Resident Attrition Research Articles

Sculpting the good surgeon or excising the bad one: How clinical teachers could perpetuate attrition in surgical residency programmes.

Attrition in surgical residencies remains a significant issue, with traditional research focusing mainly on individual and programme factors. This study explores the role of clinical teachers (CTs) in influencing attrition rates. CTs are essential in moulding residents' training, serving both as enablers of workplace learning and guardians of their medical fields. We employed a hermeneutic phenomenology framework to understand the sociocultural impacts on attrition. Data were collected through semi-structured interviews involving 19 CTs, 3 residents who left the programme and 2 who underwent remediation, following a six-step hermeneutic phenomenological analysis process. The entrenched 'good surgeon' narrative within the department demanded selflessness and total dedication, which CTs reinforced, thereby normalising a rigorous and challenging environment. This has led to attrition when residents fail to meet these challenges or choose to disengage from the system. We illustrated that CTs were pivotal in perpetuating these expectations, contributing significantly to resident attrition. CTs played a crucial role in resident attrition by enforcing a stringent cultural norm within surgical training programmes. Addressing this issue requires a visible change in CTs' role to foster a more supportive educational environment. Emphasising the beneficial aspects of the 'good surgeon' narrative and mitigating its adverse impacts is essential for reducing attrition rates and assisting all residents, including those facing challenges, in successfully completing their training.

The Effect of Intersectionality on Attrition among US General Surgery Trainees.

To examine the association between intersectionality of race, ethnicity, and sex on retention of U.S. general surgery residents. There are limited data on the role that intersectionality plays on the US general surgery resident experience. Analysis was performed using Association of American Medical Colleges (AAMC) data for general surgery residents who started their training between 2005-2015 (followed through completion). Regression analyses were used to assess demographic associations with time to attrition or successful completion of residency training. Associations between faculty and resident demographics were assessed. 25,029 residents were included. Over the decade-long study period, the number of underrepresented in medicine (UIM) residents as a percentage of all residents remained similar from 17% to 19% (P=0.24). The percent of UIM males starting training in 2005 was 11% and 12% in 2015 (P-value=0.38). UIM females comprised 5.5% of trainees in 2005 and increased to 6.9% (P-value=0.003) in 2015; and female non-UIM residents increased from 23 to 28% (P-value<0.001). The overall rate of resident attrition was 15%. UIM females had the highest yearly attrition rate at 21% compared to non-UIM males at 13% (HR 1.7, P<0.001). UIM females were more likely to leave residency compared to UIM males (HR: 1.5; P<0.001). The percent of UIM faculty was positively correlated with percent of UIM residents (r=0.64, P<0.001). Increasing intersectionality is positively associated with attrition during surgery residency. The diversity of faculty appears to be associated with resident diversity.

Developing a model describing voluntary residency attrition: a qualitative study

BackgroundMany factors influencing residency attrition are identified in the literature, but what role these factors play and how they influence each other remains unclear. Understanding more about the interaction between these factors can provide background to put the available evidence into perspective and provide tools to reduce attrition. The aim of this study was therefore to develop a model that describes voluntary residency attrition.MethodsSemi-structured interviews were held with a convenient sample of orthopaedic surgery residents in the Netherlands who dropped out of training between 2000 and 2018. Transcripts were analysed using a constructivist grounded theory approach. Concepts and themes were identified by iterative constant comparison.ResultsSeventeen interviews with former residents were analysed and showed that reasons for voluntary attrition were different for each individual and often a result of a cumulative effect. Individual expectations and needs determine residents’ experiences with the content of the profession, the professional culture and the learning climate. Personal factors like previous clinical experiences, personal circumstances and personal characteristics influence expectations and needs. Specific aspects of the residency programme contributing to attrition were type of patient care, required skills for the profession, work-life balance and interpersonal interaction.ConclusionsThis study provides a model for voluntary resident attrition showing the factors involved and how they interact. This model places previous research into perspective, gives implications for practice on the (im)possibilities of preventing attrition and opens possibilities for further research into resident attrition.

The Role of Inclusion in Increasing Diversity and Retention Across Surgical Residencies: a Literature Review.

Across surgical specialties, residencies are incentivized to improve program diversity, most often through recruitment of underrepresented minority (URM), women, LGBTQ, and disabled applicants. However, residency attrition remains high in these groups, highlighting the need for specific inclusion initiatives to improve retention and support for these cohorts. A better understanding of previous efforts at retention is paramount. This paper reviews the existing literature on inclusion and retention efforts in surgical residencies. A literature search was conducted using PubMed Central. Published articles were filtered based on date (2018-2023) and relevancy. Articles were evaluated holistically and focused on methods in increasing diversity and inclusion in residency retention. Through formal literature review focusing on pertinent research topic terms (i.e., inclusion, diversity, residency, surgery, retention), efforts that included inclusion initiatives, improving residency retention, and diversifying leadership were overarching themes. In recent years, there have been marked strides and improvements in encouraging resident diversity and inclusion. However, more widespread efforts with proven efficacy are needed in order to improve residency retention and toincrease and maintain diversity in leadership in surgery.

Neurosurgery Resident Attrition Rates Defy Trends and Decrease During COVID-19 Pandemic

We sought to determine the effects of the coronavirus disease 2019 (COVID-19) pandemic on U.S. neurosurgery resident attrition. We report the changes in resident attrition due to transfers, withdrawal, or dismissal from program training during the COVID-19 pandemic. Neurosurgery resident attrition data reported by the American Council of Graduate Medical Education for the academic year starting in July 2007 to the academic year ending in June 2022 were collected, and the rate of attrition was calculated. Individual postgraduate year program transfer rates were also calculated for the previous 7 consecutive academic years. The attrition rates for the academic years before the pandemic were compared with those during the pandemic. A total of 465 residents did not graduate from neurosurgical training during the past 15 academic years, of which 3 years were at least partially during the COVID-19 pandemic, resulting in a mean attrition rate of 2.5%. The attrition rates during the pandemic were lower than those before the pandemic (1.7% vs. 2.7%; P < 0.001), driven largely by a nearly twofold decrease in the withdrawal rate (0.67% vs. 1.2%; P= 0.003). Bivariate regression between the withdrawal and attrition rates showed a statistically significant correlation (r = 0.809; P < 0.001; r2 = 0.654). The first full year of the COVID-19 pandemic saw the most dramatic changes, with a z score for attrition of-1.9. Linear regression of the effect of training during the COVID-19 pandemic on attrition revealed a statistically significant difference (r = 0.563; P = 0.029; r2 = 0.317). The rate of withdrawal was most affected by training during the pandemic (r = 0.594; P = 0.010; r2 = 0.353). A statistically significant decline occurred in the rate of neurosurgery resident attrition during the COVID-19 pandemic that was most notable during the first full academic year (2020-2021). These findings were largely driven by a decrease in residents withdrawing from training programs. This contrasts with the overall trend toward resignation among healthcare workers during the pandemic. It is unclear what enduring ramifications this will have on neurosurgery residencies moving forward and whether we will see higher attrition rates as we transition toward a new normal. Future studies should examine trends in the attrition rates after the COVID-19 pandemic and determine the long-term effects of decreased attrition rates of residents during the pandemic.

EDITORIAL COMMENT

I appreciate the authors’ timely and influential publication identifying demographic factors associated with Urology residency attrition. As Diversity, Equity, and Inclusion (DEI) efforts continue to expand within Urology, it is imperative to assess the attrition rates of residents. It is not enough to recruit residents underrepresented in Urology, but as educators, we must ensure the resources for success are available to retain residents at risk for attrition. Although there are limitations to the study as mentioned in the manuscript, I think this data lays out what many already suspected; underrepresented minorities (URM) and women representation in Urology is not only a pipeline issue, but also a retainment issue.

The Revolving Door of Residency: Predictors of Residency Attrition for Urology Matriculants Between 2001 and 2016

To add to the literature which has reported higher attrition rates amongst General Surgery residents who identify as female or underrepresented in medicine (URM), we aimed to determine how these factors contribute to attrition within Urology. We hypothesized that women and URM Urology residents will similarly have higher attrition rates. The Association of American Medical Colleges surveyed residents to obtain matriculation and attrition status from 2001-2016. Data included demographics, medical school type, and specialty. A multivariable logistic regression model was performed to identify predictors of attrition amongst Urology residents. In our sample of 4,321 Urology residents, 22.5% were female, 9.9% were URM, 25.8% were older than 30 years, 2.5% were DO graduates and 4.7% were International Medical Graduates. On multivariable analysis, being female (OR = 2.3, p < 0.001) was associated with increased residency attrition when compared to male residents. Additionally, residents who matriculated between 30-39 years old (OR = 1.9, p < 0.001) or ≥40 years old (OR = 10.7, p < 0.001) had an increased risk of residency attrition when compared to residents who matriculated between 26-29 years old. Attrition rates for URM trainees has recently increased. Women, older, and URM Urology residents experience higher rates of attrition compared to their peers. It is essential to identify trainees with higher likelihoods of attrition to determine system-level changes to combat departures from training programs. Our study highlights the need to foster more inclusive training environments and change institutional cultures to diversify the surgical workforce.

Grit: what is it and why does it matter in medicine?

Grit refers to the combination of passion and perseverance for long-term goals. Grit has emerged as a recent topic of interest within the medical community. With ever-increasing rates of burnout and psychological distress, increasing attention has been directed towards modulatory or protective factors for these deleterious outcomes. Grit has been studied in regard to a variety of outcomes and variables in medicine. This article reviews the current literature on grit in medicine and summarises the current research on grit and performance metrics, personality characteristics, longitudinal progression, psychological well-being, diversity, equity and inclusion, burnout and residency attrition. While there is inconclusive evidence on the influence of grit on performance metrics in medicine, research consistently demonstrates a positive correlation between grit and psychological well-being and a negative correlation between grit and burnout. After discussing some of the inherent limitations of this type of research, this article suggests some possible implications and future areas for research and their potential role in cultivating psychologically healthy physicians and promoting successful careers in medicine.

Racial and Sex Disparities in Resident Attrition in Orthopaedic Surgery.

Demographic and attrition data from 2001 to 2018 were obtained from the Association of American Medical Colleges. Attrition data comprised the following categories: withdrawals, dismissals, and transfers to another specialty. Analysis compared demographic composition and determined attrition rates with subgroup analysis by race/ethnicity and sex. From 2001 to 2018, female orthopaedic residents increased from 8.77% to 15.54% and URiM residents from 9.49% to 11.32%. The overall and unintended attrition rates in orthopaedic surgery were 3.20% and 1.15%, respectively. Among female residents, the overall and unintended attrition rates were 5.96% and 2.09% compared with 2.79% and 1.01%, respectively, in male residents. URiM residents had overall and unintended attrition rates of 6.16% and 3.11% compared with 2.71% and 0.83%, respectively, for their White counterparts. Black/African American residents had an attrition rate of nearly 10%. Female residents averaged 12.9% of all residents but 24% of those leaving orthopaedics. URiM residents were 10.14% of all residents but 19.51% of those experiencing attrition. In logistic regression models, female residents had a relative risk (RR) of 2.20 (p < 0.001) for experiencing all-cause attrition and 2.09 (p < 0.001) for unintended attrition compared with male residents. Compared with their White male counterparts, URiM residents had a RR for overall and unintended attrition of 2.36 and 3.84 (p < 0.001), respectively; Black/African American residents had a RR for the same of 3.80 and 7.20 (p < 0.001), respectively. Although female resident percentage has increased, orthopaedics continues to train fewer female surgeons than all other fields. Female and URiM residents in orthopaedic surgery are disproportionately affected by attrition. While recruitment has been the primary focus of diversity, equity, and inclusion efforts, this study suggests that resident retention through appropriately supporting residents during training is equally critical.

Detecting residents at risk of attrition – A Singapore pathology residency's experience

The SingHealth Pathology Residency Program (SHPRP) is a 5-year postgraduate training program in Singapore. We face the problem of resident attrition, which has a significant impact on the individual, program and healthcare providers. Our residents are regularly evaluated, using in-house evaluations as well as assessments required in our partnership with the Accreditation Council for Graduate Medical Education International (ACGME-I). We hence sought to determine if these assessments were able to distinguish residents who would attrite from residents who would graduate successfully. Retrospective analysis of existing residency assessments was performed on all residents who have separated from SHPRP and compared with residents currently in senior residency or graduated from the program. Statistical analysis was performed on quantitative assessment methods of Resident In-Service Examination (RISE), 360-degree feedback, faculty assessment, Milestones and our own annual departmental mock examination. Word frequency analysis of narrative feedback from faculty assessment was used to generate themes.Since 2011, 10 out of 34 residents have separated from the program. RISE, Milestone data and the departmental mock examination showed statistical significance in discriminating residents at risk of attrition for specialty-related reasons from successful residents. Analysis of narrative feedback showed that successful residents performed better in areas of organization, preparation with clinical history, application of knowledge, interpersonal communication and achieving sustained progress. Existing assessment methods used in our pathology residency program are effective in detecting residents at risk of attrition. This also suggests applications in the way that we select, assess and teach residents.

Changes in Subspecialty Interest of Plastic Surgery Residents With Progression of Training: Impact on Academic Attrition.

Plastic surgery residency applicants often express interest in academic subspecialties, but only a small percentage of graduating residents pursue academic careers. Identifying reasons for academic attrition may help training programs address this discrepancy. A survey was sent to plastic surgery residents through the American Society of Plastic Surgeons Resident Council to assess interest in 6 plastic surgery subspecialties during junior and senior years of training. If a resident changed their subspecialty interest, the reasons for change were recorded. The importance of different career incentives over time were analyzed with paired t tests. Two hundred seventy-six plastic surgery residents of 593 potential respondents (46.5% response rate) completed the survey. Of 150 senior residents, 60 residents reported changing interests from their junior to senior years. Craniofacial and microsurgery were identified as the specialties with the highest attrition of interest, while interest in esthetic, gender-affirmation, and hand surgery increased. For residents who left craniofacial and microsurgery, the desire for higher compensation, to work in private practice, and the desire for improved job opportunities significantly increased. The desire for improved work/life balance was a prominent reason for subspecialty change among senior residents who changed to esthetic surgery. Plastic surgery subspecialties associated with academia, such as craniofacial surgery, suffer from resident attrition due to a variety of factors. Increased retention of trainees in craniofacial surgery, microsurgery, and academia could be improved through dedicated mentorship, improved job opportunities, and advocacy for fair reimbursement.

Racial and Sex Disparities in Resident Attrition Among Surgical Subspecialties

Racial and sex disparities are prevalent in surgical trainees. Although retrospective studies on resident attrition have been conducted for individual specialties, this study analyzes racial and sex differences in resident attrition among all surgical subspecialties over an 18-year period. To evaluate the racial and sex differences in resident attrition among surgical specialties over an 18-year period. This was a large, cross-sectional, database study that analyzed program-reported resident censuses (program information, resident demographics, and attrition status) obtained by the Association of American Medical Colleges from 2001 to 2018 for trainees in surgical residency programs. Data were analyzed from March 20, 2021, to June 8, 2022. Demographic trends (including race and ethnicity and sex) for all surgical subspecialty training programs over an 18-year period. Resident attrition includes all-cause withdrawals, dismissals, and transfers to another specialty. Unintended attrition encompasses all withdrawals, dismissals, and transfers except for changing career plans. This study included 407 461 program-reported resident years collected from 112 205 individual surgical residents (67 351 male individuals [60.0%]). The mean percentage of female trainees was 40.0% (44 835) and increased over the study period. Sex disparity remained greatest in orthopedic surgery. Residents who were underrepresented in medicine (URiM) comprised 14.9% (16 695) of all surgical trainees but demonstrated a 2.1% decrease over the study period. Overall attrition rate among all specialties was 6.9% (7759), with an unintended attrition rate of 2.3% (2556). Female residents had a significantly higher relative risk (RR) of attrition (RR, 1.16; 95% CI, 1.11-1.22; P < .001) and unintended attrition (RR, 1.17; 95% CI, 1.08-1.26; P < .001) compared with their male counterparts. URiM residents were at significantly higher RR for attrition (RR, 1.40; 95% CI, 1.32-1.48; P < .001) and unintended attrition (RR, 1.92; 95% CI, 1.75-2.11; P < .001) compared with non-URiM residents. The highest attrition (10.6% [746 of 7043]) and unintended attrition (5.2% [367 of 7043]) rates were in Black/African American residents. The lowest attrition and unintended attrition rates were seen in White residents at 6.2% (4300 of 69 323) and 1.8% (1234 of 69 323), respectively. Black/African American residents were at disproportionate risk for attrition (RR, 1.66; 95% CI, 1.53-1.80; P < .001) and unintended attrition (RR, 2.59; 95% CI, 2.31-2.90; P < .001) compared with all other residents. Orthopedic surgery had the highest attrition (RR, 3.80; 95% CI, 2.84-5.09; P < .001) and unintended attrition (RR, 7.20; 95% CI, 4.84-10.71; P < .001) for Black/African American residents. Results of this cross-sectional study suggest that the percentage of female residents in surgical specialties has improved over the last 18 years, and the percentage of URiM residents has remained relatively unchanged. Risk for attrition and unintended attrition was significantly elevated for female and URiM residents, specifically Black/African Americans. These results highlight current racial and sex disparities in resident attrition and demonstrate the importance of developing strategies to recruit, retain, and support residents.

Addressing Disparities in Resident Attrition

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20. Resident Attrition in Graduate Medical Education: The Impact of Race and Gender

20. Resident Attrition in Graduate Medical Education: The Impact of Race and Gender

A personhood and citizenship training workshop for care home staff to potentially increase wellbeing of residents with dementia: intervention development and feasibility testing of a cluster randomised controlled trial

BackgroundIn the UK, one third of people with dementia live in residential care homes, a sector where high staff turnover negatively affects continuity of care. To examine the effect of including personhood and citizenship principles in training, interventions need to be robustly tested, with outcomes relevant to residents with dementia.MethodsPhase one intervention development: The training intervention (PERSONABLE) comprised five reflective exercises facilitated by a mental health nurse/researcher. PERSONABLE was informed by four focus groups, and one field exercise, consisting of care home staff and family members. Phase two feasibility testing: Participants were (i) care home residents with dementia and (ii) care home staff working in any role. After baseline measurements, care homes were randomly allocated to (i) staff receiving PERSONABLE training or (ii) training as usual. Feasibility outcomes were the recruitment and attrition of care homes, residents and staff members (measured ten weeks between randomisation and follow-up), the acceptability of the training intervention PERSONABLE, and acceptability of outcome measures. The care home environment was evaluated, at baseline, using the Therapeutic Environment Screening Survey for Residential Care Homes. Measurements conducted at baseline and follow-up were resident wellbeing (Dementia Care Mapping™), staff knowledge of and confidence with personhood and citizenship (Personhood in Dementia Questionnaire and a perceived ability to care visual analogue scale). Inter-rater agreement for Dementia Care Mapping™ was undertaken at follow-up in one intervention and one training as a usual care home.ResultsPhase one: The developed reflective approach to the PERSONABLE exercises appeared to give staff a holistic understanding of residents living with dementia, seeing them as autonomous people rather than reductively as persons with a condition. Phase two: Six care homes, 40 residents and 118 staff were recruited. Four residents were lost to follow-up. Twenty-nine staff in the PERSONABLE arm of the study received the training intervention. In the PERSONABLE arm, 26 staff completed both baseline and follow-up measurements compared to 21 in the training as the usual arm. The most common reason for the loss to follow-up of staff was leaving employment. For the outcome measure Dementia Care Mapping™, the proportion of overall agreement between the two observers was 18.6%. High attrition of staff occurred in those homes undergoing leadership changes.ConclusionWith the right approach, it is possible to achieve good engagement during trial recruitment and intervention delivery of care home managers, staff and residents. Organisational changes are a less controllable aspect of trials but having a visible researcher presence during data collection helps to capitalise the engagement of those staff remaining in employment. Tailored, brief and flexible training interventions encourage staff participation. Simplification of study methods helps promote and retain sufficient staff in a definitive randomised controlled trial. This study found that some components of Dementia Care Mapping™ work effectively as an outcome measure. However, inter-rater reliability was poor, and the practical implementation of the measurement would need a great deal of further refinement to accurately capture the effect of a training intervention if delivered across a large number of clusters. The Dementia Care Mapping™ measurement fidelity issue would be further complicated if using multiple different unacquainted observers.Trial registrationRegistered with the ISRCTN under the title: Does a dementia workshop, delivered to residential care home staff, improve the wellbeing of residents with dementia? Trial identifier: ISRCTN13641553. Registered: 30/05/2017 http://www.isrctn.com/ISRCTN13641553.

Implementing pathways to anesthesiology: Promoting diversity, equity, inclusion, and success.

Implementing pathways to anesthesiology: Promoting diversity, equity, inclusion, and success.

Can an Emergency Surgery Scheduling Software Improve Residents’ Time Management and Quality of Life?

Background: Operating room efficiency is invaluable. Particularly in public health systems, where resources are limited and patient loads are high, efficient systems underpin the continued delivery of high quality care. In addition to impacting patients, the implementation of efficient healthcare tools has the potential to improve staff quality of life. In the face of growing surgical resident attrition and healthcare worker burnout, developments in standard practice, such as the implementation of the 80-hour work week, are necessary to improve quality of life. Materials and methods: A new online scheduling software (ORNET.CA) was created, installed, and piloted in a Level I Trauma Center after instructing users (physicians and nurses) on its use. A 20-item survey was then distributed to all users to assess the effect implementation of the software had on their quality of life. Results: ORnet was shown to improve communication between hospital staff and physicians, reduce workflow interruptions, and improve the quality of the working environment. The survey showed that 60% of residents and 50% of attending staff believed that ORNET.CA improved their quality of life. Conclusions: We present data from a novel emergency operating room scheduling system that allowed surgical residents and attending physicians to better plan their on-call shifts. Staff (resident and physician) reported survey results suggest that implementation of this system resulted in an improved quality of life and a decrease in stress and anxiety levels.

P87. CHANGES IN SUBSPECIALTY INTEREST OF PLASTIC SURGERY RESIDENTS WITH PROGRESSION OF TRAINING: IMPACT ON ACADEMIC ATTRITION

PURPOSE: Plastic surgery residency applicants often express interest in academic subspecialties, but only a small percentage of graduating residents pursue academic careers. Identifying reasons for academic attrition may help training programs address this discrepancy. METHODS: A survey was sent to plastic surgery residents via the American Society of Plastic Surgeons Resident Council to assess interest in six plastic surgery subspecialties during junior and senior years of training. If a resident changed their subspecialty interest, the reasons for change were recorded. The importance of different career incentives over time were analyzed with paired t-tests. RESULTS: 276 plastic surgery residents completed the survey. Most (77%) reported initial interest in an academic career. Out of 150 senior residents, 60 residents reported changing interests from their junior to senior years. Craniofacial and microsurgery were identified as the specialties with the highest attrition of interest, while interest in aesthetic, gender affirmation, and hand surgery increased. For residents who left craniofacial and microsurgery, the desire for higher compensation, to work in private practice, and the desire for improved job opportunities significantly increased. The desire for improved work/life balance was a prominent reason for subspecialty change among senior residents who changed to aesthetic surgery. CONCLUSION: Plastic surgery subspecialties associated with academia suffer from resident attrition due to a variety of factors. Increased retention of trainees in academia, microsurgery, and craniofacial surgery could be improved through dedicated mentorship, improved job opportunities, and advocacy for fair reimbursement.

Nationwide Study on Stress Perception Among Surgical Residents

ObjectiveDeclining number of applicants and high attrition of residents are a dire reality. Surgeons in training are confronted to various stressors which interfere with their performance and may promote burnout. This study measures stress levels of Swiss surgical residents.MethodsSwiss surgery residents taking the Surgical Basic Exam from 2016 to 2020 completed the Perceived Stress Scale 10 (PSS). The PSS measures how unpredictable, uncontrollable, and overloaded the respondents evaluate their work life. Scores up to 13 are normal, and scores around 20 are highly pathologic. High subscores of helplessness (PH) and lower subscores of self-efficacy (PSE) indicate distress.ResultsA total of 1694 questionnaires were evaluated (return rate 95.7%). Resident median (m) age was 29 years, 43.5% were female, and 72.7% of the residents were in their first 2 years of training. Residents reported a high PSS (m = 15), a high PH (m = 9), and an ordinary PSE (m = 5). Females reported worse PSS (p < 0.001), PH (p < 0.001), and PSE (p = 0.036). In multivariable analysis, male sex (p < 0.001), aiming at orthopedic (p = 0.017) or visceral surgery (p = 0.004), and French as mother tongue (p = 0.037) predicted lower stress levels, while graduating from a country not adjacent to Switzerland led to higher stress (p = 0.047).ConclusionPerceived stress levels are high in this prospective and representative cohort study of Swiss surgical residents. Females endured significantly worse stress and helplessness levels than males. These figures are worrisome as they may directly contribute to the declining attractivity of surgical residencies. Detailed sex-specific analysis and correction of stressors are urgently needed to improve residency programs.

“The captain of the ship.” A qualitative investigation of surgeon identity formation

BackgroundProfessional identity formation is essential to medical trainee education. Surgeons are expected to guide trainees through this process but may be unprepared as they may not understand their own professional identity. MethodsWe purposively selected 46 surgeons across Michigan to participate in semi-structured qualitative interviews intended to explore surgical decision-making in 2019. Thematic analysis was used to analyze the transcripts. ResultsSurgeon identity formation is a complex process influenced by factors from four domains: individual factors, interpersonal relationships, external influences, and professional experience. We found surgeon identity formation commences prior to residency training and continues to remodel long into practice. ConclusionsBy understanding surgeon identity, surgeons will be prepared to help form trainees’ professional identities and recognize opportunities for improvement. We believe changes, especially within the environment and community, will encourage medical students to enter surgical fields, decrease resident attrition, and promote surgeon well-being.