Perceptions of research experience during internal medicine training: insights from a national survey

Abstract

Background

There is limited insights into how internal medicine (IM) residents perceive research. This study aimed to assess residents’ perceptions across five domains: well-being, research competence, research support, effect on training, and research quality.

Methods

In 2022, a survey instrument was developed to assess residents’ perceptions of research across five domains. All IM programs listed in Fellowship and Residency Electronic Interactive Database (FREIDA) were contacted by email, and residents were invited to participate.

Results

A total of 530 residents from 67 IM programs completed our survey. Just over 80% of respondents had participated in research during residency. Residents were dissatisfied with research opportunities and infrastructure but viewed research funding more positively. Negative views were held regarding the impact of publication pressure on well-being and the quality of research produced. Publication pressure was perceived to compromise clinical work and limit career paths. Some residents acknowledged that research enriched their training. Residents who had already matched into a fellowship program reported higher research competency and better impressions of the impact of research on their medical training compared to those who had not yet or did not plan to match into a fellowship. Residents who planned to prioritize research in their future careers held positive perceptions of research across multiple domains.

Conclusions

This study provides valuable insights into the impact of publication pressure on IM residents. The findings suggest a need to realign expectations for research productivity or target interventions to better support research for all residents, regardless of track or career goals.

Background

Participating in scholarly activity during residency is an Accreditation Council for Graduate Medical Education (ACGME) requirement, fulfilled by activities as varied as presenting at journal clubs or serving as a journal editor [1]. Participation in research enhances career prospects, including the likelihood of securing preferred fellowship positions [2–5]. Considering the competition for internal medicine (IM) fellowships, residents may perceive research as a means to differentiate themselves from other applicants [5–7].

Teaching scientific thinking is most effective when medical trainees are involved in scientific research [8]. Anaya-Prado et al. argue that the experience of conducting research and publishing the results is a vital prerequisite to physicians effectively evaluating other scientific studies [9]. Publishing research results during medical school and residency has been shown to correlate with continued publication throughout the physician’s career [10]. A strong publication record, in turn, can contribute to career advancement. The skills developed through research and writing may provide a counterbalance to the detrimental aspects of pressure to publish (‘publication pressure’). However, the demands of pursuing research, combined with other residency responsibilities, may detract from the quality of a trainee’s clinical training, patient care, or well-being, and contribute to burnout [1,3,4]. Additionally, publication pressure is a known driver for students to engage in academic misrepresentation and erroneous claims of publications [11,12].

Understanding the pressures residents face in conducting and publishing research is crucial for reshaping residency programs so that their scholarly expectations align with actual training demands. By examining residents’ reported challenges, institutions can adapt support structures and redefine publication goals. This study investigates publication pressure through residents’ perceptions of research and publication with regards to well-being, research competence, research support, effect on medical training, and quality of research produced. Additionally, we explore potential factors that influence residents’ perceptions, including resident demographics, program details, and other motivating factors, as well as if publication pressure influences career choices.

Methods

Sample and participants

Potential participants included residents at all IM and combined IM residency programs with a program email address listed on the American Medical Association’s Fellowship and Residency Electronic Interactive Database (FREIDA) website [13].

Survey development

We adapted validated survey tools for our study and conducted pilot testing with a small group of IM residents for reliability and validity [14,15]. Those in the pilot were excluded from the final sample. Feedback refined survey questions and improved content validity. Participation in research was defined for respondents as any active engagement in scholarly work during residency (completed or ongoing). The survey assessed residents’ perceptions across domains of well-being, research competence, support, impact on training, and research quality. It was comprised of 27 five-point Likert scale statements categorized into five domains and administered via Microsoft Forms. The mean scores were computed within each domain. Low scores indicate low agreement with the statement while higher scores indicated strong agreement with the statement. The survey details can be found in the supplemental file.

Data collection

We emailed all 451 IM and combined IM residency programs and requested that they forward our electronic invitation to participate, including a link to the survey, to all current residents. After two weeks, a reminder email was sent to all programs. The survey was anonymous, with no collection of identifying information, and participation was voluntary. To submit the survey, participants were required to answer all of the questions. The survey was available for participation between May 23 and June 23, 2022.

Data analysis

We excluded responses with negligible variances where participants consistently chose the same response, irrespective of content or direction. Scores for negatively worded statements were reversed, and internal consistency was assessed using Cronbach’s alpha. Percentages, mean, and standard deviation (SD) were calculated for each survey domain. One-sample t-tests (p < 0.01) determined if mean scores significantly differed from the neutral value of 3.

We conducted a factorial analysis of variance (ANOVA) on the scores from all respondents for each domain of the survey. We explored whether perceptions differed based on several variables, including training level, race/ethnicity, gender, residency program type, fellowship match status, visa requirement, type of medical school attended, and intention to prioritize research in the future. Post-hoc comparisons were carried out using the least significant difference method. Significance was set at p < 0.006 after Bonferroni correction for multiple comparisons. All analyses were performed using IBM SPSS V27 Statistics.

Ethical considerations

The study received ethical approval from the Allegheny Health Network Research Institutional Review Board before data collection(2022-079-AGH). All participants provided informed written consent before participating in the study. The study ensured the confidentiality and anonymity of participants by not collecting any personal information. The study adhered to the ethical principles outlined in the Declaration of Helsinki [16].

Results

Internal consistency of the instrument

Supplemental Table S1 displays the Cronbach’s alpha values (range from 0.64 ‘research quality’ to 0.82 ‘effect on well-being’). These values indicate acceptable to good reliability. Corrected item-total correlations were above 0.30, suggesting that each item within its respective domain consistently measures the intended construct [17].

Participants

Sixty-seven of 451 programs shared our survey, yielding an 11.8% response rate with 530 trainee respondents out of 4,492 potential participants. Institutes that did not share our survey were not included as potential respondents. We excluded 48 non-categorical IM or IM combined trainee responses and dropped 50 responses with negligible variances. The final sample size was 432 respondents from programs from multiple states. Most represented were Pennsylvania (15.5%), Massachusetts (11.3%), New York (10.4%), Ohio (9.3%), Connecticut (7.4%), Texas (6.9%), and California (4.9%).

Participants were evenly split by gender, were mostly Asian (37.3%) or White (35.6%), and the majority were aged 26-30 (69.7%). Respondents spanned all levels of training: post-graduate-year (PGY)-1 = 144 (33.3%), PGY-2 = 156 (36.1%), PGY-3 = 127 (29.4%), and PGY-4 or higher = 5 (1.2%). Approximately half trained at university-based residency programs (48.8%), and the majority did not require a visa (70.8%) (Table 1). Career interests varied; common choices included hospital medicine (16.52%), cardiology (13.73%), hematology-oncology (9.66%), gastroenterology (9.01%), pulmonology and critical care (8.37%), and primary care (7.94%) (Supplemental Table S2).

Table 1.

Demographics and professional experiences of study participants (n = 432).

Variable	Levels	n (%)
Gender	Male	211 (48.8)
	Female	216 (50.0)
	Non-Binary	2 (0.5)
	Prefer not to say	3 (0.7)
Race	Asian	161 (37.3)
	Black or African American	23 (5.3)
	Hispanic or Latino	42 (9.7)
	White	154 (35.6)
	Other	21 (4.9)
	Prefer not to say	31 (7.2)
Training Level	PGY1	144 (33.3)
	PGY2	156 (36.1)
	PGY3	127 (29.4)
	PGY4 or greater	5 (1.2)
Residency Program	Community Based	116 (26.9)
	Community Based, University Affiliated	105 (24.3)
	University Based	211 (48.8)
Location of residency program (State abbreviation)	Northeast (PA, NY, NJ, CT, MA, RI, VT, NH, ME)	211 (48.8)
	Midwest (ND, SD, NE, KS, MO, IA, MN, IL, WI, IN, MI, OH)	88 (20.4)
	South (TX, OK, AR, LA, MS, AL, TN, KY, GA, FL, SC, NC, WV, VA, DC, MD, DE)	91 (21.1)
	West (WA, OR, ID, MT, WY, CO, UT, NV, CA, AZ, NM, AK, HI)	42 (9.7)
Matched into Fellowship	No	376 (87)
	Yes	56 (13)
Age group	<25 yrs.	4 (0.9)
	26-30 yrs.	301 (69.7)
	31-35 yrs.	109 (25.2)
	36-40 yrs.	11 (2.5)
	41-45 yrs.	3 (0.7)
	46 yrs. and greater	1 (0.2)
	Prefer not to say	3 (0.7)
Required to apply for a visa?	No	306 (70.8)
	Yes	120 (27.8)
	Prefer not to say	6 (1.4)
Residency type	Categorical Internal Medicine Resident	407 (94.2)
	Med-Peds Resident	18 (4.2)
	Other Med-Combined programs	7 (1.6)
Medical school	Allopathic US Medical School (MD)	159 (36.8)
	Caribbean Medical School (MD)	45 (10.4)
	International Medical School (MD/MBBS)	145 (33.6)
	Osteopathic US Medical School (DO)	81 (18.8)
	Other	2 (0.5)
Participation in research during residency	No	83 (19.2)
	Yes	349 (80.8)
I plan to make research an important part of my future career	Strongly Agree	44 (10.2)
	Agree	88 (20.4)
	Neither Agree nor Disagree	110 (25.5)
	Disagree	140 (32.4)
	Strongly Disagree	50 (11.6)
No. of projects published during residency	0	89 (20.6)
	1-5	219 (50.7)
	6-10	26 (6.0)
	11-15	7 (1.6)
	>15	8 (1.9)
	Prefer not to say	83 (19.2)

PGY: Postgraduate year.

Participation in research

The majority of respondents (80.8%) participated in research during residency, even if it had not yet been published or presented. The majority had published 1-5 projects (50.7%). Research participation differed significantly by PGY level (p < 0.001), with higher engagement among PGY2 and PGY3 residents. Residents who matched into fellowship were also significantly more likely to have participated in research (p < 0.001) (Supplemental Table S3). About one-third of participants did not plan for research to be an important part of their future career (32.4%).

Perception of research experiences during training

The mean value of scores in the domains of research support, research competence, and effect on medical training did not significantly differ from the neutral value of 3 (Supplement Table S4). Respondents reported a significant negative impact of publication pressure on well-being (p < 0.001) and perceived research quality (p < 0.001). The highest agreement was observed in satisfaction with research support (mean = 3.08, SD = 0.75). The lowest agreement was observed in achievement of research productivity without compromising quality (mean = 2.42, SD = 0.64).

Co-authors were the primary source of research support with 62% of participants expressing agreement or strong agreement, with supervisors following at 53% (Supplemental Table S1 and Figure 1). Satisfaction with financial support was 41%, while satisfaction with research project availability and program research support services stood at 33% and 27%, respectively.

Figure 1.

The perception of research experience by internal medicine residents.

Residents’ perceptions of their research competency varied. Fifty-seven percent felt disadvantaged due to limited pre-residency research experience. Although 61% were confident in interpreting data, only 38% believed they could handle all aspects of publishing.

Regarding the impact of research on medical training, 61% of respondents believed that publication pressure contributed to cutting corners in clinical work, and 53% believed they had to exclude some career paths due to expectations for research. Forty-three percent believed they sacrificed clinical training to achieve publications. Approximately 53% believed research enriched their training, and 73% thought their colleagues met general residency requirements despite publication pressure.

Regarding well-being, 77% worked on publications outside work hours and caused stress at home for 73%. Leisure activities were affected for 67%. Fifty-three percent struggled finding time for writing publications, 44% experienced compromised sleep, and 40% lacked peace of mind while working on publications.

Participants reported negative effects of publication pressure on research quality: 87% published without considering scientific value, 68% engaged in projects that did not interest them for the sake of publishing, 54% believed it did not add value to medical science, and 50% thought it increased scientific output at the expense of quality. Additionally, 38% suspected colleagues manipulated data due to publication pressure.

Influence of participant factors on research during residency

Respondents’ perceptions of research during medical training differed significantly by race, fellowship match status, and future career plans in research. Those who had already matched into a fellowship program reported higher levels of research competence compared to those who had not yet matched or did not plan to apply (Mean = 3.43, SD = 0.70 versus Mean = 2.99, SD = 0.76; F = 10.771, p < 0.006). Respondents that had matched into a fellowship also perceived more positive effects of research on their medical training compared to residents who had not yet or did not plan to match (Mean = 3.24, SD = 0.65 versus Mean = 2.96, SD = 0.68; F = 7.772, p < 0.006).

Significant differences were observed in self-perception of research competence based on race (F = 3.76, p < 0.006) (Table 2). To further investigate these differences, post-hoc comparisons using the least significant difference were conducted. Black/African American respondents reported higher levels of research competence compared to Asian residents (Mean = 3.40, SD = 0.78 versus Mean = 2.95, SD = 0.77). However, perceptions of research competence among residents from other racial backgrounds were similar (Supplemental Table S5).

Table 2.

Factorial ANOVA to test the difference in the perceptions of internal medicine residents regarding each domain of their experience in research according to demographics and career plans.

Domain	Variable	SS	F
Research Competence	Training Level	2.435	2.635
	Race	6.941	3.756*
	Gender	3.176	6.873
	Residency Program	1.093	1.183
	Fellowship	4.976	10.771*
	Visa	0.001	0.002
	Medical School	3.913	2.823
	Future Career	28.721	15.541*
Research Support	Training Level	1.559	1.488
	Race	5.006	2.389
	Gender	0.466	0.890
	Residency Program	2.667	2.546
	Fellowship	2.160	4.124
	Visa	1.053	2.010
	Medical School	0.849	0.541
	Future Career	0.814	0.388
Effect on Well-being	Training Level	1.343	1.169
	Race	2.316	1.008
	Gender	0.040	0.070
	Residency Program	4.064	3.537
	Fellowship	1.066	1.855
	Visa	0.528	0.918
	Medical School	0.078	0.045
	Future Career	8.708	3.789*
Research Quality	Training Level	0.037	0.051
	Race	1.898	1.330
	Gender	1.692	4.743
	Residency Program	1.914	2.683
	Fellowship	0.079	0.223
	Visa	0.017	0.047
	Medical School	1.180	1.102
	Future Career	13.151	9.217*
Effect on Medical Training	Training Level	1.092	1.458
	Race	4.121	2.752
	Gender	0.996	2.660
	Residency Program	0.080	0.106
	Fellowship	2.909	7.772*
	Visa	0.428	1.144
	Medical School	0.193	0.172
	Future Career	29.247	19.533*

SS (Sum of Squares): Measures the total variation attributable to each factor in the analysis.

F (F-ratio): The test statistic used in ANOVA, computed by dividing the MS of a factor by the MS of the error term; higher values suggest a greater likelihood that the observed effect is statistically significant.

^*p ≤ 0.006.

Significant differences existed in respondents’ perceptions based on their intentions to prioritize research in their future careers. These differences were found in research competency (F = 15.54, p < 0.006), well-being (F = 3.79, p < 0.006), research quality (F = 9.22, p < 0.006), and impact on medical training (F = 19.53, p < 0.006) (Table 2). Post-hoc analysis revealed that residents intending to pursue research careers had more positive perceptions in these areas compared to other residents (Supplemental Table S6).

Discussion

This study represents the first comprehensive investigation of IM residents’ research experiences and perceptions by exploring their impact on five key domains: well-being, research competence, research support, effect on medical training, and quality of research produced. The study sample was diverse in terms of gender, race, age, training level, residency program type, and future career plans of respondents.

Our analysis revealed several significant themes in how respondents perceive the pressure to publish (Figure 1). First, respondents expressed dissatisfaction with availability of research projects, and research support services available to them while having more favourable views about financial support. Second, they held negative views regarding the impact of research on their well-being and the quality of research produced. Third, publication pressure was perceived to compromise clinical work and limit career paths, although some residents acknowledged that research enriched their training while still allowing them to fulfil broad residency training expectations. Fourth, respondents who had already matched into a fellowship program reported higher research competence and perceived more positive effects of research on their medical training compared to those who had not yet matched or did not plan to apply. Lastly, respondents who intended to prioritize research in their future careers reported more positive perceptions of research across various domains. These findings underscore the need to balance research demands and clinical responsibilities in residency, promoting a culture that values high-quality research and resident well-being.

Programs should provide sufficient support and resources to help residents manage research workload and address associated stressors effectively. The US faces a shortage of physician-scientists [18,19] and participating in research during training can foster a desire to pursue a career as a research investigator [20–22]. Additionally, research cultivates critical thinking, sparks intellectual curiosity, and nurtures lifelong learning skills, all of which are indispensable in this era of evidence-based medicine [23–25]. Our findings and other recent studies demonstrate higher rates of research participation during training compared to earlier reports [26–28]. The increased participation of residents in research may be due to intrinsic motivation, external pressures such as career goals and fellowship aspirations, and improved institutional support [5,29].

Research support and competency

Residents’ research activity is influenced by several factors. A significant limitation for resident investigators is scarce research mentorship, often attributed to a lack of trained faculty [30]. Additionally, residents express concerns about faculty lacking time and specific curricula for research mentorship [31]. In our study, 62% of participants identified co-authors as the primary sources of support during their research endeavours. A lower, but still encouraging, 53% felt their immediate supervisors fully understood the challenges they faced while working on publications. A key element for a thriving research program is the presence of a substantial and effective mentoring pool [32]. This includes diverse types of mentors, which not only alleviates mentor fatigue, but also offers greater flexibility for both residents and mentors [32]. The low satisfaction among our participants regarding the availability of research projects likely relates to the available mentoring pool.

Respondents also expressed dissatisfaction with institutional resources available to support their research activity. Only 27% of participants in our study were satisfied with their program’s research support services. Satisfaction with financial support was generally favourable, though there is room for improvement. These findings align with existing literature, as residents have cited insufficient time, inadequate mentorship, limited faculty support, absence of a structured research curriculum or network, deficiencies in knowledge and skills, lack of incentives and rewards, inadequate research funding, and lack of personal interest in research as barriers to conducting research [23,24,33–39].

Our findings suggest a need for more formal and comprehensive research training during residency. A considerable number of participants believed their lack of research experience prior to residency put them at a disadvantage compared to their peers. Previous reports have highlighted suboptimal teaching of research skills in residency, with adequacy ranging from 19% to 38% [23,33,35]. Recent findings from program directors (PDs) indicate an increase in formal instruction of critical research skills in IM residency programs [29]. While PDs report a marked improvement in research curricula, residents may still perceive these changes as insufficient in preparing them to cope with all aspects of publishing research. This discrepancy likely explains why surveys have consistently reported low rates of resident publications in peer-reviewed journals, ranging from 5% to 10% [23,35]. While more than half of residents expressed confidence in interpreting research findings and interacting effectively with co-authors or reviewers, only 38% felt fully competent in managing all aspects of the publishing process.

Our data suggests there may be specific steps within the publishing process for which residents require further training and support, as only 38% of participants believed they could handle all aspects of publishing. Although, complete research independence may exceed typical residency expectations; programs maybe should aim for fundamental competence with key aspects of the research process. Initial investigations have shown that IM residents have a positive perception of research training that is integrated into their residency experience [40,41]. Incorporating a dedicated research curriculum has been shown to enhance residents’ scholarly output [23,33, 42,43]. Moreover, having a dedicated research director with allocated time has been shown to increase resident publication rates [23,44].

Well-being

A significant number of residents worked on publications outside of regular work hours resulting in increased stress at home and compromised engagement in leisure activities. Despite previous reports suggesting that work-hour restrictions have allowed more time for academic pursuits and increased research publications, our study highlights the persistent challenge faced by residents in finding sufficient time for research [23,26, 33–36]. Our findings align with recent reports across various specialties [45–47].

Furthermore, sleep was compromised for a substantial number of our participants, highlighting potential negative consequences for well-being. Previous studies have shown that stress and a high risk of burnout, particularly emotional exhaustion, are associated with an increased likelihood of experiencing sleep problems and insomnia [48]. In that regard, one study found that higher institutional research rankings were associated with increased depressive symptoms during intern year; however, the authors acknowledged that this association might reflect other institutional characteristics, such as greater pressure for productivity, institutional culture, or patient complexity [49].

Quality of research output

Stressors arising from publication pressure can compromise ethical decision-making and lead to scientific misconduct [50–53]. This can include fabrication, falsification, plagiarism, selective reporting, data manipulation, selective citing, and guest authorships [54]. In our study, a considerable proportion of participants (38%) suspected their colleagues had manipulated data due to publication pressure. Similar rates of perceived academic misconduct have been reported in studies involving medical students [55,56]. These behaviours ultimately pose a risk to the integrity of research-based clinical practice [57,58]. Beyond the quality of literature produced, engaging in unprofessional behaviour during training is strongly correlated with a higher likelihood of facing disciplinary action during one’s professional life [59,60].

Our study revealed additional concerning findings related to perceived integrity of the research landscape. Residents perceived that their peers prioritized quantity of research over scientific value. Numerous participants reported publishing solely for the sake of publishing, participating in projects without personal interest, and the perception that publication pressure does not advance medical science. Similar concerns have been documented before, highlighting a trend of prioritizing publishable results at the expense of quality, validity, and scientific rigour [61].

Clinical training and programmatic requirements

Responses also revealed a self-reported negative impact on clinical training. Many respondents perceived that publication pressure compromised the quality of their clinical work. Cullen et al. found that residents who ultimately matched into cardiology fellowships scored higher on the cardiology section yet lower on the overall PGY-2 ITE, indicating that time devoted to publications and other résumé-building activities for fellowship applications may reduce broad exam preparation [5]. Data suggest that research-focused institutions may also prioritize productivity at the expense of clinical outcomes [49,62,63]. An emphasis on output can have detrimental effects on academic activities that compete with research, including clinical and educational tasks [58,64,65]. Importantly, our findings represent residents’ perceptions rather than objective measures of clinical competence or performance.

Furthermore, over half of our respondents indicated that research expectations influenced their career choices. Similar trends have been observed in other specialties, such as dermatology, where high publication demands have significantly impacted applicants’ success in securing training positions [66–68]. Consequently, specialties with stringent research requirements may unintentionally deter capable trainees who could otherwise excel clinically or educationally.

Participants also recognized some positive effects of research on their training. They reported that research enriched their overall educational experience and observed that colleagues were able to meet their residency requirements despite publication pressure. Similarly, previous studies have shown that residents who undergo research training exhibit enhanced appreciation for evidence-based medicine and achieve better clinical competency scores [69,70].

How various factors impacted perceptions

The results revealed significant differences in residents’ perceptions based on participant factors, including fellowship match status, race/ethnicity, and future career plans. Residents who had already secured fellowship reported higher levels of research competence and perceived greater positive impact of research on their medical training compared to those who had not yet matched or did not plan to. This observation aligns with a longitudinal study which reported publication rates of 0.29 articles per resident per year for residents bound for fellowships, while non-fellowship-bound residents had a publication rate of 0.13 articles per resident per year [71]. This association may be influenced by increased exposure to research opportunities, greater institutional support, or self-selection of research-oriented residents into competitive fellowship pathways. However, it remains unclear whether residents’ favourable perceptions of research are a result of their success in matching, or the research experience gained during the fellowship application process.

A notable finding was the high research participation rate during residency, despite a significant portion not planning to focus on research in their future careers. Residents who expressed intentions to prioritize research in their future careers rated their research competence, impact of research on well-being, research quality, and impact on their medical training more favourably than those who did not intend to prioritize research after their training. Enhancing awareness of ACGME-compliant scholarly activities, creating pathways towards subspecialty careers that are independent of traditional publication productivity, or alternatively prioritizing the development of research aptitudes ubiquitously for all medical students and residents are steps that could create a more positive experience with research during training.

We observed significant differences in self-perceived research competence based on race, with Black/African American residents reporting higher levels compared to their Asian counterparts. Although our survey design does not allow us to definitively identify the underlying reasons for this finding. Structural inequities in residency training, such as implicit biases, differential expectations, and disparities in mentoring opportunities, have been previously documented and linked to differences in clinical performance assessment scores [72]. Future studies should explore how these structural factors influence residents’ experiences and perceptions of research competence.

Limitations

This study’s limitations include a cross-sectional design, limiting causal conclusions and temporal insights. Self-reported perceptions introduce potential bias, which we attempted to limit with pilot survey validation. The low overall response rate restricts generalizability. Potential nonresponse bias from PDs forwarding the survey may impact results systematically; those with bias for or against research may have selectively shared the survey. Participants may differ from non-respondents in research experience and perception, introducing selection bias. We acknowledge that some programs may have shared the survey but received no responses; thus, the true response rate could be lower than our calculated figure. This survey, conducted during the COVID-19 pandemic, may reflect the general heightened stress, anxiety, and burnout reported among residents [73,74]. Additionally, even within program categories (e.g. ‘university-based’), institutions vary greatly in resources and research support, highlighting that our classification does not capture the full complexity of training environments. Nevertheless, the 67 participating programs spanned multiple regions and training types, providing diverse perspectives that can yield valuable insights even if they represent only a fraction of the national resident cohort. Exclusive focus on IM residents warrants caution in generalizing findings to other specialties. Moreover, our study specifically assessed residents’ perceptions of publication pressure without direct comparisons to other residency stressors, such as clinical workload or on-call responsibilities, which limits our ability to contextualize the relative impact of publication-related stress.

Conclusion

This study provides valuable insights into the impact of publication pressure on IM residents. The findings suggest a need to realign expectations for research productivity or target interventions to better support research for all residents, regardless of career goals.

Funding Statement

The authors declare that no funding was received for this study.

Ethical approval

The Allegheny Health Network Research Institute Institutional Review Board determined the study qualified for exempt status (2022-079-AGH).

Consent for publication

Not applicable.

Disclaimers

None.

Previous presentations

None.

Clinical trial number

Not applicable.

Data sharing

The data that supports the findings of this study are available from the corresponding author, AK, upon reasonable request.

Disclosure statement

The authors report no conflict of interest.