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Original Investigation
March 2017

Prevalence and Causes of Attrition Among Surgical ResidentsA Systematic Review and Meta-analysis

Author Affiliations
  • 1Division of Vascular Surgery, St Michael’s Hospital, Toronto, Ontario, Canada
  • 2Department of Surgery, Taibah University, Madinah, Saudi Arabia
  • 3Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  • 4Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
  • 5The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
  • 6The Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
  • 7The Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  • 8The King Saud University–Li Ka Shing Collaborative Research Program, King Saud University, Riyadh, Kingdom of Saudi Arabia
  • 9Division of Cardiac Surgery, St Michael’s Hospital, Toronto, Ontario, Canada
  • 10Division of General Surgery, St Michael’s Hospital, Toronto, Ontario, Canada
  • 11Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
JAMA Surg. 2017;152(3):265-272. doi:10.1001/jamasurg.2016.4086
Key Points

Question  What is the attrition prevalence among surgical residents?

Findings  This systematic review and meta-analysis found that the pooled estimate of attrition prevalence among general surgery residents was 18%, female residents were more likely to leave than male residents, and residents were most likely to leave after the first postgraduate year owing to an uncontrollable lifestyle. The most common destination of residents who left was relocating to another general surgery program or switch to another specialty.

Meaning  Attrition prevalence is relatively high among general surgery residents and future research should focus on developing strategies to limit resident attrition.

Abstract

Importance  Attrition of residents from general surgery training programs is relatively high; however, there are wide discrepancies in the prevalence and causes of attrition reported among surgical residents in previous studies.

Objective  To summarize the estimate of attrition prevalence among general surgery residents.

Data Sources  We searched the Medline, EMBASE, Cochrane, PsycINFO, and ERIC databases (January 1, 1946, to October 22, 2015) for studies reporting on the prevalence and causes of attrition in surgical residents, as well as the characteristics and destinations of residents who left general surgery training programs. Database searches were conducted on October 22, 2015.

Study Selection  Eligibility criteria included all studies reporting on the primary (attrition prevalence) or secondary (causes of attrition and characteristics and destination of residents who leave residency programs) outcomes in peer-reviewed journals. Commentaries, reviews, and studies reporting on preliminary surgery programs were excluded. Of the 41 full-text articles collected from the title/abstract screening, 22 studies (53.7%) met the selection criteria.

Data Extraction and Synthesis  Two reviewers independently collected and summarized the data. We calculated pooled estimates using random effects meta-analyses where appropriate.

Main Outcome and Measure  Attrition prevalence of general surgery residents.

Results  Overall, we included 22 studies that reported on residents (n = 19 821) from general surgery programs. The pooled estimate for the overall attrition prevalence among general surgery residents was 18% (95% CI, 14%-21%), with significant between-study variation (I2 = 96.8%; P < .001). Attrition was significantly higher among female compared with male (25% vs 15%, respectively; P = .008) general surgery residents, and most residents left after their first postgraduate year (48%; 95% CI, 39%-57%). Departing residents often relocated to another general surgery program (20%; 95% CI, 15%-24%) or switched to anesthesia (13%; 95% CI, 11%-16%) and other specialties. The most common reported causes of attrition were uncontrollable lifestyle (range, 12%-87.5%) and transferring to another specialty (range, 19%-38.9%).

Conclusions and Relevance  General surgery programs have relatively high attrition, with female residents more likely to leave their training programs than male residents. Residents most often relocate or switch to another specialty after the first postgraduate year owing to lifestyle-related issues.

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