Within general surgery residency programs, overall attrition rates are linked to program director attitudes and program characteristics such as remediation, a study shows.
Alexander C. Schwed, MD, from Harbor–UCLA Medical Center, Torrance, California, and colleagues published the results of their multicenter analysis of 21 US residency programs in general surgery online August 16 in JAMA Surgery.
“[A]n 8.8% overall attrition rate was observed among categorical surgical residents,” the authors write. “Low-attrition programs had a higher rate of resident remediation than did high-attrition programs, and the difference was statistically significant.”
Previous studies have estimated that resident attrition accounts for the loss of up to 26% of all surgical residents who begin training. This rate is substantially higher than the reported 5-year attrition rates of between 1% and 6% for residents in programs such as obstetrics and gynecology, orthopedic surgery, and neurosurgery.
Surgical residents’ reasons for leaving programs are often personal and multifactorial. However, although studies have surveyed program directors in general surgery to examine attrition rates within their programs and their attitudes about the state of general surgery training, data are lacking on the role of program directors in preventing resident attrition.
The researchers therefore investigated the current attrition rate among categorical general surgery residents and whether it is influenced by program director attitudes and program characteristics.
They surveyed directors of 21 US residency programs in general surgery about their opinions on resident education and attrition. Survey topics covered the programs’ educational structure, operative volume, and graduation data. Program directors also provided demographic and attrition data for their programs for the academic years 2010 to 2011 to 2014 to 2015.
The programs represented different geographic locations across the United States: 12 were university-based, three were university-affiliated, and six were independent programs.
The researchers found an overall 5-year resident attrition rate of 8.8% (85 of 966 residents) among the programs, which was significantly lower than previously reported rates.
However, programs reported a wide range in 5-year resident attrition rates (2.2% – 14.3%), the authors say.
Regarding the timing of resident loss, 17.6% left after postgraduate year 1, 40.0% after postgraduate year 2, and 42.4% after postgraduate year 3 or later.
Of the residents who left their general surgery programs, 51.8% switched to another surgical discipline, 24.7% relocated to a different surgery program, and 21.2% departed graduate medical education altogether.
Programs with low attrition were more likely than those with high attrition to use resident remediation (21.0% vs 6.8%; P < .001).
Directors at high-attrition programs were more likely than those at low-attrition programs to agree with the statement, “I feel that it is my responsibility as a program director to redirect residents who should not be surgeons,” as well as with the assessment that a 6% annual rate of attrition was “too low.”
Both of these opinions highlight that the attitudes of program directors can influence the experiences of residents in their surgical training programs and whether they will complete their training, the authors write.
However, they found no differences between the two groups of programs in operative volume, mentorship opportunities, availability of elective rotations, use of a night float system, presence of a resident retreat, or availability of dedicated research time.
Resident performance, as judged by first-time pass rates on the General Surgery Qualifying Examination (P = .92) and General Surgery Certifying Examination (P = .47), also did not differ significantly between the two groups of programs.
Discussing the novel association between residency programs’ increased use of remediation and low rates of resident attrition, the authors also emphasize that a previous study found that resident remediation was not a predictor of attrition.
“Their findings taken with ours help point to the potential effect that liberal use of remediation can have on surgical trainee retention without negatively affecting a trainee’s ability to complete general surgery residency,” they write.
On the basis of these findings, the researchers suggest that increasing the use of remediation may help prevent surgical trainee loss.
However, “larger studies of general surgery residencies accredited by the Accreditation Council for Graduate Medical Education are needed to fully define the scope of the problem of resident attrition and identify additional solutions,” they conclude.
The authors have disclosed no relevant financial relationships.
JAMA Surgery. Published online August 16, 2017. Full text
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