Nature Versus Nurture: Resident Career Decisions in Emergency Medicine

Choosing a post-residency career path in emergency medicine (EM) represents a complex set of decisions involving personal preferences and training program characteristics. It is unclear to what degree the training program environment shapes these choices or if residents select training programs that align with their pre-existing career plans. We sought to evaluate resident career plans over time and assess differences between 3- and 4-year training formats in EM.

We conducted a prospective, observational, cohort study of EM residents at six ACGME-accredited residencies in the United States from 2020 to 2024. Participants reported demographics and career plans at the onset of their training and at graduation. We used analysis of covariance to determine differences in career choice and change over time between 3-year and 4-year programs. We used univariable regression to assess associations between personal and program factors on change in career choice during residency.

Eighty-one residents completed both the initial and graduation surveys. We did not detect any statistical difference between three- and four-year programs for either initial (p = 0.32) or graduation (p = 0.80) career plans. Thirty participants were undecided about their career plans at the beginning of training. There was no difference between types of changes in career choices between three- and four-year programs when including (p = 0.40) or excluding (p = 0.60) those changes of participants who were initially undecided. We did not detect any significant associations between individual (age, gender) or program (program identity, program format) factors on the change of career plans during residency.

We did not find a significant difference between program format and career plans. A minority of residents changed career plans during residency, and neither program length nor demographic factors were significantly associated with those changes. A proportion of residents begins training undecided about their career path, highlighting a potential role for early, structured career guidance.