Characteristics of junior residents choosing alternative career pathways without entering traditional specialty residency programs: An exploratory descriptive study
TL;DR
In univariable logistic regression analysis, lower scores on the clinical evaluation survey and graduation from a public university were significantly associated with selecting an alternative career pathway.
Abstract
In Japan, the standard post-training trajectory for physicians involves entering a specialty residency program to obtain board certification. However, a growing number of recent graduates are opting for alternative career pathways immediately following their two-year mandatory postgraduate clinical training. This study aimed to identify the clinical evaluation scores and baseline backgrounds of junior residents who choose these alternative career paths. This retrospective, longitudinal, descriptive study assessed 222 postgraduate year 1 (PGY1) residents during their mandatory emergency medicine (EM) rotations at an academic university hospital from fiscal years 2019 to 2024 (April 2019 to March 2025). Residents were evaluated using a standardized three-item survey based on the national E-POrtfolio of Clinical training for PostGraduates (PG-EPOC) rubrics, measuring Clinical Attitude, Knowledge and Skills, and Positive Participation. Participants were divided into the Traditional Specialty Residency Pathway Group (n=212) and the Alternative Career Pathway Group (n=10). Ten residents (4.5%) chose an alternative career pathway. This group demonstrated significantly lower scores across all three clinical assessment domains during their EM rotation compared to the traditional residency group (Total survey score mean: 2.79 vs. 3.61, P=0.0105). In univariable logistic regression analysis, lower scores on the clinical evaluation survey and graduation from a public university were significantly associated with selecting an alternative career pathway. Junior residents who bypass traditional specialty residency programs exhibit lower clinical performance and engagement scores during their initial training. Early standardized clinical assessments and distinct educational backgrounds may serve as neutral indicators for identifying residents who require enhanced career counseling or educational support during their postgraduate transition.