A comprehensive national survey on thoughts of leaving residency, alternative career paths, and reasons for staying in general surgery training

Ellis, Ryan J.; Holmstrom, Amy L.; Hewitt, D. Brock; Engelhardt, K; Yang, Anthony D.; Merkow, Ryan P.; Bilimoria, Karl Y.; Hu, Yue

doi:10.1016/j.amjsurg.2019.10.040

Cited by 16 publications

(13 citation statements)

References 25 publications

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“…A variation is seen in the relation of gender and attrition in other specialties. For example, some programs have shown a higher rate of attrition among females (33,34), while others have shown predominantly males who quit their residency program (12,35). There was no statistical signi cance in the rate of attrition between males and females reported in our study and was also observed in a literature review of surgical residencies from 1980 to 2016 (37).…”

Section: Discussioncontrasting

confidence: 62%

A Systemic Approach to Trainee Physician Wellness: Using the Theory of Change to Restructure a Pediatric Residency Program

Raza¹,

Aj²,

Humayun³

et al. 2021

Preprint

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Background: Resident well-being leads to better patient care practices, but a systematic approach is needed to achieve the wellness agenda. The Theory of Change was used for developing an interventional model for wellness in our study, after identifying the causes of burnout and attrition in a pediatric residency program. Methods: This was a quality improvement project where residents were asked about their main stressors in an anonymous open-ended feedback form. Workload (n=63, 37.5%) was identified as the main source of dissatisfaction. A database of 43 residents who quit in the past ten years was examined to find 40.0% of residents left after the first year of training and the main cause was marriage and/or family concerns (28.9%). Then literature was reviewed to build a wellness intervention's framework. Finally, the Theory of Change was applied focusing on restructuring the residency core, accountability and communication, and stress management. The final theory of the change model included the assumptions that the program needed restructuring because of high attrition, low first pass exam rate, and decreased patient satisfaction. The goal was to increase resident wellness and performance, while keeping patient care at the core. Results: The short-term outcomes were drop in attrition rate from an average of 8.67% to 1.75%, decrease in FCPS exam attempt from 3.3 to almost 1, and an increase in patient satisfaction. Conclusion: Using the Theory of Change, it was possible to address residents’ concerns, increase their retention and improve patient satisfaction by reconstructing the wellness program.

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Section: Discussioncontrasting

confidence: 62%

A Systemic Approach to Trainee Physician Wellness: Using the Theory of Change to Restructure a Pediatric Residency Program

Raza¹,

Aj²,

Humayun³

et al. 2021

Preprint

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“…Four papers [88][89][90][91] tried to assess the relationship between gender and attrition. Ellis et al 88 found that female trainees were more likely to leave surgical training (OR: 1.54, 95% CI: 1.16-2.06); equally, female sex has been found to be the only factor associated with serious thoughts of leaving residency on multivariate analysis (OR: 1.2, 95% CI: 1.1-1.3, P = 0.003) during all surgical residencies, from post graduate year 1, 2, 3 (PGY1, 2, 3) until chief years. 90 In a qualitative study 89 conducted among 12 Australian women who decided to leave surgical training, the authors found 6 main factors that contributed to this: unavailability to obtain leave, absence of a distinction between valid and invalid reasons for leave, poor mental health, absence of interactions with the women in the surgery section of their professional body and other support systems, fear of repercussion of reporting sexual harassment during surgical training, lack of pathways for independent and specific support of trainee feedback.…”

Section: Surgical Trainingmentioning

confidence: 99%

Early Barriers to Career Progression of Women in Surgery and Solutions to Improve Them

et al. 2022

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Objective: This study aims to summarize the evidence concerning the barriers that exist to the career progression of women in surgery and to provide potential solutions to overcome these obstacles. Background: Visible and invisible impediments can hinder female doctors’ pursuit of a surgical career, from choosing a surgical specialty to training opportunities and all the way through career progression. Methods: Database search of original studies about barriers for female surgeons during choice of surgical career, residency, and career progression. A query including possible solutions such as mentorship and network was included. Results: Of 4618 total articles; 4497 were excluded as duplicates, having incorrect study focus, or not being original studies; leaving 120 studies meeting the inclusion criteria. Of the articles included, 22 (18%) focused on factors affecting the pursuit of a surgical career, such as surgical work hours and limited time for outside interests, 55 (46%) analyzed the main barriers that exist during surgical residency and fellowship training, such as discrimination and sexual harassment, 27 (23%) focused on barriers to career advancement, heavy workloads, ineffective mentorship, unclear expectations for advancement, inequality in pay or work-home conflicts. Among studies reporting on possible solutions, 8 (6.5%) articles reported on the role of effective mentorship to support career advancement and to provide moral support and 8 (6.5%) on the emerging role of social media for networking. Our analysis showed how different impediments hinder surgical career progression for women, with notable consequences on burnout and attrition. Conclusions: Identification and recognition of obstacles to career progression is the first step to addressing the gender gap in surgery. Active strategies should be improved to promote a culture of diversity and to create equal opportunity for women in surgery, while implementing structured mentoring programs and investing on an adequate communication on social media to engage the future generations.

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“…Reducing burnout in surgical residents is important not only for patient safety but also to retain precious and scarce talent in the surgical field. Of concern in this context is the finding that senior female residents are more likely to quit medicine entirely if they are dissatisfied with their job as compared to male counterparts [25]. Several risk factors for burnout have been identified such as female gender, diminished decisional autonomy, and decreased institutional support [24,25].…”

Section: Burnout: Impact and Gender Differencesmentioning

confidence: 99%

Surgical Education: Focus on Gender Equality in Academic Surgery and Related Areas

Laessig¹,

Ullrich²,

Papadimos³

et al. 2022

Contemporary Topics in Graduate Medical Education - Volume 2

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Despite progress and advancements made to achieve gender equality, a glass ceiling still exists for women in surgery. Women remain largely underrepresented in academic surgery, with appointments to only 18% of surgery program director roles and 6.3% of surgical chair positions in the United States as of 2018. Inequities across various surgical subspecialties are also significant, especially in the areas of neurosurgery, orthopedic surgery, otolaryngology, and plastic and reconstructive surgery. Additional barriers exist for women in academics, including lack of high-quality female mentorship, implicit bias within letters of recommendation, and a greater incidence of reported moral injury and burn-out. Further efforts to address these inequities are necessary to retain the talents and contributions of women in surgery. Interventions that may counterbalance the continued gender gap within surgical fields include the implementation of implicit bias training, increasing institutional support, establishing formal mentorship initiatives, the introduction of early exposure programs during medical training, transparent institutional promotion policies, childcare support, and accommodation of maternity leave. The purpose of this chapter is to educate the reader regarding gender inequality in surgery and related fields and to highlight key issues central to the propagation of gender biases specifically as they relate to female surgeons across various roles and responsibilities (e.g., clinical practice, education/training, and leadership) within the contemporary academic landscape.

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A comprehensive national survey on thoughts of leaving residency, alternative career paths, and reasons for staying in general surgery training

Cited by 16 publications

References 25 publications

A Systemic Approach to Trainee Physician Wellness: Using the Theory of Change to Restructure a Pediatric Residency Program

A Systemic Approach to Trainee Physician Wellness: Using the Theory of Change to Restructure a Pediatric Residency Program

Early Barriers to Career Progression of Women in Surgery and Solutions to Improve Them

Surgical Education: Focus on Gender Equality in Academic Surgery and Related Areas

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