title: Thoughts of Quitting General Surgery Residency: Factors in Canada.
abstract: OBJECTIVE
  Attrition rates in general surgery training are higher than other surgical disciplines. We sought to determine the prevalence with which Canadian general surgery residents consider leaving their training and the contributing factors.
  
  
  METHODS
  An anonymous survey was administered to all general surgery residents in Canada. Responses from residents who considered leaving their training were assessed for importance of contributing factors. The study was conducted at the Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, a tertiary academic center.
  
  
  RESULTS
  The response rate was approximately 34.0%. A minority (32.0%) reported very seriously or somewhat seriously considering leaving their training, whereas 35.2% casually considered doing so. Poor work-life balance in residency (38.9%) was the single-most important factor, whereas concern about future unemployment (16.7%) and poor future quality of life (15.7%) were next. Enjoyment of work (41.7%) was the most frequent mitigating factor. Harassment and intimidation were reported factors in 16.7%. On analysis, only intention to practice in a nonacademic setting approached significant association with thoughts of leaving (odds ratio = 1.92, CI = 0.99-3.74, p = 0.052). There was no association with sex, program, postgraduate year, relationship status, or subspecialty interest. There was a nonsignificant trend toward more thoughts of leaving with older age.
  
  
  CONCLUSIONS
  Canadian general surgery residents appear less likely to seriously consider quitting than their American counterparts. Poor work-life balance in residency, fear of future unemployment, and anticipated poor future quality of life are significant contributors to thoughts of quitting. Efforts to educate prospective residents about the reality of the surgical lifestyle, and to assist residents in securing employment, may improve completion rates.
authors.affiliation: Department of Surgery, Royal University Hospital, Saskatoon, Saskatchewan, Canada. Electronic address: n.ginther@usask.ca.
authors.forename: David Nathan
authors.initials: DN
authors.lastname: Ginther
authors.affiliation: Department of Surgery, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
authors.forename: Sheev
authors.initials: S
authors.lastname: Dattani
authors.affiliation: Department of Surgery, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Miller
authors.affiliation: Department of Surgery, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Hayes
mesh_terms: D000328:Adult; D002170:Canada; D002321:Career Choice; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D010820:Physicians / Q000523:psychology*; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; attrition; completion rate; education; general surgery; internship and residency; personnel turnover