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Developing a model describing voluntary residency attrition: a qualitative study.

Astrid J de Vries1, Yvonne Ten Hoeve2, Debbie A D C Jaarsma3

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Residency attrition is complex, influenced by individual needs and program factors. A new model clarifies how these elements interact, offering insights to reduce physician dropout.

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AttritionGrounded theoryModel developmentPostgraduate medical education

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Area of Science:

  • Medical Education
  • Surgical Training
  • Residency Programs

Background:

  • Numerous factors contributing to residency attrition are documented, yet their interplay remains unclear.
  • Understanding these interactions is crucial for contextualizing evidence and developing effective attrition reduction strategies.
  • This study aimed to develop a comprehensive model of voluntary residency attrition.

Purpose of the Study:

  • To develop a model that describes the factors influencing voluntary residency attrition.
  • To elucidate the interactions between these factors in the context of surgical residencies.
  • To provide a framework for understanding and potentially mitigating residency attrition.

Main Methods:

  • Conducted semi-structured interviews with 17 former orthopaedic surgery residents in the Netherlands who left training between 2000 and 2018.
  • Employed a constructivist grounded theory approach for transcript analysis.
  • Utilized iterative constant comparison to identify key concepts and themes related to attrition.

Main Results:

  • Voluntary attrition reasons are individualized and often stem from cumulative effects.
  • Residents' experiences with the profession's content, culture, and learning climate are shaped by personal expectations and needs.
  • Personal factors (prior experience, circumstances, characteristics) and residency program aspects (patient care, skills, work-life balance, interactions) significantly influence attrition.

Conclusions:

  • A novel model illustrating the factors and interactions in voluntary resident attrition has been developed.
  • This model contextualizes prior research and offers practical implications for preventing attrition.
  • The study opens avenues for future research into the complexities of resident attrition.