title: Attrition from surgical residency training: perspectives from those who left.
abstract: BACKGROUND
  High rates of attrition from general surgery residency may threaten the surgical workforce. We sought to gain further insight regarding resident motivations for leaving general surgery residency.
  
  
  METHODS
  We conducted in-depth interviews to generate rich narrative data that explored individual experiences. An interdisciplinary team used the constant comparative method to analyze the data.
  
  
  RESULTS
  Four themes characterized experiences of our 19 interviewees who left their residency program. Participants (1) felt an informal contract was breached when clinical duties were prioritized over education, (2) characterized a culture in which there was no safe space to share personal and programmatic concerns, (3) expressed a scarcity of role models who demonstrated better work-life balance, and (4) reported negative interactions with authority resulting in a profound loss of commitment.
  
  
  CONCLUSIONS
  As general surgery graduate education continues to evolve, our findings may inform interventions and policies regarding programmatic changes to boost retention in surgical residency.
authors.affiliation: Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA, USA; Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, 333 Cedar Street, PO Box 208088, New Haven, CT, USA; US Department of Veterans Affairs, Connecticut Healthcare System, West Haven, CT, USA. Electronic address: tasce.bongiovanni@yale.edu.
authors.forename: Tasce
authors.initials: T
authors.lastname: Bongiovanni
authors.affiliation: Department of Surgery, New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Yeo
authors.affiliation: Department of Surgery, Duke University School of Medicine, DUMC, Durham, NC, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
authors.affiliation: Department of Surgery, Yale University School of Public Health, New Haven, CT, USA.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Yoo
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, 333 Cedar Street, PO Box 208088, New Haven, CT, USA; Department of Internal Medicine, Yale University School of Public Health, New Haven, CT, USA.
authors.forename: Theodore
authors.initials: T
authors.lastname: Long
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, 333 Cedar Street, PO Box 208088, New Haven, CT, USA; Department of Pediatrics, Yale University School of Public Health, New Haven, CT, USA.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Rosenthal
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, 333 Cedar Street, PO Box 208088, New Haven, CT, USA; Department of Psychiatry, Yale University School of Public Health, New Haven, CT, USA.
authors.forename: David
authors.initials: D
authors.lastname: Berg
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, 333 Cedar Street, PO Box 208088, New Haven, CT, USA; Division of Health Policy and Administration, Yale University School of Public Health, New Haven, CT, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Curry
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, 333 Cedar Street, PO Box 208088, New Haven, CT, USA; Department of Internal Medicine, Yale University School of Public Health, New Haven, CT, USA.
authors.forename: Marcella
authors.initials: M
authors.lastname: Nunez-Smith
mesh_terms: D000328:Adult; D002321:Career Choice; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007400:Interprofessional Relations; D007588:Job Satisfaction; D008297:Male; D009042:Motivation; D015279:Organizational Culture; D036301:Qualitative Research; D013332:Student Dropouts / Q000523:psychology*
keywords: Career choice; General surgery/education; Internship and residency/manpower