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Combatting Attrition: A Targeted Approach for General Surgery Residents and a 10-year Audit in the Era of Duty Hour Restrictions
*Daniel C. Thomas, *Michael P. DeWane, Walter E. Longo, Peter S. Yoo
Yale School of Medicine, New Haven, CT

Objective: To evaluate the impact of a targeted approach to decreasing attrition in a general surgery residency training program
Design: Review of prospectively collected data from July 1, 2006 to June 30, 2015
Setting: A large academic hospital in the northeast
Participants: Categorical general surgery trainees
Intervention: The implementation of a tripartite approach targeting 1) the recruitment & selection process; 2) early engagement and senior level specialization; 3) resident well-being via a wellness curriculum
Main outcome: Annualized attrition rate as well as reason for leaving and ultimate fate of those who left the training program
Results: Among the 84 residents who began as categorical interns from 2006-2015, 38% were women. Thirteen of 84 (15.4%) failed to complete the training program from 2006-2015, representing a 30% decrease from the preceding 20-year period. Of these, 11 (84%) withdrew, 1 (8%) transferred, and 1 (8%) was dismissed. All but 1 (92%) continued in graduate medical education. Four of the 11 (36%) who withdrew, matriculated into a surgical subspecialty. The overall annualized attrition rate during the 10-year study period was 3.7%, down from 6.8% in the preceding 20-year period.
Conclusions: Application of a specific strategy aimed toward maximizing resident satisfaction and retention in the modern era of duty hour restrictions led to a lower rate of attrition. The majority of residents who leave remain in graduate medical education and enter a nonsurgical specialty. Despite an improvement in attrition during the period after our intervention, we must continue to analyze the root cause of resident attrition and target solutions in the ever-changing environment of graduate medical education.


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