Retention of surgical trainees in England

Abstract

BackgroundSurgical training is a competitive process attracting highly motivated clinicians. The National Health Service is currently facing long waiting lists and a workforce crisis yet there is a paucity of data regarding attrition of surgical trainees in England. This study aims to describe the attrition of surgical trainees from 2016 to 2021 and explore the relationship between specialty competition ratios and attrition rates. MethodsData was obtained from Health Education England by freedom of information requests. Binary logistic regression analyses explored differences in attrition between surgical specialties. Spearman's correlation was used to assess the relationship between competition ratios and attrition rates. ResultsFrom 2016 to 2021, 481 surgical trainees have left surgical training, with an average yearly attrition rate of 2.68%. This number varied considerably across specialties with Paediatric Surgery having the highest rate at 4.20% and Trauma & Orthopaedic Surgery (T&O) the lowest at 1.52%. Compared to General Surgery, trainees in Neurosurgery, T&O and Plastic Surgery were significantly less likely to leave their respective programmes (OR 95% CI 0.53 (0.33–0.85) p = 0.009, 0.44 (0.34–0.58) p < 0.001, 0.51 (0.33–0.78) p = 0.002, respectively). Attrition rates were inversely related to competition ratios, with more competitive specialties experiencing less attrition (ρ = − 0.302 (p = 0.078)). ConclusionThese data highlight the increasing attrition of surgical trainees over recent years, with some specialties experiencing greater rates of attrition than others. Qualitative research and exit interviews are needed to ascertain the causal factors behind the attrition of surgical trainees to improve training and retention of this highly skilled workforce.