Survey reveals surgery residents concerned with motivations to pursue surgical careers

Sep 23 2009

A survey of nearly 4,500 general surgery residents finds that the majority are satisfied with their training and relationships with faculty and peers, but also indicated concerns regarding motivations for pursuing surgical careers and the need to complete specialty training, according to a study in the September 23/30 issue of JAMA, a theme issue on medical education.

General surgery residency training is facing formidable pressures, including less attraction to surgery as a profession, increasing interest in surgical subspecialization, and estimated attrition rates of 17 percent to 26 percent among categorical general surgery residents, rates that are higher than other medical residencies, according to background information in the article. "At the same time, a substantial shortage of general surgeons is predicted. Strategies responding to these complex and competing challenges can be informed by understanding general surgery residents' attitudes and experiences regarding training, and their association with attrition," the authors write.

Heather Yeo, M.D., M.H.S.R., of the Yale University School of Medicine, New Haven, Conn., and colleagues conducted a survey in January 2008 of U.S. general surgery residents to characterize their attitudes, experiences, and expectations regarding residency training and to identify predictors of attrition from residency training. Of 5,345 categorical general surgery residents, 4,402 (82.4 percent) responded, representing 248 of 249 surgical residency programs.

The researchers found that the majority of respondents (3,686, 85.2 percent) expressed high levels of satisfaction with training. "The majority of respondents (71.6 percent) reported that their program has support structures for residents who are struggling and that they can turn to the faculty when having difficulties in the program (71.9 percent). Residents generally reported very positive collaborative relationships with peers, with [84.2 percent] indicating that they can count on other residents to help them out when they are having a problem," the authors write.

A series of items examined various sources of stress and concern among residents. "Notable proportions of residents reported feeling uneasy or troubled by aspects of training and skill development," the researchers write. Of the respondents, 30.7 percent reported that the stress of work is causing strain on their family life. Also, 27.5 percent expressed apprehension about their clinical skills, worrying that they will not feel confident enough to perform procedures by themselves before they finish training, while 63.7 percent reported worry about hurting patients. Additionally, 63.8 percent of respondents indicated that they will need to complete additional specialty training in order to be competitive in the job market.

Regarding selected items analyzed by sex, men were more likely to report being satisfied with residency training than women, and women were more likely to have considered leaving residency during the prior year; men were more likely to feel their training program would provide them with someone to turn to when they are struggling and to feel they can turn to members of the faculty when having difficulties in the program.

"Reports of having considered leaving training in the prior year differed significantly across years, highest in postgraduate year 2 (19.2 percent) and lowest in postgraduate year 5 (7.2 percent)," the researchers add.

"This baseline descriptive study … may help inform efforts to respond to the complex pressures facing the surgical profession, including the ability to attract and retain increasingly diverse general surgery residents and the projected shortage of general surgeons in the coming decades," the authors conclude.