Open Access Research article

Determinants of internal medicine residents' choice in the canadian R4 Fellowship Match: A qualitative study

Vijay J Daniels* and Narmin Kassam

Author Affiliations

Department of Medicine, University of Alberta, 2F1.13 WMC 8440 - 112 Street, Edmonton, T6G 2B7, Canada

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BMC Medical Education 2011, 11:44  doi:10.1186/1472-6920-11-44

Published: 29 June 2011



There is currently a discrepancy between Internal Medicine residents' decisions in the Canadian subspecialty fellowship match (known as the R4 match) and societal need. Some studies have been published examining factors that influence career choices. However, these were either demographic factors or factors pre-determined by the authors' opinion as possibly being important to incorporate into a survey.


A qualitative study was undertaken to identify factors that determine the residents choice in the subspecialty (R4) fellowship match using focus group discussions involving third and fourth year internal medicine residents


Based on content analysis of the discussion data, we identified five themes:

1) Practice environment including acuity of practice, ability to do procedures, lifestyle, job prospects and income

2) Exposure in rotations and to role models

3) Interest in subspecialty's patient population and common diseases

4) Prestige and respect of subspecialty

5) Fellowship training environment including fellowship program resources and length of training


There are a variety of factors that contribute to Internal Medicine residents' fellowship choice in Canada, many of which have been identified in previous survey studies. However, we found additional factors such as the resources available in a fellowship program, the prestige and respect of a subspecialty/career, and the recent trend towards a two-year General Internal Medicine fellowship in our country.