Attrition in surgical residency programs

The national attrition rate from medical school averages about 1%, but attrition from surgical residency programs is much higher, roughly 16%. The risk of attrition is greater for white women and racial minority men and women than for white males. This research examines the factors that lead to attrition in these graduate residency programs by looking at the dynamic interplay between the medical institution and individual residents. We collected data from 556 certified residency programs in anesthesiology, general surgery, neurosurgery, orthopedic surgery and plastic surgery, and conducted 75 interviews with the attending physicians, residents and nurses from five neurosurgery programs. While we analyze the current shortcomings in the selection process, we also look at how the culture, structure, and organization of these educational programs affects the risk of attrition once residents have been accepted. Since surgery is one of the last stalwarts of the “old boys’ network” in medicine, an analysis of the culture of these programs helps account for the greater risk of attrition among female and racial minority residents. Additionally, surgical residency programs have demanding schedules and workloads. Residents who have trouble making a total commitment to the training program face a higher risk of attrition. But an examination of the process of resident evaluation reveals another risk. In addition to being graded on cognitive knowledge and clinical judgment, faculty evaluate residents on personal characteristics, the most important being “honesty.” We demonstrate how the medical faculty\u27s subjective assessment of elusive and contestable qualities can help identify the morally deficient among the technically proficient. It can also, however, enable discrimination. White women and racial minority men and women are hampered on a number of counts, including fewer and poorer interactions with program faculty. Poor interactions impair faculty\u27s assessment of personal characteristics. These findings suggest that the medical profession should review the evaluation process for potential abuses since being non-white or female increases residents\u27 attrition risk across these specialties and institutions, even after we control for objective measures of performance