Resident attrition is a significant issue facing graduate surgical education, with broad implications for trainees, their families, educators, and society at large. Resident attrition is costly and often may represent a poor initial selection process, inadequate training in medical school, or insufficient feedback and mentoring while the resident is in the postgraduate program. Promoting an environment that encourages mentorship may be an important first step to help residents maximize their professional potential. The successful mentoring of surgical residents is crucial because the entire specialty depends on how today’s residents face tomorrow’s challenges.

Residency is known to be a stressful, demanding undertaking, and surgical training can be particularly challenging physically, intellectually, and emotionally [37]. When residents leave the program, the entire homeostasis of the program gets affected starting from resident learning to patient care. Particularly now with the 80 hour work week restrictions in place, attrition causes tremendous scheduling difficulties that reduce services to patients, disrupt continuity of care, and stress the remaining residents resulting in demoralization and further attrition [23]. The workload of remaining residents increases and sometimes in such situations service requirements may take precedence over teaching. Moreover, gaps appear in the residency structure that may have to be filled with medical officers who are just there to provide service requirements and are not interested in the academic aspects of the program, which adversely affects the University objectives.

In order to analyze this problem, literature search was done using Medline, Google Scholar, Eric, and Scopus databases. In addition to databases, controlled vocabulary, synonyms and truncation were used to identify appropriate references. Boolean operators were used to combine search terms and references from 1985 onwards were included.

Resident attrition is costly and often may represent a poor initial selection process, inadequate training in medical school, or insufficient feedback and mentoring while the resident is in the postgraduate program [23]. Although data are accumulating, research on resident attrition has been limited regarding identifying specific cohorts who may be less likely to complete training. Significant variations have been reported in the rate of attrition among surgical residency programs [42], ranging from 14% to 32% [1,4,9,12,21]. Even though attrition is a well-known problem, the resident and program characteristics associated with attrition are poorly understood [42]. Existing studies to date consist of retrospective single institution series [1,9,23] and surveys of program directors [19, 22,26]. According to program directors, the reasons cited for leaving a surgery residency are, in order of prevalence, work hours and lifestyle, changes in specialty interest, relocation to be closer to family, the nature of surgical practice, and financial burden [8]. Attrition often starts with the application process in which most residents are drawn to the university’s overall reputation rather than the actual character of the department to which they are applying [23]. These applicants may not be knowledgeable about whether the department’s strengths match their own career interests. When the resident finally arrives on the campus, the character of the program is often revealed instantly. Most faculty members assume that bad residents drop out and the best candidates finish the program, suggesting that the problem is the resident and not the program [23]. Most know this is not true, and evidence suggests that residents who persist and those who leave are equally qualified. Essentially it is lack of integration into the departmental community that contributes most heavily to the departure of the residents [23].

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Alpine
Managing Editor
Journal of Orthopedic and trauma.
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