One of the challenges facing psychiatric residency training programs today is recruiting as many of the best and brightest medical students as possible. Psychiatry represented the choice of 4.6% of all U.S. medical graduates participating in the National Resident Matching Program in 2006 (1). This figure has increased slightly over the last decade, with 3.2% of U.S. medical graduates choosing psychiatry as a career in 1994 (2).
Residency program directors in all medical disciplines are interested in what factors drive medical students to choose a particular program. In a survey of applicants planning a career in surgery published in 2001, the factors found to be important in the choice of a residency program were strong leadership within the program, good clinical experience, and high morale among the residents (3). A similar survey among applicants to residencies in emergency medicine found that the five most important factors, in order of decreasing importance, were perceptions of friendliness, a positive work environment, impressions of the program from their interview day, academic strength, and location (4).
In 1979, Sacks and colleagues found that the most important factors for applicants to psychiatric residencies were the warmth and enthusiasm of the interviewing faculty, and the amount of contact with the residency program director and department chair (5). Between 1981 and 1984, studies suggested that geographic location, quality of clinical training, perception of resident satisfaction, eclectic orientation of training, and the applicant’s intuitive feelings about the individual residency program were all important factors (6–8).
The most recent such study was published in 1996, where Levy and Schrage from Long Island Jewish Medical Center/Hillside Hospital’s psychiatric residency program surveyed postgraduate year-1 (PGY-1) residency applicants interviewed during a 5 year period (9). The five most important factors for the interviewed applicants were program location, reputation of the program, the program’s integration within the medical school, resident satisfaction, and faculty quality (9).
Since 1996, there has been increasing discussion of life style factors playing a role in the selection of a career. Dorsey and colleagues found that a controllable life style, defined as “personal time free of practice requirements for leisure, family, and avocational pursuits, and control of total weekly hours spent on professional responsibilities,” was the most important factor for medical students in picking a specialty (10).
Given the possible changes in perceptions about residency training, the authors sought to ascertain which factors are considered important to today’s psychiatric residency applicants, as well as what aspects of a program’s curriculum could be seen as potential roadblocks for applicant recruitment. In addition, the authors sought to clarify how these factors may interrelate through statistical analysis in order to illustrate possible broader trends among applicants’ views in selecting a residency.
Approximately 3 weeks after the results of the 2006 National Residency Match Program were announced, an anonymous, single-page questionnaire was sent to all applicants who interviewed for a PGY-1 position at the Johns Hopkins Hospital Psychiatry Residency Program. It included 11 questions and was divided into two sections: six questions pertaining to psychiatric residency programs in general and five questions specific to the Johns Hopkins Hospital residency. The questions were chosen based on discussion between one of the authors (DSD) and resident colleagues regarding the factors that were important to their choice of a residency program, as well as from informal discussions between residency applicants and interviewers.
The general questions addressed the importance of the following six factors: call schedule, salary and benefits, perceived prestige of the psychiatry department, perceived philosophical orientation of the psychiatry department, presence of separate research and/or clinical tracks within the residency program, and exposure to training in different psychotherapy modalities during residency. Respondents indicated the importance of these factors on a 3-point scale: important, neutral, or not important.
The five factors more specific to the Johns Hopkins Hospital psychiatric residency program included: location in Baltimore, presence of intensive care medical rotations during the PGY-1 year, entirely inpatient internal medicine training experience during the PGY-1 year, absence of pediatrics and/or family medicine rotations during the PGY-1 year, and the overall impression of the psychotherapy curriculum at Johns Hopkins Hospital. Respondents indicated how these factors affected their views of the hospital’s psychiatric residency program on a 5-point scale: very positive, positive, neutral, negative, or very negative. A 5-point scale was chosen in order to draw out greater distinctions in applicant views regarding the Johns Hopkins Hospital residency program.
An area of particular interest was whether there were any correlations between factors affecting the selection of a residency program, suggesting possible trends in applicant views, such as a trend toward valuing a more “controllable lifestyle” as described by Dorsey and colleagues (10). In order to ascertain such trends, pair-wise nonparametric correlations (Spearman’s Rho coefficients [rs]) were calculated for all factors. Statistical significance was set at 2-tailed alpha=0.05. All data analyses were performed using SPSS version 13.0.
Fifty applicants returned completed surveys, for a response rate of 49%. There were no partially completed surveys. In order to ensure frankness in responses, no identifying data regarding the respondents (i.e., age, gender, ethnicity, name or location of medical school, or class rank) were obtained.
As depicted in Table 1, the most important general factors in selecting a psychiatric residency program were reported to be perceived philosophical orientation of the psychiatry department, exposure to different modalities of psychotherapy, and perceived prestige of the psychiatry department. Table 2 displays the respondents’ views of five factors specific to the Johns Hopkins Hospital psychiatric residency.
The following correlations between factors were statistically significant (alpha<0.05) (table available upon request): call schedule and salary/benefits (Spearman’s rs=0.50), location of the Johns Hopkins Hospital residency program in Baltimore and an entirely inpatient internal medicine experience in PGY-1 (rs=0.30), presence of ICU rotations during the PGY-1 year and an entirely inpatient internal medicine experience in the PGY-1 year (rs=0.62), presence of ICU rotations and absence of pediatrics and/or family medicine rotations during the PGY-1 year (rs=0.51) and an entirely inpatient internal medicine experience and the absence of pediatrics and/or family medicine rotations during the PGY-1 year (rs=0.50).
Additionally, the following factors were significantly negatively correlated: importance of call schedule and the presence of ICU rotations during the PGY-1 year (rs=−0.33), importance of call schedule and the absence of pediatrics and/or family medicine rotations during the PGY-1 year (rs=−0.30), importance of salary/benefits and perceived prestige of the department (rs=−0.28), and the importance of salary/benefits and perceived philosophical orientation of the department (rs=−0.39).
The single most important factor in choosing a psychiatric residency program, for applicants surveyed here, was the perception of a department’s philosophical orientation. In interviewing numerous applicants, it seemed to the authors that applicants’ views regarding the meaning of philosophical orientation was whether a department was of a “biological,” “psychodynamic,” or “biopsychosocial” orientation. In order to define fully what a psychiatric department’s philosophical orientation is would require a great deal of knowledge of the department. It is difficult to see how an accurate impression could be obtained in a single day of interviews.
In evaluating the survey results and the correlation data, several trends were apparent. For instance, respondents who rated a program’s call schedule as an important factor in their decision-making process tended to view both the presence of ICU rotations during the PGY-1 year and the absence of pediatrics and/or family medicine rotations during the PGY-1 year at Johns Hopkins Hospital negatively. One interpretation for this trend is that residency applicants who viewed a program’s call schedule as an important factor also viewed ICU rotations as an indication of more on-call responsibilities, and thus as a negative. Consistent with this hypothesis, applicants who tended to view the presence of ICU rotations during the PGY-1 year negatively also tended to view the entirely inpatient internal medicine experience negatively. Such applicants may have a more controllable lifestyle in mind for both the residency period and afterward (e.g., full-time outpatient independent practice). They may also be less interested in pursuing careers in consultation-liaison psychiatry and/or geriatric psychiatry, fields for which a significant background in internal medicine is helpful. Finally, some of the applicants who viewed the absence of pediatrics and/or family medicine rotations during the PGY-1 year negatively could represent a subsection that has already developed an interest in child psychiatry and believe that further exposure to the pediatric patient population beginning in internship is essential.
There are several limitations to this study. First, the response rate was only 49%; thus the results may well not generalize to all applicants to the Johns Hopkins Hospital residency program. While the response rate to this survey is lower than to prior similar surveys (66.7% in Levy and Schrage’s study ), it is important to note that several correlations were statistically significant without correction for multiple testing (i.e., suggesting some, though not overwhelming, statistical power). Second, it is important to clarify that the original purpose of the survey was to obtain information regarding factors of importance to interviewed Johns Hopkins Hospital applicants, not to do research. Thus, in an effort to maximize return rate with a simple form, only a small number of domains were assessed. Third, because no identifying information was obtained, it is difficult to say that the sample of respondents in this study is truly representative of the diverse group of applicants who apply for psychiatric residency positions. Finally, this study only collected data during the 2006 interview/match season, so it may not represent evolving trends among applicants.
Despite its limitations, the results of this survey do present several interesting and important findings. Applicants to psychiatric residency programs today view their perceptions of the philosophical orientation of a psychiatry department, as well as exposure to different modalities of psychotherapy, as very important factors in their selection of a residency program. These factors were rated as important more often than the call schedule of or the salary offered by a residency program (see Table 1). Also, applicants who tended to view call schedule as an important factor also tended to view the presence of ICU rotations and the absence of pediatrics and/or family medicine rotations during the PGY-1 year as negatives. Knowledge of these trends could be useful to psychiatric residency program directors in assessing factors that influence the program choice of their applicants.
The authors wish to acknowledge Dr. Philip R. Slavney for assistance with editing the manuscript and Dr. J. Raymond DePaulo for his support of this project.