Career Outcomes of Nondesignated Preliminary Surgery Residents: A Systematic Review and Meta-Analysis

Nondesignated preliminary surgery (NDPS) residency offers postgraduate medical education with no guarantee of a subsequent categorical position. Some literature exists detailing the career outcomes of these residents, but these results are complicated by the limited scale of these studies. The purpose of this systematic review and meta-analysis is to summarize the career outcomes of these residents from the existing literature.

The PubMed, Scopus, Cochrane, CINAHL, and PsycINFO databases were queried from inception for studies reporting the career outcomes of NDPS residents. Data were collected and extracted by 2 independent reviewers in accordance with PRISMA guidelines. The primary outcome of this study is the proportion of NDPS residents obtaining a categorical general surgery position. Secondary outcomes include the percentages of residents obtaining surgical subspecialty positions, obtaining nonsurgical specialty positions, and leaving graduate medical education.

Overall, 13 studies reporting NDPS residents (n = 2606) were identified. The overall pooled estimate for obtaining a categorical general surgery position after NDPS residency was 37.1% (95% CI, 31.3%-43.2%), with significant heterogeneity (I² = 81.8%; p < 0.001). Residents in the second postgraduate year were significantly more likely than those in the first year to obtain a general surgery position (50.6% vs 29.0%, respectively; p < 0.001). Residents subsequently training in a surgical subspecialty (13.3%) largely entered orthopedics (3.6%), urology (2.1%), and obstetrics and gynecology (1.6%). For residents entering nonsurgical training (32.1%), a majority entered anesthesiology (11.7%), internal medicine (3.8%), and radiology (3.8%).

Although NDPS residents have heterogenous career outcomes, they largely obtain categorical positions in general surgery and surgical subspecialties.