Factors Associated with Attrition and Performance Throughout Surgical Training: A Systematic Review and Meta-Analysis
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SCIENTIFIC REVIEW
Factors Associated with Attrition and Performance Throughout Surgical Training: A Systematic Review and Meta-Analysis Carla Hope1
•
John-Joe Reilly2 • Gareth Griffiths3 • Jon Lund1 • David Humes4,5
Accepted: 18 October 2020 Ó The Author(s) 2020
Abstract Background Attrition within surgical training is a challenge. In the USA, attrition rates are as high as 20–26%. The factors predicting attrition are not well known. The aim of this systematic review is to identify factors that influence attrition or performance during surgical training. Method The review was performed in line with PRISMA guidelines and registered with the Open Science Framework (OSF). Medline, EMBASE, PubMed and the Cochrane Central Register of Controlled Trials were searched for articles. Risk of bias was assessed using the Newcastle–Ottawa scale. Pooled estimates were calculated using random effects meta-analyses in STATA version 15 (Stata Corp Ltd). A sensitivity analysis was performed including only multi-institutional studies. Results The searches identified 3486 articles, of which 31 were included, comprising 17,407 residents. Fifteen studies were based on multi-institutional data and 16 on single-institutional data. Twenty-nine of the studies are based on US residents. The pooled estimate for overall attrition was 17% (95% CI 14–20%). Women had a significantly higher pooled attrition than men (24% vs 16%, p \ 0.001). Some studies reported Hispanic residents had a higher attrition rate than non-Hispanic residents. There was no increased risk of attrition with age, marital or parental status. Factors reported to affect performance were non-white ethnicity and faculty assessment of clinical performance. Childrearing was not associated with performance. Conclusion Female gender is associated with higher attrition in general surgical residency. Longitudinal studies of contemporary surgical cohorts are needed to investigate the complex multi-factorial reasons for failing to complete surgical residency.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05844-0) contains supplementary material, which is available to authorised users. & Carla Hope [email protected] 1
Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby DE22 3NE, UK
2
Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
3
Ninewells Hospital, Dundee, UK
4
Division of Epidemiology and Public Health, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
5
National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, E Floor West Block, QMC Campus, Nottingham NG7 2UH, UK
123
World J Surg
Introduction
1.
Attrition within surgical training is a challenge, in the USA, attrition rates are as high as 20–26% [1, 2]. It is a priority to retain surgical residents to meet the increasing healthcare demand and to re
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