title: How residents learn predicts success in surgical residency.
abstract: BACKGROUND
  Predictors of success in surgical residency have been poorly understood. Previous studies have related prior performance to future success without consideration of personal attributes that help an individual succeed. Surgical educators should consider how residents learn to gain insight into early identification of residents at risk of failing to complete their surgical training.
  
  
  METHODS
  We examined our 14-year database of surgical resident learning-style assessments, Accreditation Council for Graduate Medical Education operative log data of graduating residents from 1999 to 2012, first time pass rates on the American Board of Surgery Qualifying and Certifying examinations, and departmental records to identify those residents who did not complete their surgery training at our institution. Statistical analysis was performed using the chi-square test, Wilcoxon rank-sum, and regression analysis with significance set at p < 0.05.
  
  
  RESULTS
  We analyzed 441 learning-style assessments from 130 residents. Surgical residents are predominantly action-based learners, with converging (219, 49.7%) and accommodating (112, 25.4%) being the principal learning styles. Assimilating (66, 15%) and diverging (44, 10%) learning styles, where an individual learns by observation, were less common. Regression analysis comparing learning style with case volume revealed that residents who are action-based learners completed more cases at graduation (p < 0.05 for each). Additionally, surgical residents who transferred to a nonsurgical residency or nonphysician field were more likely to learn by observation (p = 0.0467).
  
  
  CONCLUSIONS
  Surgical residents are predominantly action-based learners. However, a subset of surgical residents learn primarily by observation. These residents are at risk for a less robust operative experience and not completing surgical training. Learning-style analysis may be utilized by surgical educators to identify the potential at-risk residents in general surgery.
authors.affiliation: Department of Surgery, University of Cincinnati, Cincinnati, Ohio. Electronic address: quillirc@email.uc.edu.
authors.forename: Ralph C
authors.initials: RC
authors.lastname: Quillin
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Pritts
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Edwards
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Davis
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D002983:Clinical Competence; D015331:Cohort Studies; D003162:Competency-Based Education; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000458:organization & administration; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
keywords: Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; attrition; general surgery; learning style; operative volume; success