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Rebekah A. Naylor, MD; Joan S. Reisch, PhD; R. James Valentine, MD

Arch Surg. 2008;143(7):647-652.

Objective  To determine whether variables in the surgery resident selection process will predict attrition or performance during residency training.

Design  Retrospective study.

Setting  A university residency program.

Participants  A total of 111 categorical surgery residents matched during a 10-year period (1991-2000).

Main Outcome Measures  Satisfactory outcome included successful completion of training and the American Board of Surgery examinations on the first attempt. Participants with a satisfactory outcome were stratified into good or marginal performance based on adverse actions during residency.

Results  Of 111 residents studied, 28 (25.2%) had an unsatisfactory outcome; attrition occurred in 25 (22.5%). Univariate analysis identified the following variables as predictors of unsatisfactory outcome: age at entry older than 29 years (P = .005), female sex (P = .02), courses repeated (P = .01), "C" grades on transcript (P = .01), no participation in team sports (P = .02), and lack of superlative comments in the dean's letter (P = .03). The following variables were retained in the multivariate model: age older than 29 years (odds ratio [OR], 0.11; 95% confidence interval [CI], 0.02-0.47; P = .003), summary comments in the dean's letter (OR, 4.57; 95% CI, 2.00-10.43; P < .001), participation in team sports (OR, 4.96; 95% CI, 1.36-18.05; P = .02), and merit scholarship in medical school (OR, 0.25; 95% CI, 0.08-0.78; P = .02).

Conclusions  Attrition can be predicted from factors identified on residency applications, with nonacademic factors being more important. Among residents who completed the program, no predictors of performance were identified.

Author Affiliations: Department of Surgery (Drs Naylor and Valentine) and Division of Biostatistics, Department of Clinical Sciences (Dr Reisch), University of Texas Southwestern Medical Center at Dallas.