title: Prevalence and Causes of Attrition Among Surgical Residents: A Systematic Review and Meta-analysis.
abstract: Attrition of residents from general surgery training programs is relatively high; however, there are wide discrepancies in the prevalence and causes of attrition reported among surgical residents in previous studies.
  
  
  
  To summarize the estimate of attrition prevalence among general surgery residents.
  
  
  
  We searched the Medline, EMBASE, Cochrane, PsycINFO, and ERIC databases (January 1, 1946, to October 22, 2015) for studies reporting on the prevalence and causes of attrition in surgical residents, as well as the characteristics and destinations of residents who left general surgery training programs. Database searches were conducted on October 22, 2015.
  
  
  
  Eligibility criteria included all studies reporting on the primary (attrition prevalence) or secondary (causes of attrition and characteristics and destination of residents who leave residency programs) outcomes in peer-reviewed journals. Commentaries, reviews, and studies reporting on preliminary surgery programs were excluded. Of the 41 full-text articles collected from the title/abstract screening, 22 studies (53.7%) met the selection criteria.
  
  
  
  Two reviewers independently collected and summarized the data. We calculated pooled estimates using random effects meta-analyses where appropriate.
  
  
  
  Attrition prevalence of general surgery residents.
  
  
  
  Overall, we included 22 studies that reported on residents (n = 19 821) from general surgery programs. The pooled estimate for the overall attrition prevalence among general surgery residents was 18% (95% CI, 14%-21%), with significant between-study variation (I2 = 96.8%; P < .001). Attrition was significantly higher among female compared with male (25% vs 15%, respectively; P = .008) general surgery residents, and most residents left after their first postgraduate year (48%; 95% CI, 39%-57%). Departing residents often relocated to another general surgery program (20%; 95% CI, 15%-24%) or switched to anesthesia (13%; 95% CI, 11%-16%) and other specialties. The most common reported causes of attrition were uncontrollable lifestyle (range, 12%-87.5%) and transferring to another specialty (range, 19%-38.9%).
  
  
  
  General surgery programs have relatively high attrition, with female residents more likely to leave their training programs than male residents. Residents most often relocate or switch to another specialty after the first postgraduate year owing to lifestyle-related issues.
authors.affiliation: Division of Vascular Surgery, St Michael's Hospital, Toronto, Ontario, Canada2Department of Surgery, Taibah University, Madinah, Saudi Arabia.
authors.forename: Zeyad
authors.initials: Z
authors.lastname: Khoushhal
authors.affiliation: Division of Vascular Surgery, St Michael's Hospital, Toronto, Ontario, Canada3Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Hussain
authors.affiliation: Division of Vascular Surgery, St Michael's Hospital, Toronto, Ontario, Canada3Department of Surgery, University of Toronto, Toronto, Ontario, Canada4Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Elisa
authors.initials: E
authors.lastname: Greco
authors.affiliation: Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada5The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada6The Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada7The Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada8The King Saud University-Li Ka Shing Collaborative Research Program, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada4Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada8The King Saud University-Li Ka Shing Collaborative Research Program, King Saud University, Riyadh, Kingdom of Saudi Arabia9Division of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Subodh
authors.initials: S
authors.lastname: Verma
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada4Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada10Division of General Surgery, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Ori
authors.initials: O
authors.lastname: Rotstein
authors.affiliation: The Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Tricco
authors.affiliation: Division of Vascular Surgery, St Michael's Hospital, Toronto, Ontario, Canada3Department of Surgery, University of Toronto, Toronto, Ontario, Canada4Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada8The King Saud University-Li Ka Shing Collaborative Research Program, King Saud University, Riyadh, Kingdom of Saudi Arabia11Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Omran
mesh_terms: D002321:Career Choice; D013502:General Surgery / Q000193:education* / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008019:Life Style; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D012737:Sex Factors; D000072358:Work-Life Balance