Challenges to implementation of medical residency programs in China: a five-year study of attrition from West China hospital.

PURPOSE

To increase opportunities for advanced clinical training, a few medical schools in China have created U.S.-style, temporary-contract residency programs for medical graduates, but nearly nothing is known about what proportion of residents successfully complete these programs or what factors affect attrition.

METHOD

By directly surveying and interviewing residents who withdrew voluntarily, the authors examined attrition from 16 medical specialties in the residency program of West China Hospital, Sichuan University, from the start of the program in 2003 through 2008.

RESULTS

During the study period, 562 trainees matriculated into the program, and 127 (22.6%) withdrew before completing it; 106 (18.9%) withdrew voluntarily. Those who left voluntarily most frequently cited three reasons: (1) permanent employment in other hospitals, (2) pursuit of a higher academic degree, and (3) personal reasons. Nearly 90% (n = 92) of the residents who left voluntarily did so within two years of obtaining their medical license. Women were 1.82-fold more likely than men to leave (95% CI 1.20-2.76, P = .005). Attrition by specialty ranged from 3.7% to 42.9% over the study period. Surgery had one of the lowest attrition rates.

CONCLUSIONS

Attrition is a challenge for the West China residency program just as it is for U.S. residency programs, but the factors behind attrition in each country differ significantly. To reduce attrition from temporary-contract residency programs in China, the programs themselves and government policies may need to change so that completing such residencies is as competitive an option as taking permanent hospital positions immediately after graduation.