An analysis of attrition from Canadian neurosurgery residency programs

To determine the magnitude of and reasons for attrition from neurosurgical residency programs in Canada.

Directors of the 13 Canadian neurosurgery residency programs were asked to complete questionnaires on their programs, magnitude of attrition, reasons for attrition, and selection criteria. Open-ended questions were assessed with content analysis and quantified with dual-scaling techniques. Similar questionnaires were sent to 30 residents who had completed training; six residents who had voluntarily withdrawn were interviewed.

Twelve of the 13 directors (92%) responded. Forty-two residents voluntarily withdrew from residency training between 1980 and 1992; withdrawal rates grew during that period. The number of dismissals--approximately 1.8 per year--remained constant. Reasons for voluntary withdrawal focused on excessive workloads and unexpected residency demands, whereas reasons for dismissal related primarily to deficits in professional attitudes and behaviors such as interpersonal skills and ethics. In selecting residents, programs with low attrition rates gave more importance to a candidate's work ethic than did programs with high attrition rates. The low-attrition programs also gave more importance to the relationship developed with residents during training.

These results suggest that voluntary attrition from neurosurgical residency is significant and is related to issues of lifestyle control. Dismissal is rarely related to cognitive or psychomotor deficits, but usually occurs for concerns about professionalism such as ethics and interpersonal skills and behaviors. Further studies are necessary to confirm these findings across specialties and countries.