Heather L Yeo1,2, Jonathan S Abelson1, Matthew M Symer1, Jialin Mao2, Fabrizio Michelassi1, Richard Bell3, Art Sedrakyan2, Julie A Sosa4,5. 1. Department of Surgery, New York-Presbyterian and Weill Cornell Medical Center, New York, New York. 2. Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York. 3. Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania. 4. Department of Surgery, Duke Cancer Institute, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. 5. Department of Medicine, Duke Cancer Institute, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Abstract
Importance: Attrition in general surgery residency remains high, and attrition that occurs in the later years is the most worrisome. Although several studies have retrospectively investigated the timing of attrition, no study to date has prospectively evaluated a national cohort of residents to understand which residents are at risk for attrition and at what point during residency. Objective: To prospectively evaluate individual resident and programmatic factors associated with the timing of attrition during general surgery residency. Design, Setting, and Participants: This longitudinal, national cohort study administered a survey to all categorical general surgery interns from the class of 2007-2008 during their first 30 days of residency and linked the data with 9-year follow-up data assessing program completion. Data were collected from June 1, 2007, through June 30, 2016. Main Outcomes and Measures: Kaplan-Meier curves evaluating time to attrition during the 9 years after the start of residency. Results: Among our sample of 836 residents (306 women [36.6%] and 528 men [63.2%]; gender unknown in 2), cumulative survival analysis demonstrated overall attrition for the cohort of 20.8% (n = 164). Attrition was highest in the first postgraduate year (67.6% [n = 111]; absolute rate, 13.3%) but continued during the next 6 years, albeit at a lower rate. Beginning in the first year, survival analysis demonstrated higher attrition among Hispanic compared with non-Hispanic residents (21.1% vs 12.4%; P = .04) and at military programs compared with academic or community programs after year 1 (32.3% vs 11.0% or 13.5%; P = .01). Beginning in year 4 of residency, higher attrition was encountered among women compared with men (23.3% vs 17.4%; P = .05); at year 5, at large compared with small programs (26.0% vs 18.4%; P = .04). Race and program location were not associated with attrition. Conclusions and Relevance: Although attrition was highest during the internship year, late attrition persists, particularly among women and among residents in large programs. These results provide a framework for timing of interventions in graduate surgical training that target residents most at risk for late attrition.
Importance: Attrition in general surgery residency remains high, and attrition that occurs in the later years is the most worrisome. Although several studies have retrospectively investigated the timing of attrition, no study to date has prospectively evaluated a national cohort of residents to understand which residents are at risk for attrition and at what point during residency. Objective: To prospectively evaluate individual resident and programmatic factors associated with the timing of attrition during general surgery residency. Design, Setting, and Participants: This longitudinal, national cohort study administered a survey to all categorical general surgery interns from the class of 2007-2008 during their first 30 days of residency and linked the data with 9-year follow-up data assessing program completion. Data were collected from June 1, 2007, through June 30, 2016. Main Outcomes and Measures: Kaplan-Meier curves evaluating time to attrition during the 9 years after the start of residency. Results: Among our sample of 836 residents (306 women [36.6%] and 528 men [63.2%]; gender unknown in 2), cumulative survival analysis demonstrated overall attrition for the cohort of 20.8% (n = 164). Attrition was highest in the first postgraduate year (67.6% [n = 111]; absolute rate, 13.3%) but continued during the next 6 years, albeit at a lower rate. Beginning in the first year, survival analysis demonstrated higher attrition among Hispanic compared with non-Hispanic residents (21.1% vs 12.4%; P = .04) and at military programs compared with academic or community programs after year 1 (32.3% vs 11.0% or 13.5%; P = .01). Beginning in year 4 of residency, higher attrition was encountered among women compared with men (23.3% vs 17.4%; P = .05); at year 5, at large compared with small programs (26.0% vs 18.4%; P = .04). Race and program location were not associated with attrition. Conclusions and Relevance: Although attrition was highest during the internship year, late attrition persists, particularly among women and among residents in large programs. These results provide a framework for timing of interventions in graduate surgical training that target residents most at risk for late attrition.
Authors: Melina R Kibbe; Christoph Troppmann; Carlton C Barnett; Benedict C Nwomeh; Oluyinka O Olutoye; Cataldo Doria; Robin D Kim; Mahesh H Mankani; Siobhan A Corbett; Walter L Biffl; Margaret L Schwarze Journal: Ann Surg Date: 2009-02 Impact factor: 12.969
Authors: Zeyad Khoushhal; Mohamad A Hussain; Elisa Greco; Muhammad Mamdani; Subodh Verma; Ori Rotstein; Andrea C Tricco; Mohammed Al-Omran Journal: JAMA Surg Date: 2017-03-01 Impact factor: 14.766
Authors: Edward Gifford; Joseph Galante; Amy H Kaji; Virginia Nguyen; M Timothy Nelson; Richard A Sidwell; Thomas Hartranft; Benjamin Jarman; Marc Melcher; Mark Reeves; Christopher Reid; Garth R Jacobsen; Jonathan Thompson; Chandrakanth Are; Brian Smith; Tracey Arnell; Oscar J Hines; Christian de Virgilio Journal: JAMA Surg Date: 2014-09 Impact factor: 14.766
Authors: Kathryn E Engelhardt; Karl Y Bilimoria; Julie K Johnson; D Brock Hewitt; Ryan J Ellis; Yue Yung Hu; Jeanette W Chung; Lindsey Kreutzer; Remi Love; Eddie Blay; David D Odell Journal: JAMA Surg Date: 2020-09-01 Impact factor: 14.766
Authors: Arghavan Salles; Robert C Wright; Laurel Milam; Roheena Z Panni; Cara A Liebert; James N Lau; Dana T Lin; Claudia M Mueller Journal: J Surg Educ Date: 2018-09-19 Impact factor: 2.891
Authors: Marianne Casilla-Lennon; Stephanie Hanchuk; Sijin Zheng; David D Kim; Benjamin Press; Justin V Nguyen; Alyssa Grimshaw; Michael S Leapman; Jaime A Cavallo Journal: Am J Surg Date: 2021-07-21 Impact factor: 2.565
Authors: Laura C Guglielmetti; Christian Gingert; Anna Holtz; Reinhard Westkämper; Jochen Lange; Michel Adamina Journal: World J Surg Date: 2022-03-18 Impact factor: 3.282
Authors: Luis C Garcia; Tait D Shanafelt; Colin P West; Christine A Sinsky; Mickey T Trockel; Laurence Nedelec; Yvonne A Maldonado; Michael Tutty; Liselotte N Dyrbye; Magali Fassiotto Journal: JAMA Netw Open Date: 2020-08-03
Authors: James A Berry; Dario A Marotta; Paras Savla; Emilio C Tayag; Saman Farr; Rida Javaid; Daniel K Berry; Sara E Buckley; Anna Rogalska; Dan E Miulli Journal: Cureus Date: 2021-06-26