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Original Investigation
August 2018

Association of Expectations of Training With Attrition in General Surgery Residents

Author Affiliations
  • 1Department of Surgery, New York–Presbyterian Hospital, Weill Cornell Medicine, New York, New York
  • 2Department of Surgery, Duke Cancer Institute, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
  • 3Department of Healthcare Policy and Research, New York–Presbyterian Hospital, Weill Cornell Medicine, New York, New York
  • 4Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia Pennsylvania
JAMA Surg. 2018;153(8):712-717. doi:10.1001/jamasurg.2018.0611
Key Points

Question  What attitudes and expectations of training are associated with attrition in general surgery residents?

Findings  In a national cohort of 828 categorical general surgery interns, those with realistic expectations of residency were less likely to undergo attrition. Those who chose their training program based on reputation were more likely to undergo attrition.

Meaning  Attrition from general surgery training programs among incoming interns might be reduced by increased awareness of the rigors of surgery residency.

Abstract

Importance  Attrition from general surgery training is highest during internship. Whether the expectations and attitudes of new trainees affect their subsequent risk of attrition is unknown.

Objective  To identify the expectations of general surgery residency associated with attrition from training.

Design, Setting, and Participants  This prospective observational cohort study included categorical general surgery interns entering training in the 2007-2008 academic year. Residents were surveyed regarding their expectations of training and of life as an attending at the start of their intern year (June 1 to August 31, 2007). Expectations were grouped into factors by principal component analysis, and a multivariable model was created using these factors in addition to known demographic and program characteristics associated with attrition. Follow-up was completed on December 31, 2016.

Main Outcomes and Measures  Attrition from training was determined by linkage to American Board of Surgery resident files through 2016, allowing 8 additional years of follow-up.

Results  Of 1048 categorical surgery interns in the study period, 870 took the survey (83.0% response rate), and 828 had complete information available for analysis (524 men [63.3%], 303 women [36.6%], and 1 missing information [0.1%]). Most were white (569 [69.1%]) and at academic programs (500 [60.4%]). Six hundred sixty-six residents (80.4%) completed training. Principal component analysis generated 6 factors. On adjusted analysis, 2 factors were associated with attrition. Interns who choose their residency based on program reputation (factor 2) were more likely to drop out (odds ratio, 1.08; 95% CI, 1.01-1.15). Interns who expected as an attending to work more than 80 hours per week, to have a stressful life, and to be the subject of malpractice litigation (career life expectation [factor 6]) were less likely to drop out (odds ratio, 0.90; 95% CI, 0.82-0.98).

Conclusions and Relevance  Interns with realistic expectations of the demands of residency and life as an attending may be more likely to complete training. Medical students and residents entering training should be given clear guidance in what to expect as a surgery resident.

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