title: A national study of attrition in general surgery training: which residents leave and where do they go?
abstract: OBJECTIVE
  Implementation of the 80-hour mandate was expected to reduce attrition from general surgery (GS) residency. This is the first quantitative report from a national prospective study of resident/program characteristics associated with attrition.
  
  
  METHODS
  Analysis included all categorical GS residents entered on American Board of Surgery residency rosters in 2007 to 2008. Cases of attrition were identified by program report, individually confirmed, and linked to demographic data from the National Study of Expectations and Attitudes of Residents in Surgery administered January 2008.
  
  
  RESULTS
  All surgical categorical GS residents active on the 2007-2008 resident rosters (N = 6,303) were analyzed for attrition. Complete National Study of Expectations and Attitudes of Residents in Surgery demographic information was available for 3959; the total and survey groups were similar with regard to important characteristics. About 3% of US categorical residents resigned in 2007 to 2008, and 0.4% had contracts terminated. Across all years (including research), there was a 19.5% cumulative risk of resignation. Attrition was highest in PGY-1 (5.9%), PGY-2 (4.3%), and research year(s) (3.9%). Women were no more likely to leave programs than men (2.1% vs. 1.9%). Of several program/resident variables examined, postgraduate year-level was the only independent predictor of attrition in multivariate analysis. Residents who left GS whose plans were known most often pursued nonsurgical residencies (62%), particularly anesthesiology (21%) and radiology (11%). Only 13% left for surgical specialties.
  
  
  CONCLUSIONS
  Attrition rates are high despite mandated work hour reductions; 1 in 5 GS categorical residents resigns, and most pursue nonsurgical careers. Demographic factors, aside from postgraduate year do not appear predictive. Residents are at risk for attrition early in training and during research, and this could afford educators a target for intervention.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT 06520-8062, USA. heather.yeo@yale.edu
authors.forename: Heather
authors.initials: H
authors.lastname: Yeo
authors.forename: Emily
authors.initials: E
authors.lastname: Bucholz
authors.forename: Julie
authors.initials: J
authors.lastname: Ann Sosa
authors.forename: Leslie
authors.initials: L
authors.lastname: Curry
authors.forename: Frank R
authors.initials: FR
authors.lastname: Lewis
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Jones
authors.forename: Kate
authors.initials: K
authors.lastname: Viola
authors.forename: Zhenqui
authors.initials: Z
authors.lastname: Lin
authors.forename: Richard H
authors.initials: RH
authors.lastname: Bell
mesh_terms: D000328:Adult; D002321:Career Choice; D016009:Chi-Square Distribution; D004503:Education, Medical, Graduate; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D013332:Student Dropouts / Q000706:statistics & numerical data*; D014481:United States; D016526:Workload