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Brandt O, Tjardes T, Grimaldi G, Mutschler M, Imach S. [Analysis of risk factors for dropping out of residency in orthopedics and trauma surgery]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:788-798. [PMID: 36357588 PMCID: PMC10520118 DOI: 10.1007/s00113-022-01249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Currently, there are no data available on dropouts from residency programs and changes of clinic in orthopedics and trauma surgery (O&T). The aim of the study is to identify personal and structural risk factors leading to dropout or switching of postgraduate training in O&T in order to present solution strategies. METHODS A nationwide anonymous online survey was conducted among residents in O&T in summer 2020. Official mail addresses were identified via the Traumanetzwerk© of the DGU and the German Hospital Federation (n = 2090). A questionnaire (51 questions) was administered using SurveyMonkey (San Mateo, CA, USA). All residents who worked in O&T for at least 1 month in the 6 years prior to the start of the survey (from 07/2014) were eligible to participate. A binary logistic regression was calculated to identify the risk factors. The significance level was p = 0.05. RESULTS Of the 221 respondents, 37% switched hospital and 5% dropped out altogether. The regression revealed 3 significant risk factors for switching hospitals. Living in a partnership (p = 0.029, RR: 2.823) and less than 2 days of shadowing before the start of residency (p = 0.002, RR: 2.4) increased the risk of switching. Operating room (OR) allocation of residents according to the training plan/status (p = 0.028, RR: 0.48) reduces the risk of switching. Significant risk factors for leaving postgraduate training could not be determined (insufficient number of cases, n = 11). DISCUSSION Switching the hospital and residency dropouts in O&T are a relevant problem (42%). Gender has no significant influence. Tools such as longer job shadowing, as well as OR allocation according to the training plan/status can minimize the risk of switching.
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Affiliation(s)
- Oskar Brandt
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken der Stadt Köln gGmbH, Krankenhaus Köln-Merheim, Universität Witten/Herdecke, Ostmerheimer Str. 220, 51109, Köln, Deutschland
| | - Thorsten Tjardes
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken der Stadt Köln gGmbH, Krankenhaus Köln-Merheim, Universität Witten/Herdecke, Ostmerheimer Str. 220, 51109, Köln, Deutschland
| | - Gina Grimaldi
- Universitätsklinik für Unfallchirurgie, Otto von Guericke Universität Magdeburg, Magdeburg, Deutschland
| | - Manuel Mutschler
- Abteilung für Fuß und Sprunggelenkschirurgie, Waldkrankenhaus Bonn, Johanniter GmbH, Universität Witten/Herdecke, Bonn, Deutschland
| | - Sebastian Imach
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken der Stadt Köln gGmbH, Krankenhaus Köln-Merheim, Universität Witten/Herdecke, Ostmerheimer Str. 220, 51109, Köln, Deutschland.
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Querido SJ, de Rond MEJ, Wigersma L, ten Cate O. Some residents drop out of specialty training. How important is prior clinical experience? A survey among residents in the Netherlands. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc5. [PMID: 36923321 PMCID: PMC10010763 DOI: 10.3205/zma001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/10/2022] [Accepted: 11/23/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The drop-out rate among residents across all medical specialties in the Netherlands approximates 12.7%. This implies a capacity loss in the medical workforce, a waste of educational resources and personal damage to individuals. The aim of our study was to investigate reasons for dropping out of residency and the relationship with medical work experience after medical school and prior to residency, which is common among Dutch graduates. METHOD A questionnaire listing 28 reasons for drop-out was developed and tested. The questionnaire was sent in a nationwide survey to all residents who drop out between 1 September 2017 and 1 September 2019. The respondents were asked to indicate on a 5-point Likert scale, how they weighed reasons for drop-out. Factor analysis was applied to identify dominant factors. RESULTS The response rate was 39% (N=129; 99 females) representing all medical specialties. The factor structure of our measure showed 5 factors; high emotional job demands, lack of professional satisfaction, incompatible lifestyle, tensions in working relationships and disappointing career perspectives. Of the respondents 69 (54%) had prior clinical experience as a physician-not-in-training in the same medical specialty before residency. The factor "lack of professional satisfaction" weighed heavier for respondents without prior experience as a reason for drop-out. CONCLUSION Of influence on dropping out of residency is the lack of a clear image of the responsibilities as a physician within the residency of choice, fuelled by limited prior experience after medical school and before residency. One third of dropouts confirmed that prior physician experience within the same specialty could have prevented dropping out or prevented choosing this specialty in the first place.
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Affiliation(s)
- Sophie J. Querido
- University Medical Center Utrecht, Center for Research and Development of Education, Utrecht, The Netherlands
- Central Board for Specialty training in Elderly Care Medicine in the Netherlands (SOON), Utrecht, The Netherlands
| | | | - Lode Wigersma
- Dutch Association of Public Health Physicians (VAV), Utrecht, The Netherlands
| | - Ole ten Cate
- University Medical Center Utrecht, Center for Research and Development of Education, Utrecht, The Netherlands
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Shi HH, Westrup AM, O'Neal CM, Hendrix MC, Dunn IF, Gernsback JE. Women in Neurosurgery Around the World: A Systematic Review and Discussion of Barriers, Training, Professional Development, and Solutions. World Neurosurg 2021; 154:206-213.e18. [PMID: 34280544 DOI: 10.1016/j.wneu.2021.07.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Women have been a minority in neurosurgery since the foundation of the specialty. Women who choose to pursue neurosurgery or advance in their career must overcome various obstacles. In this article, we discuss the proportion of women in neurosurgery globally and the obstacles they face, as well as the solutions being implemented. METHODS A systematic review of studies concerning international women in neurosurgery was conducted. Article inclusion was assessed based on relevance to women of neurosurgery, geographic region, date, and classification (rates/data, barriers, or solutions). RESULTS From the specified search, 127 articles were retrieved, and 27 met the inclusion criteria. Of the total, 25 countries were represented and discussed in the articles. Primary classification of articles resulted in 50 for data/rates, 22 for barriers, and 17 for possible solutions. DISCUSSION Despite cultural differences among unique regions of the globe, women face similar challenges when pursuing neurosurgery, such as difficulty advancing their careers, balancing duties at work and at home, meeting social and cultural expectations, and finding support and mentorship. Encouragingly, measures are already being implemented worldwide to allow women to fulfill their multiple other roles through maternity leave policies, increasing their access to mentors, and enabling promotions throughout their careers. CONCLUSIONS With the shortage of neurosurgeons in many regions of the world, the recruitment of female neurosurgeons plays a vital role in meeting those demands. Our cultures and professional societies should celebrate their inclusion and promotion and accommodate the complex role of women as neurosurgeons, mothers, partners, scientists, and leaders.
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Affiliation(s)
- Helen H Shi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Alison M Westrup
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Christen M O'Neal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Madeline C Hendrix
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Joanna E Gernsback
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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Pascual JSG, Ignacio KHD, Khu KJO. Paving the Path to Wellness: A Systematic Review of Wellness Programs for Neurosurgery Trainees. World Neurosurg 2021; 152:206-213.e5. [PMID: 34146737 DOI: 10.1016/j.wneu.2021.06.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neurosurgical trainees have a heavy workload and poor quality of life, resulting in high rates of burnout and attrition. Consequently, wellness programs have been used by various training institutions to combat this situation. OBJECTIVE We aimed to identify and describe wellness programs available for neurosurgical trainees in their training institutions, the outcome measures used to assess them, and their efficacy. METHODS A systematic review of the literature was made following PRISMA guidelines. RESULTS Six studies were included in the review, describing wellness programs from 9 institutions. All programs except 1 used exercise as the core component. The other components included physical and mental well-being lectures, team-building activities, and cultural excursions. Most institutions used piloted satisfaction and perception questionnaires to assess efficacy. Trainee perceptions of wellness programs were generally positive, but the responses on validated questionnaires and surveys were mixed. Barriers to the program included lack of institutional support, time constraints, fatigue, and feelings of guilt in prioritizing wellness over patient care. CONCLUSIONS There is a paucity of literature regarding trainee wellness in neurosurgery. A few training programs have instituted wellness initiatives for trainees, and the feedback was generally positive. However, objective measures of efficacy such as validated questionnaires and scales yielded mixed results.
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Affiliation(s)
- Juan Silvestre G Pascual
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Katrina Hannah D Ignacio
- Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Kathleen Joy O Khu
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines.
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Lulla T, Behmer Hansen RT, Smith CA, Silva NA, Patel NV, Nanda A. Women neurosurgeons around the world: a systematic review. Neurosurg Focus 2021; 50:E12. [PMID: 33789239 DOI: 10.3171/2020.12.focus20902] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gender disparities in neurosurgery have persisted even as the number of female medical students in many countries has risen. An understanding of the current gender distribution of neurosurgeons around the world and the possible factors contributing to country-specific gender disparities is an important step in improving gender equity in the field. METHODS The authors performed a systematic review of studies pertaining to women in neurosurgery. Papers listed in PubMed in the English language were collected. A modified grounded theory approach was utilized to systematically identify and code factors noted to contribute to gender disparities in neurosurgery. Statistical analysis was performed with IBM SPSS Statistics for Windows. RESULTS The authors identified 39 studies describing the density of women neurosurgeons in particular regions, 18 of which documented the proportion of practicing female neurosurgeons in a single or in multiple countries. The majority of these studies were published within the last 5 years. Eight factors contributing to gender disparity were identified, including conference representation, the proverbial glass ceiling, lifestyle, mentoring, discrimination, interest, salary, and physical burden. CONCLUSIONS The topic of women in neurosurgery has received considerable global scholarly attention. The worldwide proportion of female neurosurgeons varies by region and country. Mentorship was the most frequently cited factor contributing to noted gender differences, with lifestyle, the glass ceiling, and discrimination also frequently mentioned. Future studies are necessary to assess the influence of country-specific sociopolitical factors that push and pull individuals of all backgrounds to enter this field.
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Affiliation(s)
- Tina Lulla
- 1Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey; and
| | | | - Cynthia A Smith
- 1Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey; and
| | - Nicole A Silva
- 2Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina
| | - Nitesh V Patel
- 1Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey; and
| | - Anil Nanda
- 1Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey; and
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Mittelman A, Palmer M, Dugas J, Spector JA, McCabe K, Sheng AY. A Nationwide Survey of Program Directors on Resident Attrition in Emergency Medicine. West J Emerg Med 2020; 22:86-93. [PMID: 33439812 PMCID: PMC7806332 DOI: 10.5811/westjem.2020.10.48286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Despite the burdens that resident attrition places upon programs and fellow trainees, emergency medicine (EM) as a specialty has only begun to explore the issue. Our primary objectives were to quantify attrition in EM residency programs and elucidate the reasons behind it. Our secondary objectives were to describe demographic characteristics of residents undergoing attrition, personal factors associated with attrition, and methods of resident replacement. METHODS We conducted a national survey study of all EM program directors (PDs) during the 2018-2019 academic year. PDs were asked to identify all residents who had left their program prior to completion of training within the last four academic years (2015-2016 to 2018-2019), provide relevant demographic information, select perceived reasons for attrition, and report any resident replacements. Frequencies, percentages, proportions, and 95% confidence intervals were obtained for program- and resident-specific demographics. We performed Fisher's exact tests to compare reasons for attrition between age groups. RESULTS Of 217 PDs successfully contacted, 118 completed the questionnaire (response rate of 54%). A third of programs (39 of 118) reported at least one resident attrition. A total of 52 residents underwent attrition. Attrition was most likely to occur prior to completion of two years of training. Gender and underrepresented minority status were not associated with attrition. Older residents were more likely to leave due to academic challenges. The most common reported reason for attrition was to switch specialties. Resident replacement was found in 42% of cases. CONCLUSION One-third of programs were affected by resident attrition. Gender and underrepresented minority status were not associated with attrition.
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Affiliation(s)
- Andrew Mittelman
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Madeline Palmer
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Julianne Dugas
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Jordan A Spector
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Kerry McCabe
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Alexander Y Sheng
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
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Zaed I, Menna G, Caccavella VM, Stumpo V, Giordano M, Caimmi E, Wheeler DR, Tinterri B. Italian Neurosurgical Residents' Experience with Research Activities: A National Survey. World Neurosurg 2020; 142:e101-e110. [DOI: 10.1016/j.wneu.2020.06.105] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 11/28/2022]
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The Career Impact of the National Undergraduate Neuroanatomy Competition. World Neurosurg 2019; 133:e535-e539. [PMID: 31562974 DOI: 10.1016/j.wneu.2019.09.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Neurosurgery is a notoriously difficult career to enter and requires medical students to engage in extracurricular activities to demonstrate their commitment to the specialty. The National Undergraduate Neuroanatomy Competition (NUNC) was established in 2013 as a means for students to display this commitment as well as academic ability. METHODS A bespoke 22-item questionnaire was designed to determine career outcomes and the role of competition attendance in job applications. It was distributed using the SurveyMonkey website to the 87 attendees at the 2013 and 2014 competitions. RESULTS Responses were received by 40 competitors (response rate, 46.0%). Twenty-four responders (60.0%) intended to pursue a career in either neurosurgery (n = 18) or neurology (n = 6). This included 10 responders (25.0%) who had successfully entered either neurosurgery (n = 9) or neurology (n = 1). The performance of these 10 was significantly better than the other responders (57.0 ± 13.6% vs. 46.5 ± 13.5% [n = 30]; P = 0.036). Seventeen responders (42.5%) either included their attendance at NUNC in a post-Foundation job application or intend to. CONCLUSIONS The NUNC provides the opportunity for medical students to demonstrate their interest in neurosurgery. It has the potential to be used as a tool for recognizing medical students suitable for neurosurgery training.
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