Prevention of Surgical Resident Attrition by a Novel Selection Strategy
*Rachel R Kelz, James L Mullen, Larry R Kaiser, *Lori A Pray, *Gregg Shea, Jeff A Drebin, *Chris J Wirtalla, Jon B Morris
Department of Surgery, University of Pennsylvania, Philadelphia, PA
Despite implementation of the ACGME work rules, lifestyle and generational priorities have fostered a persistently high attrition rate for surgical trainees. We proactively sought to evaluate/modify the resident selection strategy (RSS) to reduce resident attrition (RA).
An independent external review of residents who left the training program and a detailed analysis of the RSS were performed by an organizational management expert. Modifications implemented in 2005 (the intervention) included standardization of the screening and interview format. Applicants were required to submit a 500 word essay related to stress management, organizational skills, future aspirations, and prioritization abilities. This formed the basis of an extended, personalized, and structured interview script. Candidate characteristics and RA were compared for the five years before and after the intervention using Fisher’s exact test or chi-square.
Age, sex, birthplace, medical school ranking, step 1 score and ABSITE performance were not significantly different between the interview strategies. Risk factors for RA included gender, ABSITE performance and faculty evaluations. Resident performance and RA were significantly affected by the RSS.
RA was dramatically reduced following the intervention. A custom designed process to identify candidates most likely to succeed substantially improved resident retention in a demanding academic training program.