Background
Attrition from general surgery residency remains constant at approximately 20% despite
nearly a decade of work-hour reform and studies aiming to identify common risk factors.
High rates of attrition from training have a wide impact, from the overall quality
of trainees produced to implications on public health and the broader surgical work
force. We set out to evaluate a novel character trait, grit, defined as passion and
perseverance for long-term goals, as a marker and potential risk factor for resident
attrition.
Methods
Twelve Accreditation Council for Graduate Medical Education–approved general surgery
residency programs participated in a prospective, multi-institutional, survey-based
analysis of grit and attrition during the 2012–2013 academic year. Participating individuals
were blinded with regards to the primary outcome of the study. Participating institutions
were blinded to the responses of their trainees. Participating residency programs
were located in a variety of settings, from university-based health systems to community
hospitals.
Results
Sixty-eight percent (68%) of residents (180 of 265) at participating institutions
completed the study. The primary end point for this study was attrition from residency
as a function of grit. Secondary end points included an evaluation of the utility
of the grit score in surgical residents, variability of grit according to postgraduate
year, sex, measurements of resident satisfaction with current program, lifestyle,
and career goals. Finally, the study included an analysis of key resident support
strategies. The attrition rate across 12 institutions surveyed was approximately 2%
(5 residents). Of those five, three participated in our study. All three had below-median
levels of grit. Those residents with below-median grit were more likely to contemplate
leaving surgical residency. Given the low attrition rate, no variable surveyed reached
statistical significance in our analysis. Key support strategies for residents responding
included family, friends outside of residency, co-residents, and formal mentorship
through their particular residency.
Conclusion
In this preliminary underpowered study, grit appears to be a promising marker and
risk factor for attrition from surgical residency. In an effort to retain residents,
programs should consider screening for grit in current residents and directing support
to those residents with below-median values, with a focus on building family, friend,
and formal mentor relationships.
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References
- Graduate medical education in surgery in the United States.Surg Clin North Am. 2007; 87 (v-vi): 811-823
- Attrition in graduate surgical education: an analysis of the 1993 entering cohort of surgical residents.J Am Coll Surg. 1999; 189: 602-610
- Attrition of categoric general surgery residents: results of a 20-year audit.Am J Surg. 2009; 197 (discussion 779-80): 774-778
- Attrition in otolaryngology residency.Otolaryngol Head Neck Surg. 2011; 145: 753-754
- Attrition from ophthalmology residency programs.Am J Ophthalmol. 2004; 138: 863-864
- The nature and fate of categorical surgical residents who “drop out”.Am J Surg. 1998; 175: 236-239
- Attrition and replacement of general surgery residents.Surg Clin North Am. 2004; 84 (ix): 1525-1535
- A national study of attrition in general surgery training: Which residents leave and where do they go?.Ann Surg. 2010; 252 (discussion 534-6): 529-534
- Voluntary changes in surgery career paths: A survey of the program directors in surgery.J Am Coll Surg. 2003; 196: 611-616
- Has the 80-hour work week had an impact on voluntary attrition in general surgery residency programs?.J Am Coll Surg. 2006; 202: 340-344
- Surgical residency and attrition: Defining the individual and programmatic factors predictive of trainee losses.J Am Coll Surg. 2013; 216: 461-471
- The predictive value of general surgery application data for future resident performance.J Surg Educ. 2011; 68: 513-518
- Factors related to attrition in surgery residency based on application data.Arch Surg. 2008; 143 (discussion 651-2): 647-651
- Gender-related attrition in a general surgery training program.J Surg Res. 1998; 77: 59-62
- Prevention of surgical resident attrition by a novel selection strategy.Ann Surg. 2010; 252: 537-543
- Grit: perseverance and passion for long-term goals.J Pers Soc Psychol. 2007; 92: 1087-1101
- Development and validation of the short grit scale (grit-s).J Pers Assess. 2009; 91: 166-174
- The training of the surgeon.Bull Johns Hopkins Hospital. 1904; 15: 267-275
- National Resident Matching Program. How do general surgery replacement residents match up with those recruited through the national resident matching program?.Am J Surg. 2004; 187: 702-704
- Determining personal talents and behavioral styles of applicants to surgical training: a new look at an old problem, part I.J Surg Educ. 2011; 68: 534-541
- Determining personal talents and behavioral styles of applicants to surgical training: a new look at an old problem, part II.J Surg Educ. 2012; 69: 23-29
- “Join the club”: effect of resident and attending social interactions on overall satisfaction among 4390 general surgery residents.Arch Surg. 2012; 147: 408-414
- Stress training for the surgical resident.Am J Surg. 2013; 205: 169-174
Article info
Publication history
Published online: February 10, 2014
Accepted:
January 31,
2014
Identification
Copyright
© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
