Status of Resident Attrition From Surgical Residency in the Past, Present, and Future Outlook

Faris Shweikeh, Alexander C. Schwed, Chiu-Hsieh Hsu, Valentine N Nfonsam

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: To investigate the current rate of attrition in general surgery residency, assess the risk factors, and identify prevention strategies. Design: A literature review of the PubMed and MEDLINE databases, from January 1, 1980 to February 1, 2016, for relevant articles. The calculated attrition rate and the statistically significant influencing factors were the main measures and outcomes. Selection: All English language articles that described attrition from a general surgery residency were included. Articles that performed an assessment of attrition rates, academic performance, reasons for resident loss, and demographics were identified and data from these studies were collected. Random-effect meta-analysis and meta-regression based on a generalized mixed-effects model was performed. Results: A total of 26 studies were included. Reported attrition rates ranged from 2% to 30% over the course of residency training. Random-effect meta-analysis is indicative of a yearly attrition rate of 2.4% (95% CI: 1.3%-3.5%) and a cumulative 5-year attrition rate of 12.9% (95% CI: 7.9%-17.8%). Most of them leave residency during their first 2 years, and the rate significantly decreases with increasing postgraduate year (p < 0.0001). The Accreditation Council for Graduate Medical Education mandated 80-hour week is associated with a higher rate, though not significantly (3.2% [95% CI: 1.3%-5.1%] vs. 2.2% [0.9%-3.5%], p = 0.37). Pooled analysis demonstrates no statistically significant difference in the rate of attrition between males and females (2.1% [95% CI: 1.1%-3%] vs. 2.9% [95% CI: 1.6%-4.1%], p = 0.73). Most remain in graduate medical education and pursue residency training in other specialties. Conclusion: Attrition in general surgery most commonly occurs within the first 2 years of training and, in contrast to previous findings, is not related to female sex. Restrictions on work hours seem to have increased the rate, whereas remediation practices can prevent it. Training programs should direct efforts towards attrition-prevention strategies.

Original languageEnglish (US)
JournalJournal of Surgical Education
DOIs
StateAccepted/In press - 2017

Fingerprint

Internship and Residency
surgery
resident
present
Graduate Medical Education
graduate
course of training
Meta-Analysis
accreditation
English language
training program
education
Accreditation
regression
PubMed
MEDLINE
Language
performance
Demography
Outcome Assessment (Health Care)

Keywords

  • Attrition
  • Graduate medical education
  • Incidence
  • Internship and residency
  • Practice-Based Learning and Improvement
  • Risk factors
  • Surgical specialties

ASJC Scopus subject areas

  • Surgery
  • Education

Cite this

@article{463326ac84fa46948141861b194eccc8,
title = "Status of Resident Attrition From Surgical Residency in the Past, Present, and Future Outlook",
abstract = "Objective: To investigate the current rate of attrition in general surgery residency, assess the risk factors, and identify prevention strategies. Design: A literature review of the PubMed and MEDLINE databases, from January 1, 1980 to February 1, 2016, for relevant articles. The calculated attrition rate and the statistically significant influencing factors were the main measures and outcomes. Selection: All English language articles that described attrition from a general surgery residency were included. Articles that performed an assessment of attrition rates, academic performance, reasons for resident loss, and demographics were identified and data from these studies were collected. Random-effect meta-analysis and meta-regression based on a generalized mixed-effects model was performed. Results: A total of 26 studies were included. Reported attrition rates ranged from 2{\%} to 30{\%} over the course of residency training. Random-effect meta-analysis is indicative of a yearly attrition rate of 2.4{\%} (95{\%} CI: 1.3{\%}-3.5{\%}) and a cumulative 5-year attrition rate of 12.9{\%} (95{\%} CI: 7.9{\%}-17.8{\%}). Most of them leave residency during their first 2 years, and the rate significantly decreases with increasing postgraduate year (p < 0.0001). The Accreditation Council for Graduate Medical Education mandated 80-hour week is associated with a higher rate, though not significantly (3.2{\%} [95{\%} CI: 1.3{\%}-5.1{\%}] vs. 2.2{\%} [0.9{\%}-3.5{\%}], p = 0.37). Pooled analysis demonstrates no statistically significant difference in the rate of attrition between males and females (2.1{\%} [95{\%} CI: 1.1{\%}-3{\%}] vs. 2.9{\%} [95{\%} CI: 1.6{\%}-4.1{\%}], p = 0.73). Most remain in graduate medical education and pursue residency training in other specialties. Conclusion: Attrition in general surgery most commonly occurs within the first 2 years of training and, in contrast to previous findings, is not related to female sex. Restrictions on work hours seem to have increased the rate, whereas remediation practices can prevent it. Training programs should direct efforts towards attrition-prevention strategies.",
keywords = "Attrition, Graduate medical education, Incidence, Internship and residency, Practice-Based Learning and Improvement, Risk factors, Surgical specialties",
author = "Faris Shweikeh and Schwed, {Alexander C.} and Chiu-Hsieh Hsu and Nfonsam, {Valentine N}",
year = "2017",
doi = "10.1016/j.jsurg.2017.07.015",
language = "English (US)",
journal = "Journal of Surgical Education",
issn = "1931-7204",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Status of Resident Attrition From Surgical Residency in the Past, Present, and Future Outlook

AU - Shweikeh, Faris

AU - Schwed, Alexander C.

AU - Hsu, Chiu-Hsieh

AU - Nfonsam, Valentine N

PY - 2017

Y1 - 2017

N2 - Objective: To investigate the current rate of attrition in general surgery residency, assess the risk factors, and identify prevention strategies. Design: A literature review of the PubMed and MEDLINE databases, from January 1, 1980 to February 1, 2016, for relevant articles. The calculated attrition rate and the statistically significant influencing factors were the main measures and outcomes. Selection: All English language articles that described attrition from a general surgery residency were included. Articles that performed an assessment of attrition rates, academic performance, reasons for resident loss, and demographics were identified and data from these studies were collected. Random-effect meta-analysis and meta-regression based on a generalized mixed-effects model was performed. Results: A total of 26 studies were included. Reported attrition rates ranged from 2% to 30% over the course of residency training. Random-effect meta-analysis is indicative of a yearly attrition rate of 2.4% (95% CI: 1.3%-3.5%) and a cumulative 5-year attrition rate of 12.9% (95% CI: 7.9%-17.8%). Most of them leave residency during their first 2 years, and the rate significantly decreases with increasing postgraduate year (p < 0.0001). The Accreditation Council for Graduate Medical Education mandated 80-hour week is associated with a higher rate, though not significantly (3.2% [95% CI: 1.3%-5.1%] vs. 2.2% [0.9%-3.5%], p = 0.37). Pooled analysis demonstrates no statistically significant difference in the rate of attrition between males and females (2.1% [95% CI: 1.1%-3%] vs. 2.9% [95% CI: 1.6%-4.1%], p = 0.73). Most remain in graduate medical education and pursue residency training in other specialties. Conclusion: Attrition in general surgery most commonly occurs within the first 2 years of training and, in contrast to previous findings, is not related to female sex. Restrictions on work hours seem to have increased the rate, whereas remediation practices can prevent it. Training programs should direct efforts towards attrition-prevention strategies.

AB - Objective: To investigate the current rate of attrition in general surgery residency, assess the risk factors, and identify prevention strategies. Design: A literature review of the PubMed and MEDLINE databases, from January 1, 1980 to February 1, 2016, for relevant articles. The calculated attrition rate and the statistically significant influencing factors were the main measures and outcomes. Selection: All English language articles that described attrition from a general surgery residency were included. Articles that performed an assessment of attrition rates, academic performance, reasons for resident loss, and demographics were identified and data from these studies were collected. Random-effect meta-analysis and meta-regression based on a generalized mixed-effects model was performed. Results: A total of 26 studies were included. Reported attrition rates ranged from 2% to 30% over the course of residency training. Random-effect meta-analysis is indicative of a yearly attrition rate of 2.4% (95% CI: 1.3%-3.5%) and a cumulative 5-year attrition rate of 12.9% (95% CI: 7.9%-17.8%). Most of them leave residency during their first 2 years, and the rate significantly decreases with increasing postgraduate year (p < 0.0001). The Accreditation Council for Graduate Medical Education mandated 80-hour week is associated with a higher rate, though not significantly (3.2% [95% CI: 1.3%-5.1%] vs. 2.2% [0.9%-3.5%], p = 0.37). Pooled analysis demonstrates no statistically significant difference in the rate of attrition between males and females (2.1% [95% CI: 1.1%-3%] vs. 2.9% [95% CI: 1.6%-4.1%], p = 0.73). Most remain in graduate medical education and pursue residency training in other specialties. Conclusion: Attrition in general surgery most commonly occurs within the first 2 years of training and, in contrast to previous findings, is not related to female sex. Restrictions on work hours seem to have increased the rate, whereas remediation practices can prevent it. Training programs should direct efforts towards attrition-prevention strategies.

KW - Attrition

KW - Graduate medical education

KW - Incidence

KW - Internship and residency

KW - Practice-Based Learning and Improvement

KW - Risk factors

KW - Surgical specialties

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