Despite many great changes to surgical training in the US, attrition has remained consistently high (>20% from general surgical training). Today I listened to an interview with Julie Ann Sosa, an author of recent research ‘Association of time to attrition in surgical residency with individual resident and programmatic factors’ published in JAMA Surgery.
It drew me in for two reasons. First, the study strongly focused on understanding the trainee perspective: their expectations, perceptions and attitudes and whether their perspectives about surgery as a career change during training. Secondly, I was curious to know what parallels there might be with our own investigation commissioned by the Royal Australasian College of Surgeons (RACS) on why trainees leave in which we explored their training experiences and their leaving experiences and how they could be improved (see our full report here).
I also love the accessibility of a podcast! At The Ardnell Group we’re enjoying many of the extended conversations that JAMA and other journals are developing. In this case the podcast gave the opportunity to get behind the academic work with these key questions:
- What was the personal motivation to do the work?
- What was the author’s most surprising finding?
Julie Ann was really honest in her responses. She wanted to ask “What are we doing wrong in surgical training?” to be able to start putting it right! She was most surprised by the really late withdrawals seeing these as a genuine loss for the individual and also for the training program.
The research showed that any trainee is at risk. Surgery and surgical training is a stressful business! It was acknowledged that some early attrition is understandable for trainees who realise that surgery simply isn’t for them. Factors contributing to a decision to leave interact and change over time as individuals ‘evolve’ across training. Being female and being hispanic were both demographic risk factors for attrition in the US study. And the podcast unpacked the complexity behind this finding. Women were more likely to change their family commitments (e.g. finding a partner and starting a family) after entering training and hispanic trainees were more likely to enter training with pre-existing family commitments. But the stress of family commitments together with training requirements were cumulative and threatened progression.
We interviewed surgical trainees in Australia and New Zealand in our own study and heard similar accounts of this accumulation of stress. It was rare for a single issue to lead to a decision to leave.
Both studies point to the need for radical rethinking and well-resourced change. Julie Ann suggests promoting genuine training-family integration – building social support structures, building respect for each other, ensuring expectations of training are appropriate, by workplaces and training programs supporting trainees to undertake both training and meet their family obligations outside training. She challenges faculty to become much more inclusive in their own group and take steps to promote genuine diversity. She poses the questions which are a little different to the ones we usually think of when trying to improve a training program:
- How do we integrate families into training?
- How do we support systems for child care?
- How do we include trainees and their families in the social fabric of training?
Do you have interventions available at your workplace to support trainees and their families during training? What can you do better, starting today?
You can listen to the audio here.
Reference: Yeo HL, Abelson JS, Symer MM, et al. Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors. JAMA Surg. 2018;153(6):511–517. doi:10.1001/jamasurg.2017.6202