Five-year attrition rates of residents in general surgery programs at 8.8% is significantly lower than previously observed, according to a study published in JAMA Surgery. Increasing remediation might help prevent the loss of surgical trainees.

Surgical resident attrition poses a problem in the continued training of surgeons. Trainees may leave a program so they can pursue a different medical specialty, continue training at a different program, or just leave graduate medical education completely. There is limited evidence of whether program directors have any role in preventing surgical resident attrition.

To some degree, attrition is normal in any training program; however, when general surgery was compared with other surgical disciplines, it was shown to have significantly higher resident attrition rates. Program directors have not previously given their thoughts on resident attrition, so this study aimed to assess their attitudes toward resident attrition, observe whether their attitudes correlate with the attrition rate, measure current resident attrition rates, and look at factors that are causing high or low attrition rates.

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To examine these aims, 21 general surgery directors were asked to participate in a voluntary survey that used a 4-point Likert scale and asked about the educational structure, operative volume, and graduation data of the directors’ programs.  Participating program directors were also asked to provide demographic and attrition data. The directors were asked to only include categorical surgical residents and the number of residents undergoing remediation. All the data that were collected were calculated to find the annual attrition rate for their program. The highest quartile (>3.4%) of trainee losses in the year was compared with the lowest quartile (<1.5%) of losses.

This study included  12 university-based programs (57.1%), 3 university-affiliated programs (14.3%), and 6 independent programs (28.6%). Of the 966 residents enrolled in a program, 85 (8.8%) left their training; of the 85 who left, 15 (17.6%) left after postgraduate year 1 (PGY 1), 34 (40.0%) after PGY 2, and 36 (42.2%) left after PGY 3 or later.

There were different reasons for the residents leaving: 44 (51.8%) left for another medical specialty, 21 (25.3%) transferred to a different surgical training program, and 18 (21.7%) left graduate medical education completely. There was a range of 0.73% to 6.0% trainee loss in the annual attrition rates for the programs.

It was found that low-attrition programs were more likely to use remediation than high-attrition programs. It was also found that a program director can have a strong influence on the “feel” of the program. The directors at high-attrition programs believed that an average annual attrition rate of 6% was “too low” or “just right,” whereas the directors of low-attrition programs thought it was “too high.” This finding supported that some program directors keep out residents they do not believe should be surgeons, and other directors try to help guide their trainees in such a way that most of them graduate.

The study states that it is not easy to identify the “right” amount of trainee loss, and it is clear that some residents who begin training should not continue. However, it was found that if high-attrition programs increased remediation use, they could lower their rates of attrition.


Schwed AC, Lee SL, Salcedo ES, et al. Association of general surgery resident remediation and program director attitudes with resident attrition [published online August 16, 2017]. JAMA Surg. doi: 10.1001/jamasurg.2017.2656