title: Attrition in surgical residency programmes: Causes and effects.
abstract: OBJECTIVE
  To determine the rate and trend of attrition from a surgical residency programme and to identify the reasons for attrition.
  
  
  METHODS
  A questionnaire-based survey was conducted at a university hospital. Separate questionnaires were designed for residents and programme directors (PDs). The residents who left the training voluntarily from one of the five surgical residency programmes (i.e., general surgery, orthopaedics, neurosurgery, otorhinolaryngology and urology) during the academic years 2005-2011 were identified from a departmental database. The residents who did not respond after three attempts at contact, or those who refused to participate, were excluded.
  
  
  RESULTS
  During the last 6 years, 106 residents were recruited; 84 (78%) were men, of whom 34.5% left the programme voluntarily. Of 22 women, half (54%) left the programme voluntarily (P = 0.07). The overall 6-year attrition rate was 39%. The reasons identified for attrition, in descending order, were personal reasons, attitude of senior residents or faculty, and change of specialty. None of the residents cited an excess workload as a reason for their leaving the programme. About 40% rejoined the same specialty after leaving, while 35% chose a different specialty (80% chose a different surgical subspecialty and 20% chose medicine). There was a significant discrepancy in the perspective of residents and PDs about the reasons for attrition.
  
  
  CONCLUSIONS
  Attrition among surgical residents, in particular woman residents, is high. Personal reasons and interpersonal relations were the most commonly cited reasons. Programme managers and residents have significantly different perspectives, again an indication of a communication gap.
authors.affiliation: Section of Urology, Department of Surgery, Aga Khan University, Karachi, Pakistan.
authors.forename: Mehwash
authors.initials: M
authors.lastname: Nadeem
authors.affiliation: Section of General Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan.
authors.forename: M Shahrukh
authors.initials: MS
authors.lastname: Effendi
authors.affiliation: Section of Urology, Department of Surgery, Aga Khan University, Karachi, Pakistan.
authors.forename: M
authors.initials: M
authors.lastname: Hammad Ather
keywords: Attrition; Programme director; Residency; Resident; Urology