Factors Influencing Applicants’ Decisions to Not Pursue Emergency Medicine Residency in 2023: A National Survey

Methods: This was a cross-sectional survey of recent graduates of 17 EM residency programs.Content validity evidence was developed via literature review and expert involvement.Response process validity evidence was developed by piloting with think-aloud resting.Programs represent a diverse sample of national residencies.Each program contact sent 3 weekly emails to their recently graduated residents.IRB approval was obtained from St. Luke's Hospital.Descriptive statistics were used to summarize the data, and a chi-squared analysis was done to compare 3-and 4-year programs.Results: 88 out of a possible 195 respondents answered (45%).Respondents were from both 3-year (46/114 from 11 programs) and 4-year programs (42/81 from 6 programs).5/88 (6%) reported their simulation curriculum was inadequate, 34/88 (39%) reported it was adequate, 43/88 (49%) reported it was superb, and 6/88 (7%) reported it was superfluous.The most common procedure requiring simulation to graduate was cricothyrotomy (78/88; 89%), followed by pericardiocentesis (77/88, 88%), and lateral canthotomy (64/88, 73%).Of procedures in 4 year programs, 531/601 (88%) were done without simulation; while 580/782 (76%) of procedures in 3 year programs were done without simulation (p<0.05).Discussion: Simulation plays an important role in resident education.Participation in simulation was a graduation requirement at every surveyed program.In addition, for each unique procedure, we found at least one instance of a graduate relying upon simulation to supplement their minimum procedure numbers.Most residents report their simulation training is at least adequate.Graduates of 4-year programs indicated less reliance on simulation.This study adds to literature supporting robust simulation training to fill gaps in procedural clinical opportunity.More work is needed to guide timing of trainings, and assessment of competency through non-numerical methods.