents described being exposed to career options through formalized curricula such as required rotations, career fairs, and subspeciality tracks, highlighting the importance of access to faculty with diverse areas of clinical and academic expertise. Many noted that exposure was often self-driven. We identified three major themes regarding career decisions: instrumental factors, people involved, and processes of decision making. Instrumental factors included personal interests, goals, and values as well as practice characteristics, financial considerations, timing, and opportunity costs. Mentors and family were highly involved in resident career decisions. Residents often utilized reflection and conversations with mentors and peers in their decision-making process. Participants recommended that programs provide exposure to diverse career options early in training, protect time for career education, and ensure adequate mentorship and a supportive community. Participants suggested specific curricular content and strategies to support career decisions. This study illuminates important factors involved in resident career decision making and how programs can support their trainees. Essential components include diverse experiences and building a reflective mentorship environment.