Of the 288 people surveyed, 2 expressed their wish not to answer and 4 had an invalid email address. In total, 202 people (70%) responded to the questionnaire. Of the respondents, 9 (4%) were later excluded from the analysis due to missing data. In the end, the analysis was based on 193 people. The average age was 27 (± 2) years old. The sex ratio was 0.48 (93 women/193). Among the 193 respondents, 73 (38%) were single without children, 103 in a relationship without children (53%), and 17 in a relationship with children (9%). The respondent sample included 43 (22%) students in their 1st year of specialty in emergency medicine, 56 (29%) in their 2nd year, 31 (16%) in their 3rd year, 30 (16%) in their last year of specialty (4th year), a student on call, 5 (3%) students undergoing additional training in pediatric emergency, and 26 (14%) had been young graduates for < 1 year.
For each promotion, Table 1 details respondents’ motivation to practice Emergency Medicine and for an academic career in Emergency Medicine (rated out of 6), as well as the order of importance for the five overall motivational factors influencing their career choice (lifestyle, prestige/salary, orientation/social impact, interest in the field of activity, a role-model’s influence). On a scale from 1 to 6, motivation to practice Emergency Medicine was a median of 6 (6–6) and that for achieving an academic career in Emergency Medicine was a median of 3 (2–4). Twenty participants (10%) showed a genuine motivation for an academic career by rating this item 5 or 6 (out of 6).
The proportion of students strongly motivated by an academic career was not different according to the year of study (from the 1st year to the 5th year, 9%, 12%, 13%, 5%, 12%, P for trend, 0.83), nor by sex (12% for men, 9% for women, p value of 0.59). On the other hand, it was higher among the 77 students with a first-level master's degree (17% vs 6%, p value of 0.03) (Table 1 and Fig. 1).
The proportion of students with a first-level master's degree was higher among men (47% vs 32%, P = 0.054) and decreased with the year of study (from year 1 to year 5, 46%, 47%, 39%, 30%, 28%, P for trend, 0.03). The multivariate logistic regression showed a significant association between a high motivation for a university career and a first-level master’s research degree (OR, 3.2 [95%CI 1.3 to 3.9]) but did not show a significant association between higher motivation and sex or year of study.
For all respondents, the overall motivational factors were, in descending order: field of activity, societal impact, lifestyle, a role-model’s influence, and prestige/salary. Across the years of training, the societal impact and the field of activity were the two main overall motivational factors for an academic career (Table 1). Lifestyle, prestige and salary were the least important motivational factors at the end of the course. At the start of training a role-model’s influence was not a motivating factor but became more important toward the end of the course.
The specific appeal or deterrent factors for pursuing an academic career in Emergency Medicine were shown in Fig. 2. There is a strong appeal factor for teaching, but weaker factors for research and management. The time it takes to prepare the skills for an academic position and compatibility with family life were both deterrents. The 5 most important motivational factors for students strongly motivated by an academic career were: the variety of responsibilities and activities, teaching, intellectual challenge, promotion of emergency medicine, and working in university hospitals, with a median rating of 5 or 6 out of 6 (Table 2). The appeal of research and management were ranked in 7th and 8th position, with a median rating of 4.5 and 4, respectively.
Principal component analysis of motivational factors did not discriminate respondents who were highly motivated by an academic career compared to others (Fig. 3). However, highly motivated students tended to have higher scores on the 1st principal component (PC1) and lower scores on the 5th principal component (PC5). Higher PC1 and lower PC5 were associated with a higher appeal of working in a university hospital, research, and managerial responsibility for an Emergency Department. Higher PC1 and PC5 were associated with a higher appeal of teaching, peer recognition, a mentor’s influence, and varied activities. Higher PC1 combined with PC5 close to 0, was associated with a higher appeal of intellectual challenge. Among PC1 and PC5, the appeal of research and teaching seemed poorly correlated, which was confirmed by linear regression that showed no association between these motivational factors (estimate, 0.05 (0.06); p value of 0.38).
Measures to improve the appeal of UH careers in Emergency Medicine
Among the 8 motivational levers, 6 favored the appeal of an academic career for more than 50% of respondents (Fig. 4). Among respondents strongly motivated by an academic career, the 5 most important potential levers were the possibility of devoting at least 50% of the time to clinical activity, the time dedicated for assignments, clear recruitment prospects, the possibility to undertake only one or two assignments among teaching and research, and the opportunity to have experienced mentor oversight for an academic career (Table 2).