Remediation Reduces Surgery Resident Attrition

Struggling general surgery residents are more likely to complete their training when programs offer more opportunities for remediation to improve deficiencies.

A recent review shows that attrition rates in general surgery training programs were lower than expected, and researchers credit remediation programs designed to help struggling residents.

The study, published today in the Journal of the American Medical Association Surgery, found that attrition was lower than previously determined – 8.8% instead of 20% – in the 21 programs that researchers surveyed. The study also found that program directors’ attitudes and support for struggling residents and resident education were significantly different when the authors compared high- and low-attrition programs.

“Our survey found general surgery residents were more likely to complete their training in programs that offered more opportunities for formal or informal remediation programs that were designed to improve their deficiencies (or weaknesses)” said Christian de Virgilio, MD, an LA BioMed researcher and corresponding author for the study.

“We feel that some program directors view themselves more as gatekeepers whose responsibility is to redirect general surgery residents who should not be surgeons, whereas others see themselves as shepherds whose role is to help guide those residents who are initially struggling to successfully complete the rigors of surgical residency," de Virgilio said.

The Association of American Medical Colleges has predicted a shortage of between 20,000 and 29,000 surgeons by 2030. AAMC said the number of surgeons in training remains about the same as in previous years but is not keeping pace with population growth, which is expected to grow by about 12% by 2030.

Also by 2030, the number of U.S. residents aged 65 and older is expected to increase by 55%, and the number of people aged 75 and older will grow by 73%.

Of the 21 programs examined in the JAMA study, 12 were university-based programs, three were affiliated with a university and six were independent. In those programs, 85 of the 966 general surgery residents failed to complete their training over a five-year period from July 2010 through June 2015.

Of those who failed to complete their general surgery training, 15 left during the first year of training; 34 during the second year, and 36 during the third year or later.
 
The researchers found a nearly seven-fold difference between the training program with the lowest attrition rate, 2.2%, and the one with the highest rate, 14.3%, over five years.

In the programs with lower attrition rates, researchers found one-in-five residents received some support or remediation to help ensure they would complete their general surgery training. In the programs with higher attrition rates, the researchers reported that only about one-in-15 residents received remediation.

“Residents’ early departures from their general surgery training programs can have an adverse impact on the morale of the other residents who continue in the program and on the training schedules for these programs,” de Virgilio said.

“These losses also threaten both the individual programs and the medical profession’s ability to meet the future needs for general surgeons to care for our nation’s population,” he said.