title: Surgical residency and attrition: defining the individual and programmatic factors predictive of trainee losses.
abstract: BACKGROUND
  Voluntary resident attrition remains problematic despite recent changes in postgraduate general surgery training, including reduction of work hours.
  
  
  METHODS
  We conducted a prospective study of all postgraduate year (PGY)-1 and -2 trainees on the 2008 American Board of Surgery resident roster (ABS-RR) who completed the National Study of Expectations and Attitudes of Residents in Surgery (NEARS) survey after the American Board of Surgery In-Training Examination (ABSITE) in 2008 or 2009.
  
  
  RESULTS
  Among 2,222 PGY-1 and -2 residents on the 2008 ABS-RR, 2,033 completed the NEARS survey in 2008 or 2009 (91.5%). The only demographic or programmatic variables associated with voluntary attrition on univariate analysis were PGY-1 status (9.4% risk vs 4.5% risk for PGY-2, p < 0.001) and program location (p = 0.03). Response differences (p < 0.01) were noted in 23 survey items. In multivariate modeling, PGY-2 status was protective against voluntary attrition (p < 0.001, hazard ratio [HR] 0.41), while programs located outside of the South (Northeast: p = 0.006, HR 2.39; Midwest: p = 0.01, HR 2.37; West: p = 0.10, HR 1.76) were associated with higher attrition. The attrition group more frequently reported that they had considered leaving training (p < 0.001, HR 2.59), that the personal cost of training was too great (p < 0.001, HR 2.89), that they were dissatisfied with their operative experience (p = 0.002, HR 1.89), and that they were not committed to completing their training (p < 0.001, HR 3.96). Using the estimated regression coefficient for each variable in the multivariate models, we calculated a risk score for individual residents; these scores were used to construct covariate-adjusted survivorship functions.
  
  
  CONCLUSIONS
  Resident attitudes, PGY-1 status, and program location are most frequently associated with voluntary attrition. Our risk score calculation represents a novel potential tool for programs to quantify deficiencies in the training experience of residents, and develop targeted strategies to limit disaffection and improve resident retention.
authors.affiliation: Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Sullivan
authors.forename: Heather
authors.initials: H
authors.lastname: Yeo
authors.forename: Sanziana A
authors.initials: SA
authors.lastname: Roman
authors.forename: Maria M
authors.initials: MM
authors.lastname: Ciarleglio
authors.forename: Xiangyu
authors.initials: X
authors.lastname: Cong
authors.forename: Richard H
authors.initials: RH
authors.lastname: Bell
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008019:Life Style; D008297:Male; D015999:Multivariate Analysis; D010561:Personnel Staffing and Scheduling; D012934:Social Isolation; D000078329:Workforce; D055815:Young Adult