An analysis of attrition from Canadian neurosurgery residency programs

Purpose. To determine the magnitude of and reasons for attrition from neuro surgical residency programs in Canada. Method. Directors of the 13 Canadian neurosurgery residency programs were a sked to complete questionnaires on their programs, magnitude Of attrition, reasons for attrition, and selection criteria. Open-ended questions were as sessed with content analysis and quantified with dual-scaling techniques. S imilar questionnaires were sent to 30 residents who had completed training; six residents who had voluntarily withdrawn were interviewed. Results. Twelve of the 13 directors (92%) responded. Forty-two residents vo luntarily withdrew from residency training between 1980 and 1992; withdrawa l rates grew during that period. The number of dismissals-approximately 1.8 per year-remained constant. Reasons for voluntary withdrawal focused on ex cessive workloads and unexpected residency demands, whereas reasons for dis missal related primarily to deficits in professional attitudes and behavior s 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 als o gave more importance to the relationship developed with residents during training. Conclusion. These results suggest that voluntary attrition from neurosurgic al residency is significant and is related to issues of lifestyle control. Dismissal is rarely related to cognitive or psychomotor deficits, but usual ly occurs for concerns about professionalism suck as ethics and interperson al skills and behaviors. Further studies are necessary to confirm these fin dings across specialties and countries.