Tea and cognitive health in aging: Current evidence and future directions.

Academic physicians educate and mentor medical students, residents, and fellows, conduct cutting-edge research, and provide patient care to fulfil the tripartite mission of academic medicine []. In 2021, 42% of U.S. medical graduates completing the Association of American Medical College’s (AAMC) annual Graduation Questionnaire reported planning to pursue academic-medicine faculty positions during their careers []. Twenty percent of physicians who completed residency training between 2011 and 2020 held a full-time faculty position at U.S. medical schools in 2021 []. As clinical practice provides more than half of medical schools’ revenue [], and they face needs for increased clinical-enterprise growth to support the research and education missions [], research-intensive institutions may seek to retain physicians who primarily provide clinical care, a group not traditionally recruited in research-intensive institutions. National-cohort studies have identified several variables positively associated with academic-medicine faculty appointment including conducting research and/or authorship on publications during medical school and residency, graduating with MD/PhD (vs. MD or MD/other-advanced) degrees [], and among MD/PhD graduates attending Medical Scientist Training Programme (MSTP)-funded medical schools []. Medical school-related debt has been associated with a lower likelihood of choosing an academic-medicine career among anaesthesiology interns, residents, and fellows [], and positive-mentoring experiences during fellowship have been associated with pursuing an academic-medicine career []. However, fellows’ decision-making about whether to stay at the institution where they trained remains understudied. With 28,868 fellows training in subspecialties in the U.S. in 2023-2024 [], fellows can be an important source of future faculty. Graduating residents may apply to fellowship positions using the Electronic Residency Application Service® (ERAS®) [], wherein fellows apply to their desired subspecialty. Applicants are evaluated by fellowship programmes through a combination of application review and interviews. Following interviews, applicants rank their preferred programmes and programmes rank their preferred applicants in ERAS. An algorithmic process matches applicants to a fellowship programme based on these ranked preferences. In smaller subspecialty fellowships, most commonly surgical and non-clinical (often research or academic career pathway) fellowships, the application process may occur outside of ERAS through direct application and interview. Fellows earn wages as employees of the institution where they train. Fellowships may include either or both subspecialty training after residency and focused preparation for an academic career, but fellowships are not degree programmes. Understanding fellows’ decision-making might assist fellowship programme directors in recruiting and guiding fellows’ career development during training to align with and support fellows’ career goals [] as well as gauge and promote a fellow’s interest in staying at the institution where they trained to meet institutional and departmental needs, if a position is available. To investigate fellows’ decisions to remain at their institution of training, we planned a mixed-methods study at Washington University School of Medicine (WashU Medicine) to identify variables associated with fellows’ decisions to join our faculty, to explore reasons for their decisions, and to examine what can be done to encourage fellows to accept offered positions.