title: Attrition of categoric general surgery residents: results of a 20-year audit.
abstract: BACKGROUND
  Attrition of general surgery residents is of continued concern in graduate medical education. It results in loss of morale and resources and often leaves programs scrambling to find replacement residents. The aim of this study was to evaluate the incidence of attrition of categoric general surgery residents as well as the fate of those who left the general surgery training program among a defined cohort of categoric general surgery residents in a university hospital residency training program.
  
  
  METHODS
  We retrospectively reviewed the files of all general surgery residents at the Yale University School of Medicine-Yale New Haven Hospital Surgery Program who began as categoric interns from July 1, 1986 to June 30, 2006. Ninety-nine residents were identified. Attrition of residents was divided into withdrawals (changed specialty or left graduate medical education), transfers (transferred to a different program in general surgery), and dismissals (dismissed from the program).
  
  
  RESULTS
  Among the 99 residents who began as categoric interns from 1986 to 2006, 66 of 99 (67%) were men. Thirty of 99 (30%) failed to complete the general surgery training program. Of these, 21 of 30 (70%) withdrew, 5 of 30 (17%) transferred, and 4 of 30 (13%) were dismissed. Attrition occurred before entering the third clinical year in 23 of 30 (77%). Two of 30 (7%) left graduate medical education. Thirteen of 21 (62%) who withdrew entered primary care or another nonsurgical specialty, whereas 7 of 21 (38%) matriculated into a surgical subspecialty. The attrition rate was 40% (12 of 30) since the academic year 2000. The overall annual attrition rate for the past 20 years was 6.7%.
  
  
  CONCLUSIONS
  Attrition in our general surgery training remains low. Most who leave remain in graduate medical education and transfer to a different specialty. The overwhelming majority leave before beginning their third clinical year. Although our 6.7% annual attrition rate remains favorable (national attrition rate in general surgery 5.8%), we must continue to analyze the root causes and solutions.
authors.affiliation: Department of Surgery, Yale University, School of Medicine, New Haven, CT, USA. walter.longo@yale.edu
authors.forename: Walter E
authors.initials: WE
authors.lastname: Longo
authors.forename: John
authors.initials: J
authors.lastname: Seashore
authors.forename: Andrew
authors.initials: A
authors.lastname: Duffy
authors.forename: Robert
authors.initials: R
authors.lastname: Udelsman
mesh_terms: D000328:Adult; D005260:Female; D013502:General Surgery; D006801:Humans; D007396:Internship and Residency; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D000078329:Workforce; D055815:Young Adult