title: [Attrition and poor performance in general practice training: age, competence and knowledge play a role].
abstract: OBJECTIVE
  To investigate which determinants are related to poor performance and forced attrition in the first year residency in general practice (GP).
  
  
  METHODS
  Observational retrospective cohort study.
  
  
  METHODS
  We collected data relating to personal characteristics such as age, sex and clinical experience from residents who started the GP training in Utrecht, the Netherlands, in the period March 2005-August 2007. We also collected competence scores from the domains 'medical expertise', 'doctor-patient communication' and 'professionalism', as well as scores on a national GP knowledge test. The outcome measures were 'poor performance' and 'forced attrition'. Multivariate logistic regression was used to analyse correlations between personal characteristics, competence scores on the 3 domains and knowledge scores in the first trimester on the one hand and poor performance or forced attrition on the other.
  
  
  RESULTS
  215 residents started the GP training. In the first trimester a quarter of the residents had an insufficient score in 1 or more of the domains. Competence scores were mutually correlated, but did not correlate with the knowledge score. 18 residents showed poor performance and 3 were forced to stop their training. Poor performance and forced attrition were correlated with age (adjusted odds ratio (OR): 1.1; 95% CI: 1.0-1.3), insufficient knowledge (adjusted OR: 8.9; 3.0-26.3) and medical expertise (adjusted OR: 2.1; 1.1-4.0) at the beginning of the training.
  
  
  CONCLUSIONS
  Age, insufficient knowledge of general practice, and insufficient competence in the domain of 'medical expertise' at the beginning of the training are risk factors for poor performance by residents and attrition from their GP training.
authors.affiliation: Universitair Medisch Centrum Utrecht, Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde, Utrecht, the Netherlands.
authors.forename: Margit I
authors.initials: MI
authors.lastname: Vermeulen
authors.forename: Marijke M
authors.initials: MM
authors.lastname: Kuyvenhoven
authors.forename: N P A Peter
authors.initials: NP
authors.lastname: Zuithoff
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: H M Ron
authors.initials: HM
authors.lastname: Pieters
mesh_terms: D000328:Adult; D000367:Age Factors; D002983:Clinical Competence; D015331:Cohort Studies; D005260:Female; D058005:General Practitioners / Q000193:education* / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency / Q000592:standards / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D010563:Personnel Turnover; D012189:Retrospective Studies; D013332:Student Dropouts / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult