Division of Vascular Surgery, St Michael's Hospital, Toronto, Ontario, Canada2Department of Surgery, Taibah University, Madinah, Saudi Arabia.
Division of Vascular Surgery, St Michael's Hospital, Toronto, Ontario, Canada3Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
JAMA Surg. 2017 Mar 1;152(3):265-272. doi: 10.1001/jamasurg.2016.4086.
Attrition of residents from general surgery training programs is relatively high; however, there are wide discrepancies in the prevalence and causes of attrition reported among surgical residents in previous studies.
To summarize the estimate of attrition prevalence among general surgery residents.
We searched the Medline, EMBASE, Cochrane, PsycINFO, and ERIC databases (January 1, 1946, to October 22, 2015) for studies reporting on the prevalence and causes of attrition in surgical residents, as well as the characteristics and destinations of residents who left general surgery training programs. Database searches were conducted on October 22, 2015.
Eligibility criteria included all studies reporting on the primary (attrition prevalence) or secondary (causes of attrition and characteristics and destination of residents who leave residency programs) outcomes in peer-reviewed journals. Commentaries, reviews, and studies reporting on preliminary surgery programs were excluded. Of the 41 full-text articles collected from the title/abstract screening, 22 studies (53.7%) met the selection criteria.
Two reviewers independently collected and summarized the data. We calculated pooled estimates using random effects meta-analyses where appropriate.
Attrition prevalence of general surgery residents.
Overall, we included 22 studies that reported on residents (n = 19 821) from general surgery programs. The pooled estimate for the overall attrition prevalence among general surgery residents was 18% (95% CI, 14%-21%), with significant between-study variation (I2 = 96.8%; P < .001). Attrition was significantly higher among female compared with male (25% vs 15%, respectively; P = .008) general surgery residents, and most residents left after their first postgraduate year (48%; 95% CI, 39%-57%). Departing residents often relocated to another general surgery program (20%; 95% CI, 15%-24%) or switched to anesthesia (13%; 95% CI, 11%-16%) and other specialties. The most common reported causes of attrition were uncontrollable lifestyle (range, 12%-87.5%) and transferring to another specialty (range, 19%-38.9%).
General surgery programs have relatively high attrition, with female residents more likely to leave their training programs than male residents. Residents most often relocate or switch to another specialty after the first postgraduate year owing to lifestyle-related issues.
外科住院医师培训项目的人员流失相对较高；然而，之前的研究报告中外科住院医师的流失率和原因存在很大差异。
总结普通外科住院医师流失率的估计值。
我们检索了 Medline、EMBASE、Cochrane、PsycINFO 和 ERIC 数据库（1946 年 1 月 1 日至 2015 年 10 月 22 日），以获取关于外科住院医师流失率及其原因的研究报告，以及离开普通外科培训项目的住院医师的特征和去向。数据库检索于 2015 年 10 月 22 日进行。
纳入标准包括所有在同行评议期刊上报告主要（流失率）或次要（流失原因和离开住院医师项目的住院医师特征和去向）结果的研究。排除评论、综述和初步外科项目报告。从标题/摘要筛选中收集了 41 篇全文文章，其中 22 篇（53.7%）符合选择标准。
两名评审员独立收集和总结数据。我们在适当的情况下使用随机效应荟萃分析计算汇总估计值。
普通外科住院医师的流失率。
总体而言，我们纳入了 22 项报告普通外科项目住院医师（n=19821）的研究。普通外科住院医师总体流失率的汇总估计值为 18%（95%CI，14%-21%），各研究间差异显著（I2=96.8%；P<0.001）。与男性（分别为 25%和 15%）相比，女性普通外科住院医师的流失率明显更高，且大多数住院医师在毕业后第一年离开（48%；95%CI，39%-57%）。离开的住院医师通常转移到另一个普通外科项目（20%；95%CI，15%-24%）或转到麻醉科（13%；95%CI，11%-16%）和其他专业。报告的最常见流失原因是无法控制的生活方式（范围，12%-87.5%）和转至其他专业（范围，19%-38.9%）。
普通外科项目的人员流失率相对较高，女性住院医师比男性住院医师更有可能离开培训项目。住院医师通常在毕业后第一年因生活方式相关问题而转移或转至其他专业。
