Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, DE22 3NE, UK.
Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
World J Surg. 2021 Feb;45(2):429-442. doi: 10.1007/s00268-020-05844-0. Epub 2020 Oct 26.
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.
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.
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.
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.
外科培训中的人员流失是一个挑战。在美国，流失率高达 20-26%。预测流失的因素尚不清楚。本系统评价的目的是确定影响外科培训期间流失或表现的因素。
本评价按照 PRISMA 指南进行，并在开放科学框架（OSF）上进行了注册。在 Medline、EMBASE、PubMed 和 Cochrane 对照试验中心注册库中搜索文章。使用纽卡斯尔-渥太华量表评估偏倚风险。使用 STATA 版本 15（StataCorp Ltd）中的随机效应荟萃分析计算汇总估计值。进行了敏感性分析，仅包括多机构研究。
搜索共确定了 3486 篇文章，其中 31 篇被纳入，共包括 17407 名住院医师。有 15 项研究基于多机构数据，16 项基于单机构数据。29 项研究基于美国住院医师。总体流失的汇总估计值为 17%（95%CI 14-20%）。女性的总体流失率明显高于男性（24%比 16%，p<0.001）。一些研究报告称，西班牙裔住院医师的流失率高于非西班牙裔住院医师。年龄、婚姻或父母状况与流失风险增加无关。报告称影响表现的因素是非白人种族和教师对临床表现的评估。养育子女与表现无关。
一般外科住院医师中，女性性别与较高的流失率相关。需要对当代外科队列进行纵向研究，以调查未能完成外科住院医师培训的复杂多因素原因。
