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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.

journal_name

J Surg Educ

journal_title

Journal of surgical education

authors

Shweikeh F,Schwed AC,Hsu CH,Nfonsam VN

doi

10.1016/j.jsurg.2017.07.015

subject

Has Abstract

pub_date

2018-01-01 00:00:00

pages

254-262

issue

eissn

1931-7204

issn

1878-7452

pii

S1931-7204(17)30098-3

journal_volume

pub_type

杂志文章,meta分析,评审

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