Department of Surgical Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2010 Feb;17(2):364-70. doi: 10.1245/s10434-009-0732-x. Epub 2009 Dec 3.
Surgery is a profoundly exciting and rewarding profession, so it is alarming to see a diminishing of passion for the field in the trainees that are now coming through our doors. The attrition rate of surgical residents is unacceptably high, especially when compared with other fields.
To investigate potential causes behind the current high attrition rates seen in general surgery residency programs. Medline was searched (January 1990 to November 2009). The Internet was searched (Google) for informational sites, newsletters, and informally published articles.
Attrition rates in general surgery residency programs are > or =20%, and many residents withdrawing from the programs go to other fields. The implementation of the 80-hour work week, while reported to improve quality of life, has not reduced attrition rates, presumably because the same amount of material needs to be learned in what is now a shorter period of time. The use of physician extenders to relieve residents of routine floor work that does not contribute to residency training is one solution. Another is the reformulation of clinical duties to make time use more efficient. Most importantly, recruitment should be restricted to those students with the intellectual, physical, behavioral, and emotional traits that make them suitable for the field of surgery.
Attrition rates from general surgery residencies may be reduced by increasing the efficiency of the training programs to optimize time use. Recruitment should target those students who have, or who are most likely to develop, a passion for the art of surgery.
外科是一个令人兴奋且极富回报的职业，但现在我们看到，进入这一领域的受训者对该领域的热情正在减退，这令人担忧。外科住院医师的淘汰率高得令人无法接受，尤其是与其他领域相比。
为了调查当前普通外科住院医师培训项目中高淘汰率的潜在原因。检索 Medline（1990 年 1 月至 2009 年 11 月）。在互联网上（Google）搜索信息网站、时事通讯和非正式发布的文章。
普通外科住院医师培训项目的淘汰率>或=20%，许多退出该项目的住院医师转至其他领域。虽然实施 80 小时工作周被认为可以提高生活质量，但并没有降低淘汰率，大概是因为现在需要在更短的时间内学习相同数量的材料。使用医生助手来减轻住院医师从事对住院医师培训没有贡献的日常病房工作，这是一种解决方案。另一种方法是重新制定临床职责，以提高时间利用效率。最重要的是，招聘应限制在那些具有智力、身体、行为和情感特征的学生，这些特征使他们适合外科领域。
通过提高培训计划的效率来优化时间利用，普通外科住院医师的淘汰率可能会降低。招聘应针对那些对手术艺术有或最有可能发展出热情的学生。
