2019 General Surgery Presentations

Gabrielle Rolland, MD1, Eric P Ahnfeldt, DO2, Charles H Chestnut, DO3, Robert M Cromer, MD4, Byron J Faler, MD5, Andrew D Galusha, MD6, Romeo C Ignacio, MD7, Dwight C Kellicut, MD8, Daniel T Lammers, MD9, Timothy A Platz, DO10, Brandon W Propper, MD11, M Logan Rawlins, MD12, E Matthew Ritter, MD1; 1The Department of Surgery at Uniformed Services University of the Health Sciences & Walter Reed National Military Medical Center, National Capital Regional Simulation Consortium, 2The Department of General Surgery at William Beaumont Army Medical Center, 3The Department of General Surgery at UNLV-Nellis Air Force Base, 4The Department of General Surgery at Keesler Medical Center, 5The Department of General Surgery at Dwight D. Eisenhower Army Medical Center, 6The Department of General Surgery at Wright-Patterson Medical Center, 7The Department of General Surgery at Naval Medical Center San Diego, 8The Department of General Surgery at Tripler Army Medical Center, 9The Department of General Surgery at Madigan Army Medical Center, 10The Department of General Surgery at Naval Medical Center Portsmouth, 11The Department of General Surgery at San Antonio Military Medical Center, 12The Department of General Surgery at UC Davis-David Grant USAF Medical Center

Introduction: The objective of our study was to assess the attrition rate in military general surgery residency programs and identify potential militarily relevant predictors of attrition. The estimated attrition rate for civilian categorical general surgery residents in the United States is 20%, while previous literature has estimated military attrition at 35%.  Those currently involved in military GME believe this estimate is inaccurate as it likely did not account for military specific needs resulting in non-continuous training.

Methods: Deidentified data was collected from all 12 Military Health System General Surgery residency programs (4 Air Force, 4 Army, 2 Navy, 1 Air Force/Army, and 1 Army/Navy). Data was collected on residents offered a categorical contract during the years of 2010, 2011 and 2012.  The categorical year for residents in the Army and Navy was the PGY 2 year. For the Air Force, it was the PGY 1 year.  Data collected included gender, branch of service, age at start of continuous contract, and GMO tour experience.   For those who did not graduate, data on post-graduate year at time of attrition, reasons for attrition, and deficiencies in core competencies were solicited.

Results: 138 residents (39 Air Force, 63 Army, 36 Navy) became categorical from 2010 to 2012.  47 (34.1 %) were women, 132 (95.7%) were <35 years old, and 24 (17.4%) did a GMO tour.  Fifteen individuals left residency prior to graduation (12 resigned, 1 resigned in lieu of termination, 2 terminated) for an overall attrition rate of 10.9%. The Air Force, Army and Navy attrition rates slightly differed (17.9%, 6.3% and 11.1% respectively, p=0.187). There was no difference in attrition rate based on gender (11% vs 10.6%, p= 0.950). Categorical residents that completed a GMO tour trended toward higher attrition rates (20.8% vs 8.8%, p=0.084) while those who started their continuous contract over the age of 35 were statistically discernable (50% vs 9.1%, p=0.002).

Conclusions: Due to the nature of Military GME, the previous attempt at estimating the attrition rate in Military General Surgery residencies was inaccurate. Our data reflects a true attrition rate of 10.9% which is half that of our civilian counterparts.  Attrition rates amongst genders and services did not differ, but older trainees and those completing GMO tours showed higher rates of attrition. Service GME leadership should consider these data when setting GME program selection policy.