Thomas J. Leibrandt

This article attempts to assess the effect of the duty-hour limitations implemented in 2003 on voluntary withdrawal of general surgery residents. A questionnaire asked the program directors how many categorical general surgery residents left voluntarily in 2003 to 2004, their training levels, why they left, and where they went. Results were compared with an identical study of 2000 to 2001 and analyzed statistically using chi-square analysis. A total of 215 programs (85%) responded, compared with 206 programs (81%) in the previous study. One hundred two programs (48%) reported voluntary attrition of 148 residents, compared with 110 programs (53%) and 167 residents previously. An average of 1.5 residents per program left in programs that reported attrition and 0.7 residents per program in all responders, compared with 1.5 and 0.8 residents in the previous study. In both studies, most programs with attrition lost one (66% [2000 to 2001] and 65% [2003 to 2004]) or two residents (21% [2000 to 2001] and 27% [2003 to 2004]). Most attrition occurred at PGY1 (47%) and PGY2 (28%) levels; a total of 75% of all attrition occurred at these levels, compared with a total of 76% in the previous study. One hundred eleven residents (75%) entered other medical specialties, and 23 (16%) transferred to other general surgery programs, compared with 105 residents (63%) and 40 residents (24%) in the previous study. In both studies, personal issues and work hours/lifestyle were cited as the most common reasons for leaving. In each study, the net loss to general surgery (the number of residents who left voluntarily divided by the total resident population at risk) was 3% for that academic year. Analysis showed no statistically significant difference. Rates and patterns of attrition seem to have been unaffected by Accreditation Council for Graduate Medical Education work-hours limitations.

Although the Accreditation Council for Graduate Medical Education (ACGME) requires that all of its approved residency programs have written goals and objectives and an evaluation process, many programs have difficulty achieving these goals. For eight years, the general surgery residency program at Abington Memorial Hospital has used a system that integrates each rotation's cognitive, clinical, and procedural objectives into the faculty's evaluation of residents and residents' evaluation of the rotation. The integration of goals and objectives with the post-rotation evaluations provides the program with an ongoing and continual assessment of each resident's progress, the effectiveness of the faculty as teachers, and the educational value of each rotation. In this essay, the authors describe this integrated system and provide examples of one rotation's goals and objectives and the evaluation forms used by faculty and residents.