Dataset Information

Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors.

ABSTRACT: Importance:Attrition in general surgery residency remains high, and attrition that occurs in the later years is the most worrisome. Although several studies have retrospectively investigated the timing of attrition, no study to date has prospectively evaluated a national cohort of residents to understand which residents are at risk for attrition and at what point during residency. Objective:To prospectively evaluate individual resident and programmatic factors associated with the timing of attrition during general surgery residency. Design, Setting, and Participants:This longitudinal, national cohort study administered a survey to all categorical general surgery interns from the class of 2007-2008 during their first 30 days of residency and linked the data with 9-year follow-up data assessing program completion. Data were collected from June 1, 2007, through June 30, 2016. Main Outcomes and Measures:Kaplan-Meier curves evaluating time to attrition during the 9 years after the start of residency. Results:Among our sample of 836 residents (306 women [36.6%] and 528 men [63.2%]; gender unknown in 2), cumulative survival analysis demonstrated overall attrition for the cohort of 20.8% (n?=?164). Attrition was highest in the first postgraduate year (67.6% [n?=?111]; absolute rate, 13.3%) but continued during the next 6 years, albeit at a lower rate. Beginning in the first year, survival analysis demonstrated higher attrition among Hispanic compared with non-Hispanic residents (21.1% vs 12.4%; P?=?.04) and at military programs compared with academic or community programs after year 1 (32.3% vs 11.0% or 13.5%; P?=?.01). Beginning in year 4 of residency, higher attrition was encountered among women compared with men (23.3% vs 17.4%; P?=?.05); at year 5, at large compared with small programs (26.0% vs 18.4%; P?=?.04). Race and program location were not associated with attrition. Conclusions and Relevance:Although attrition was highest during the internship year, late attrition persists, particularly among women and among residents in large programs. These results provide a framework for timing of interventions in graduate surgical training that target residents most at risk for late attrition.

SUBMITTER: Yeo HL

PROVIDER: S-EPMC5875388 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors.

Yeo Heather L HL Abelson Jonathan S JS Symer Matthew M MM Mao Jialin J Michelassi Fabrizio F Bell Richard R Sedrakyan Art A Sosa Julie A JA

JAMA surgery 20180601 6

<h4>Importance</h4>Attrition in general surgery residency remains high, and attrition that occurs in the later years is the most worrisome. Although several studies have retrospectively investigated the timing of attrition, no study to date has prospectively evaluated a national cohort of residents to understand which residents are at risk for attrition and at what point during residency.<h4>Objective</h4>To prospectively evaluate individual resident and programmatic factors associated with the ...[more]

PMID: 29466536

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Project description:ImportancePrevious studies of resident attrition have variably included preliminary residents and likely overestimated categorical resident attrition. Whether program director attitudes affect attrition has been unclear.ObjectivesTo determine whether program director attitudes are associated with resident attrition and to measure the categorical resident attrition rate.Design, setting, and participantsThis multicenter study surveyed 21 US program directors in general surgery about their opinions regarding resident education and attrition. Data on total resident complement, demographic information, and annual attrition were collected from the program directors for the study period of July 1, 2010, to June 30, 2015. The general surgery programs were chosen on the basis of their geographic location, previous collaboration with some coauthors, prior work in surgical education and research, or a program director willing to participate. Only categorical surgical residents were included in the study; thus, program directors were specifically instructed to exclude any preliminary residents in their responses.Main outcomes and measuresFive-year attrition rates (2010-2011 to 2014-2015 academic years) as well as first-time pass rates on the General Surgery Qualifying Examination and General Surgery Certifying Examination of the American Board of Surgery (ABS) were collected. High- and low-attrition programs were compared.ResultsThe 21 programs represented different geographic locations and 12 university-based, 3 university-affiliated, and 6 independent program types. Programs had a median (interquartile range [IQR]) number of 30 (20-48) categorical residents, and few of those residents were women (median [IQR], 12 [5-17]). Overall, 85 of 966 residents (8.8%) left training during the study period: 15 (17.6%) left after postgraduate year 1, 34 (40.0%) after postgraduate year 2, and 36 (42.4%) after postgraduate year 3 or later. Forty-four residents (51.8%) left general surgery for another surgical discipline, 21 (24.7%) transferred to a different surgery program, and 18 (21.2%) exited graduate medical education altogether. Each program had an annual attrition rate ranging from 0.73% to 6.0% (median [IQR], 2.5% [1.5%-3.4%]). Low-attrition programs were more likely than high-attrition programs to use resident remediation (21.0% vs 6.8%; P < .001). Median (IQR) Qualifying Examination pass rates (93% [90%-98%] vs 92% [86%-100%]; P = .92) and Certifying Examination pass rates (83% [68%-84%] vs 81% [71%-86%]; P = .47) were similar. Program directors at high-attrition programs were more likely than their counterparts at low-attrition programs to agree with this statement: "I feel that it is my responsibility as a program director to redirect residents who should not be surgeons."Conclusions and relevanceThe overall 5-year attrition rate of 8.8% was significantly lower than previously reported. Program directors at low-attrition programs were more likely to use resident remediation. Variations in attrition may be explained by program director attitudes, although larger studies are needed to further define program factors affecting attrition.

Project description:ImportanceLabor unions are purported to improve working conditions; however, little evidence exists regarding the effect of resident physician unions.ObjectiveTo evaluate the association of resident unions with well-being, educational environment, salary, and benefits among surgical residents in the US.Design, setting, and participantsThis national cross-sectional survey study was based on a survey administered in January 2019 after the American Board of Surgery In-Training Examination (ABSITE). Clinically active residents at all nonmilitary US general surgery residency programs accredited by the American Council of Graduate Medical Education who completed the 2019 ABSITE were eligible for participation. Data were analyzed from December 5, 2020, to March 16, 2021.ExposuresPresence of a general surgery resident labor union. Rates of labor union coverage among non-health care employees within a region were used as an instrumental variable (IV) for the presence of a labor union at a residency program.Main outcomes and measuresThe primary outcome was burnout, which was assessed using a modified version of the abbreviated Maslach Burnout Inventory and was defined as experiencing any symptom of depersonalization or emotional exhaustion at least weekly. Secondary outcomes included suicidality, measures of job satisfaction, duty hour violations, mistreatment, educational environment, salary, and benefits.ResultsA total of 5701 residents at 285 programs completed the pertinent survey questions (response rate, 85.6%), of whom 3219 (56.5%) were male, 3779 (66.3%) were White individuals, 449 (7.9%) were of Hispanic ethnicity, 4239 (74.4%) were married or in a relationship, and 1304 (22.9%) had or were expecting children. Among respondents, 690 residents were from 30 unionized programs (10.5% of programs). There was no difference in burnout for residents at unionized vs nonunionized programs (297 [43.0%] vs 2175 [43.4%]; odds ratio [OR], 0.92 [95% CI, 0.75-1.13]; IV difference in probability, 0.15 [95% CI, -0.11 to 0.42]). There were no significant differences in suicidality, job satisfaction, duty hour violations, mistreatment, educational environment, salary, or benefits except that unionized programs more frequently offered 4 weeks instead of 2 to 3 weeks of vacation (27 [93.1%] vs 52 [30.6%]; OR, 19.18 [95% CI, 3.92-93.81]; IV difference in probability, 0.77 [95% CI, 0.09-1.45]) and more frequently offered housing stipends (10 [38.5%] vs 9 [16.1%]; OR, 2.15 [95% CI, 0.58-7.95]; IV difference in probability, 0.62 [95% CI 0.04-1.20]).Conclusions and relevanceIn this evaluation of surgical residency programs in the US, unionized programs offered improved vacation and housing stipend benefits, but resident unions were not associated with improved burnout, suicidality, job satisfaction, duty hour violations, mistreatment, educational environment, or salary.

Project description:BackgroundThe Democratic Republic of the Congo (DRC) remains one of the countries most impacted by malaria despite decades of control efforts, including multiple mass insecticide treated net (ITN) distribution campaigns. The multi-scalar and complex nature of malaria necessitates an understanding of malaria risk factors over time and at multiple levels (e.g., individual, household, community). Surveillance of households in both rural and urban settings over time, coupled with detailed behavioral and geographic data, enables the detection of seasonal trends in malaria prevalence and malaria-associated behaviors as well as the assessment of how the local environments within and surrounding an individual's household impact malaria outcomes.MethodsParticipants from seven sites in Kinshasa Province, DRC were followed for over two years. Demographic, behavioral, and spatial information was gathered from enrolled households. Malaria was assessed using both rapid diagnostic tests (RDT) and polymerase chain reaction (PCR) and seasonal trends were assessed. Hierarchical regression modeling tested associations between behavioral and environmental factors and positive RDT and PCR outcomes at individual, household and neighborhood scales.ResultsAmong 1591 enrolled participants, malaria prevalence did not consistently vary seasonally across the sites but did vary by age and ITN usage. Malaria was highest and ITN usage lowest in children ages 6-15 years across study visits and seasons. Having another member of the household test positive for malaria significantly increased the risk of an individual having malaria [RDT: OR = 4.158 (2.86-6.05); PCR: OR = 3.37 (2.41-4.71)], as did higher malaria prevalence in the 250 m neighborhood around the household [RDT: OR = 2.711 (1.42-5.17); PCR: OR = 4.056 (2.3-7.16)]. Presence of water within close proximity to the household was also associated with malaria outcomes.ConclusionsTaken together, these findings suggest that targeting non-traditional age groups, children >5 years old and teenagers, and deploying household- and neighborhood-focused interventions may be effective strategies for improving malaria outcomes in high-burden countries like the DRC.

Project description:BACKGROUND:Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts. METHODS:A cross-sectional national survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination assessed mistreatment, burnout (evaluated with the use of the modified Maslach Burnout Inventory), and suicidal thoughts during the past year. We used multivariable logistic-regression models to assess the association of mistreatment with burnout and suicidal thoughts. The survey asked residents to report their gender. RESULTS:Among 7409 residents (99.3% of the eligible residents) from all 262 surgical residency programs, 31.9% reported discrimination based on their self-identified gender, 16.6% reported racial discrimination, 30.3% reported verbal or physical abuse (or both), and 10.3% reported sexual harassment. Rates of all mistreatment measures were higher among women; 65.1% of the women reported gender discrimination and 19.9% reported sexual harassment. Patients and patients' families were the most frequent sources of gender discrimination (as reported by 43.6% of residents) and racial discrimination (47.4%), whereas attending surgeons were the most frequent sources of sexual harassment (27.2%) and abuse (51.9%). Proportion of residents reporting mistreatment varied considerably among residency programs (e.g., ranging from 0 to 66.7% for verbal abuse). Weekly burnout symptoms were reported by 38.5% of residents, and 4.5% reported having had suicidal thoughts during the past year. Residents who reported exposure to discrimination, abuse, or harassment at least a few times per month were more likely than residents with no reported mistreatment exposures to have symptoms of burnout (odds ratio, 2.94; 95% confidence interval [CI], 2.58 to 3.36) and suicidal thoughts (odds ratio, 3.07; 95% CI, 2.25 to 4.19). Although models that were not adjusted for mistreatment showed that women were more likely than men to report burnout symptoms (42.4% vs. 35.9%; odds ratio, 1.33; 95% CI, 1.20 to 1.48), the difference was no longer evident after the models were adjusted for mistreatment (odds ratio, 0.90; 95% CI, 0.80 to 1.00). CONCLUSIONS:Mistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.

Project description:Importance:Important metrics of residency program success include the clinical outcomes achieved by trainees after transitioning to practice. Previous studies have shown significant differences in reported training experiences of general surgery residents at nonuniversity-based residency (NUBR) and university-based residency (UBR) programs. Objective:To examine the differences in practice patterns and clinical outcomes between surgeons trained in NUBR and those trained in UBR programs. Design, Setting, and Participants:This observational cohort study linked the claims data of patients who underwent general surgery procedures in New York, Florida, and Pennsylvania between January 1, 2012, and December 31, 2013, to demographic and training information of surgeons in the American Medical Association Physician Masterfile. Patients who underwent a qualifying procedure were grouped by surgeon. Practice pattern analysis was performed on 3638 surgeons and 1 237 621 patients, representing 214 residency programs. Clinical outcomes analysis was performed on 2301 surgeons and 312 584 patients. Data analysis was conducted from February 1, 2017, to July 31, 2017. Exposures:NUBR or UBR training status. Main Outcomes and Measures:Inpatient mortality, complications, and prolonged length of stay. Results:No significant differences were observed between the NUBR-trained surgeons and UBR-trained surgeons in age (mean, 53.3 years vs 53.7 years), sex (female, 18.2% vs 16.9%), or years of clinical experience (mean, 16.5 years vs 16.5 years). Overall, NUBR-trained surgeons compared with UBR-trained surgeons performed more procedures (median interquartile range [IQR], 328 [93-661] vs 164 [49-444]; P < .001) and performed a greater proportion of procedures in the outpatient setting (risk difference, 6.5; 95% CI, 6.4 to 6.7; P < .001). Before matching, the mean proportion of patients with documented inpatient mortality was lower for NUBR-trained surgeons than for UBR-trained surgeons (risk difference, -1.01; 95% CI, -1.41 to -0.61; P < .001). The mean proportion of patients with complications (risk difference, -3.17%; 95% CI, -4.21 to -2.13; P < .001) and prolonged length of stay (risk difference, -1.89%; 95% CI, -2.79 to -0.98; P < .001) was also lower for NUBR-trained surgeons. After matching, no significant differences in patient mortality, complications, and prolonged length of stay were found between NUBR- and UBR-trained surgeons. Conclusions and Relevance:Surgeons trained in NUBR and UBR programs have distinct practice patterns. After controlling for patient, procedure, and hospital factors, no differences were observed in the inpatient outcomes between the 2 groups.

Project description:ImportanceBurnout among physicians is high, with resulting concern about quality of care. With burnout beginning early in physician training, much-needed data are lacking on interventions to decrease burnout and improve well-being among resident physicians.ObjectivesTo design a departmental-level burnout intervention, evaluate its association with otolaryngology residents' burnout and well-being, and describe how residents used and perceived the study intervention.Design, setting, and participantsA prospective, nonrandomized crossover study was conducted from September 25, 2017, to June 24, 2018, among all 19 current residents in the Department of Otolaryngology at the University of Minnesota. Statistical analysis was performed from June 28 to August 7, 2018.InterventionsAll participants were assigned 2 hours per week of protected nonclinical time alternating with a control period of no intervention at 6-week intervals.Main outcomes and measuresBurnout was measured by the Maslach Burnout Inventory and Mini-Z Survey. Well-being was measured by the Resident and Fellow Well-Being Index and a quality-of-life single-item self-assessment. In addition to a baseline demographic survey, participants completed the aforementioned surveys at approximately 6-week intervals during the study period.ResultsAmong the 19 residents in the study (10 men [53%]), the overall protected time intervention (week 0 to week 32) was associated with a mean decrease of 0.63 points (95% CI, -1.03 to -0.22 points) in the Maslach Burnout Inventory emotional exhaustion score, indicating a clinically meaningful decrease in burnout, and a mean decrease of 1.26 points (95% CI, -2.18 to -0.34 points) in the Resident and Fellow Well-Being Index score, indicating a clinically meaningful improvement in well-being. The baseline to week 32 mean changes in the Maslach Burnout Inventory depersonalization score, Maslach Burnout Inventory personal accomplishment score, and quality-of-life single-item self-assessment were not clinically meaningful. There were clinically meaningful improvements in 4 of 6 tested Mini-Z Questionnaire items from baseline to week 32: job stress (weighted κ statistic, 0.21; 95% CI, -0.11 to 0.53), burnout (weighted κ statistic, 0.25; 95% CI, -0.02 to 0.53), control over workload (weighted κ statistic, 0.26; 95% CI, -0.01 to 0.53), and sufficient time for documentation (weighted κ statistic, 0.31; 95% CI, 0.08 to 0.54).Conclusions and relevanceThis study found that 2 hours per week of protected nonclinical time was associated with decreased burnout and increased well-being in a small sample of otolaryngology residents. Future randomized clinical studies in larger cohorts are warranted to infer causality of decreased burnout and increased well-being as a result of protected nonclinical time.

Dataset Information

Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors.

Publications

Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors.

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