Graduates of medical school who enter residency programs seem more likely to change specialty or discontinue completely if they are highly qualified academically, pursuing general surgery, or a five-year surgical specialty, according to an article released on December 15, 2008 in Archives of Surgery, one of the JAMA/Archives journals.
The graduate medical education system is structured in a specific way. “Although it is possible to change specialties during graduate medical education (GME), failure of a resident to complete the stipulated period of GME can be a problem for both program directors and residents,” write the authors. “Such resident attrition, in which the resident discontinues GME in his or her initial specialty to pursue GME in a different specialty or to discontinue GME entirely, can have widespread ramifications, causing difficulties with program scheduling for remaining trainees and disruption of patient care delivery.”
To investigate this attrition, Dorothy A. Andriole, M.D., of the Washington University School of Medicine, St. Louis, and colleagues evaluated GME enrollment and attrition within 795 students graduating from one medical institution between 1994 and 2000. Each participant planned to continue his education in a particular specialty immediately after graduation or in a year or preliminary training which would lead to an advanced position. Students were evaluated in terms of academic achievement, with high achievement considered election to Alpha Omega Alpha (AOA) Honor Medical Society or the achievement of another advance degree, such as the MD-PhD degree.
In six years minimum follow-up, 6% (47 students) of the 795 participants did not complete GME in the initially chosen specialty. Of these 47, 22 completed one year or less of training, 14 completed between one and two years, and three completed more than two years of training in this initial specialty. Many were also delayed: “For many of the 41 graduates who continued GME in different specialties, there was an interval of up to several years before they resumed GME, often because they had pursued research in a desired specialty,” write the authors.
There was no association between this attrition and graduation year, gender, or age. Attrition was, however, found to coincide with the advanced degrees that were held, AOA election, and the specific specialty chosen by the professional. The authors point out: “Four of the six graduates who entirely discontinued GME training held M.D. and Ph.D. degrees and subsequently pursued exclusively research-based careers.”
The authors conclude that these trends could have great implications on the system of medical education. “Finally, the issue of attrition during GME should be considered in the context of the projected physician shortage in the United States and growing concerns about the structure and efficiency of the GME process,” they write. “Efforts to redesign unnecessarily circuitous or lengthy specialty-specific training paths and to minimize nondurable specialty choice decisions by our students could enhance the systemwide efficiency of GME at the national level.”
Attrition During Graduate Medical Education: Medical School Perspective
Dorothy A. Andriole, MD; Donna B. Jeffe, PhD; Heather L. Hageman, MBA; Mary E. Klingensmith, MD; Rebecca P. McAlister, MD; Alison J. Whelan, MD
Arch Surg. 2008;143(12):1172-1177.
Written by Anna Sophia McKenney