scholarly journals Analysis of national trends in neurosurgical resident attrition

2019 ◽  
Vol 131 (5) ◽  
pp. 1668-1673 ◽  
Author(s):  
Nitin Agarwal ◽  
Michael D. White ◽  
Susan C. Pannullo ◽  
Lola B. Chambless
Keyword(s):  
Residency Training ◽  
Clinical Medicine ◽  
Medical Specialty ◽  
Attrition Rate ◽  
Junior Resident ◽  
Advanced Degree ◽  
Attrition Rates ◽  
Medical Specialties ◽  
Targeted Interventions ◽  
Significant Difference

OBJECTIVEResident attrition creates a profound burden on trainees and residency programs. This study aims to analyze trends in resident attrition in neurological surgery.METHODSThis study followed a cohort of 1275 residents who started neurosurgical residency from 2005 to 2010. Data obtained from the American Association of Neurological Surgeons (AANS) included residents who matched in neurosurgery during this time. Residents who did not finish their residency training at the program in which they started were placed into the attrition group. Residents in the attrition group were characterized by one of five outcomes: transferred neurosurgery programs; transferred to a different specialty; left clinical medicine; deceased; or unknown. A thorough internet search was conducted for residents who did not complete their training at their first neurosurgical program. Variables leading to attrition were also analyzed, including age, sex, presence of advanced degree (Ph.D.), postgraduate year (PGY), and geographical region of program.RESULTSResidents starting neurosurgical residency from 2005 to 2010 had an overall attrition rate of 10.98%. There was no statistically significant difference in attrition rates among the years (p = 0.337). The outcomes for residents in the attrition group were found to be as follows: 33.61% transferred neurosurgical programs, 56.30% transferred to a different medical specialty, 8.40% left clinical medicine, and 1.68% were deceased. It was observed that women had a higher attrition rate (18.50%) than men (10.35%). Most attrition (65.07%) occurred during PGY 1 or 2. The attrition group was also observed to be significantly older at the beginning of residency training, with a mean of 31.69 years of age compared to 29.31 in the nonattrition group (p < 0.001). No significant difference was observed in the attrition rates for residents with a Ph.D. (9.86%) compared to those without a Ph.D. (p = 0.472).CONCLUSIONSA majority of residents in the attrition group pursued training in different medical specialties, most commonly neurology, radiology, and anesthesiology. Factors associated with an increased rate of attrition were older age at the beginning of residency, female sex, and junior resident (PGY-1 to PGY-2). Resident attrition remains a significant problem within neurosurgical training, and future studies should focus on targeted interventions to identify individuals at risk to help them succeed in their medical careers.

Attrition in Podiatric Medicine and Surgery Residency

2020 ◽  
Vol 110 (6) ◽  
Author(s):  
Andrew J. Meyr ◽  
Spruha Magodia
Keyword(s):  
Risk Factors ◽  
Residency Training ◽  
Training Programs ◽  
Residency Training Program ◽  
Program Directors ◽  
Attrition Rate ◽  
Medical Specialties ◽  
Temple University ◽  
The Temple ◽  
E Mail

Background The objective of this study was to investigate the rate of attrition within podiatric medicine and surgery residency training programs. Methods Between the academic years 2006–2007 and 2015–2016, the Temple University School of Podiatric Medicine matched 780 graduates into 163 different residency training programs. Program directors from these sites were individually contacted by e-mail and asked whether the specific Temple University School of Podiatric Medicine graduates who originally matched with their program 1) completed the program, 2) transferred to another program, 3) quit the program, or 4) were fired from the program. Results Results were returned with respect to 614 (78.7%) of the 780 graduates, representing 103 (63.2%) of the 163 training programs. Program directors reported that 573 (93.3%) of the 614 graduates completed the program, 17 (2.8%) transferred from the program, six (1.0%) quit the program, five (0.8%) were fired by the program, and 13 (2.1%) matched but never started the program. This equates to an annual attrition rate of 0.46% for residents who started the podiatric residency training program that they matched with. Conclusions We conclude that the rate of attrition in podiatric medicine and surgery residency training appears to be relatively low or at least in line with other medical specialties, and hope that this information leads to other investigations examining attrition, specifically as it relates to physician-specific and program-specific risk factors for attrition.

Duration of Pediatric and Internal Medicine Practice in Oregon

PEDIATRICS ◽  
1989 ◽  
Vol 83 (3) ◽  
pp. 428-432
Author(s):  
GEORGE J. SCHUNK ◽  
HAROLD T. OSTERUD
Keyword(s):  
Primary Care ◽  
Early Retirement ◽  
Medical Profession ◽  
Career Change ◽  
Attrition Rate ◽  
Attrition Rates ◽  
Medical Specialties ◽  
Career Changes ◽  
Primary Care Pediatricians ◽  
Young Physicians

This study was prompted by the perception that there were few pediatricians older than 60 years of age in the state of Oregon who were practicing primary care pediatrics. The hypothesis that there was a high practice attrition rate of primary care pediatricians was suggested by this observation. This could be the result either of early retirement or career change. Data concerning attrition rates in medical specialties are sparse. Manpower studies of the medical profession have described the entry of students into medicine and the entry of young physicians into medical practice but have not offered information regarding the exit from practice or the frequency of career changes.

scholarly journals A hospital-wide transition from paper to digital problem-oriented clinical notes

2017 ◽  
Vol 08 (02) ◽  
pp. 502-514 ◽  
Author(s):  
Felix HJM Cillessen ◽  
Pieter de Vries Robbé ◽  
Marion Biermans
Keyword(s):  
User Satisfaction ◽  
Medical Center ◽  
Univariate Analysis ◽  
Medical Specialty ◽  
Physician Satisfaction ◽  
Professional Experience ◽  
Medical Specialties ◽  
Clinical Notes ◽  
Significant Difference ◽  
Wide Transition

SummaryObjectives: To evaluate the use, usability, and physician satisfaction of a locally developed problem-oriented clinical notes application that replaced paper-based records in a large Dutch university medical center.Methods: Using a clinical notes database and an application event log file and a cross-sectional survey of usability, authors retrospectively analyzed system usage for medical specialties, users, and patients over 4 years. A standardized questionnaire measured usability. Authors analyzed the effects of sex, age, professional experience, training hours, and medical specialty on user satisfaction via univariate analysis of variance. Authors also examined the correlation between user satisfaction in relation to users’ intensity of use of the application.Results: In total 1,793 physicians used the application to record progress notes for 219,755 patients. The overall satisfaction score was 3.2 on a scale from 1 (highly dissatisfied) to 5(highly satisfied). A statistically significant difference occurred in satisfaction by medical specialty, but no statistically significant differences in satisfaction took place by sex, age, professional experience, or training hours. Intensity of system use did not correlate with physician satisfaction.Conclusions: By two years after the start of the implementation, all medical specialties utilized the clinical notes application. User satisfaction was neutral (3.2 on a 1–5 scale). Authors believe that the significant factors facilitating this transition mirrored success factors reported by other groups: a generic, consistent, and transparent design of the application; intensive collaboration; continuous monitoring; and an incremental rollout.Citation: Cillessen FHJM, de Vries Robbé PF, Biermans MCJ. A hospital-wide transition from paper to digital problem-oriented clinical note. Appl Clin Inform 2017; 8: 502–514 https://doi.org/10.4338/ACI-2016-08-RA-0137

scholarly journals Migrant physicians’ choice of employment and the medical specialty general practice: a mixed-methods study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Linda Sturesson ◽  
Per J. Palmgren ◽  
Magnus Öhlander ◽  
Gunnar H. Nilsson ◽  
Terese Stenfors
Keyword(s):  
General Practice ◽  
Mixed Methods ◽  
Medical Specialty ◽  
Structured Interview ◽  
Private Life ◽  
Medical Specialties ◽  
Job Opportunities ◽  
First Choice ◽  
Significant Difference ◽  
Positive Experiences

Abstract Objective In many countries, migrant physicians (MP) tend to fill staff shortages in medical specialties perceived as low status. The aim of this study was to explore aspects that influence MPs’, with a medical degree from outside EU/EEA, choice of employment and medical specialty in Sweden, and to explore and understand a potential over-representation in general practice (family medicine), a specialty suffering from staff shortages in Sweden. Methods A mixed-methods approach was applied. This included questionnaire data from 101 MPs training and working as medical specialists in Sweden and semi-structured interview data from four MPs specializing in general practice. Results Regardless of specialty, the most influential aspects when choosing employment were the ability to combine work with family, to develop one´s competence, and to have highly competent colleagues. Women scored higher on some aspects related to private life and the surroundings. More than half (55%) of the respondents specialized in general practice, and more women than men. The MPs in general practice scored higher on the aspect ‘ability to have the same patients for a longer period’ than MPs specializing in other specialties. No significant difference between MP general practitioner respondents and MPs in other medical specialties was found in relation to the item ‘Was the specialty your first choice?ʼ. Aspects identified in the interviews that influenced the choice to specialize in general practice related to job opportunities, positive experiences of primary health care, working conditions, and family conditions. Conclusion Labour market conditions such as high competition, and the time-consuming recertification process, can influence the choice to specialize in general practice as this reduces the time to become a medical specialist. We however did not find any results indicating that MPs’ decision to specialize in general practice and to work as general practitioners was any less voluntary than that of MPs who chose other specialties.

scholarly journals Engineering students’ attitudinal beliefs by gender and student division: a methodological comparison of changes over time

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Madison E. Andrews ◽  
Anita D. Patrick ◽  
Maura Borrego
Keyword(s):  
Self Efficacy ◽  
Engineering Students ◽  
Focal Point ◽  
Value Engineering ◽  
Longitudinal Analyses ◽  
Utility Value ◽  
Cross Sectional ◽  
Targeted Interventions ◽  
Significant Difference ◽  
Over Time

Abstract Background Students’ attitudinal beliefs related to how they see themselves in STEM have been a focal point of recent research, given their well-documented links to retention and persistence. These beliefs are most often assessed cross-sectionally, and as such, we lack a thorough understanding of how they may fluctuate over time. Using matched survey responses from undergraduate engineering students (n = 278), we evaluate if, and to what extent, students’ engineering attitudinal beliefs (attainment value, utility value, self-efficacy, interest, and identity) change over a 1-year period. Further, we examine whether there are differences based on gender and student division, and then compare results between cross-sectional and longitudinal analyses to illustrate weaknesses in our current understanding of these constructs. Results Our study revealed inconsistencies between cross-sectional and longitudinal analyses of the same dataset. Cross-sectional analyses indicated a significant difference by student division for engineering utility value and engineering interest, but no significant differences by gender for any variable. However, longitudinal analyses revealed statistically significant decreases in engineering utility value, engineering self-efficacy, and engineering interest for lower division students and significant decreases in engineering attainment value for upper division students over a one-year period. Further, longitudinal analyses revealed a gender gap in engineering self-efficacy for upper division students, where men reported higher means than women. Conclusions Our analyses make several contributions. First, we explore attitudinal differences by student division not previously documented. Second, by comparing across methodologies, we illustrate that different conclusions can be drawn from the same data. Since the literature around these variables is largely cross-sectional, our understanding of students’ engineering attitudes is limited. Our longitudinal analyses show variation in engineering attitudinal beliefs that are obscured when data is only examined cross-sectionally. These analyses revealed an overall downward trend within students for all beliefs that changed significantly—losses which may foreshadow attrition out of engineering. These findings provide an opportunity to introduce targeted interventions to build engineering utility value, engineering self-efficacy, and engineering interest for student groups whose means were lower than average.

scholarly journals Decreased Medical Care During the COVID-19 Pandemic – A Comprehensive Analysis of Radiological Examinations

2021 ◽  
Author(s):  
Annette Aigner ◽  
Bernd Hamm ◽  
Florian Nima Fleckenstein ◽  
Tazio Maleitzke ◽  
Georg Böning ◽  
...  
Keyword(s):  
Medical Care ◽  
Control Period ◽  
Surrogate Marker ◽  
Medical Specialty ◽  
Case Volume ◽  
Medical Specialties ◽  
Key Points ◽  
Depth Analysis ◽  
The Impact ◽  
Radiological Examinations

Objectives As a cross-section discipline within the hospital infrastructure, radiological departments might be able to provide important information regarding the impact of the COVID-19 pandemic on healthcare. The goal of this study was to quantify changes in medical care during the first wave of the pandemic using radiological examinations as a comprehensive surrogate marker and to determine potential future workload. Methods A retrospective analysis of all radiological examinations during the first wave of the pandemic was performed. The number of examinations was compared to time-matched control periods. Furthermore, an in-depth analysis of radiological examinations attributed to various medical specialties was conducted and postponed examinations were extrapolated to calculate additional workload in the near future. Results A total of 596,760 examinations were analyzed. Overall case volumes decreased by an average of 41 % during the shutdown compared to the control period. The most affected radiological modalities were sonography (–54 %), X-ray (–47 %) followed by MRI (–42 %). The most affected medical specialty was trauma and orthopedics (–60 % case volume) followed by general surgery (–49 %). Examination numbers increased during the post-shutdown period leading to a predicted additional workload of up to 22 %. Conclusion This study shows a marked decrease in radiological examinations in total and among several core medical specialties, indicating a significant reduction in medical care during the first COVID-19 shutdown. Key Points: Citation Format

Bridging the Gap With Choosing Wisely Recommendations: What Laboratory Topics Matter Most to Other Medical Specialty Societies?

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S143-S143
Author(s):  
Barbara Caldwell
Keyword(s):  
Women’S Health ◽  
Women's Health ◽  
Laboratory Tests ◽  
Pap Smear ◽  
Medical Specialty ◽  
Laboratory Medicine ◽  
Choosing Wisely ◽  
Topic Area ◽  
Medical Specialties ◽  
Smear Testing

Abstract Introduction This study sought to evaluate the nature and frequency of laboratory recommendations made by medical societies other than ASCP. Methods Review of all 2012 to 2018 ABIM Choosing Wisely (CW) non-ASCP laboratory recommendations and categorization of recommendations per topic area. Results There are 107 total recommendations made by other medical specialties that involve laboratory medicine. The most common recommendations are (1) Transfusion Medicine: to minimize transfusion of PRCs (19 recommendations, 18%); (2) Women’s Health: Pap smear testing, other women’s health testing (18 recommendations, 17%); and (3) General Laboratory: reducing repetitive routine laboratory tests (10 recommendations, 9%). Most (64, 60%) recommendations addressed screening while 29 (27%) focused on treatment and 14 (13%) were related to monitoring disease. Conclusion Almost one-half (44%) of all recommendations fell into three common areas and there were more recommendations related to screening for disease than for treatment or monitoring. For Choosing Wisely to achieve increasing success, increasing efforts are needed to disseminate this information, promote multidisciplinary effective test utilization, and encourage continued laboratory medicine recommendations from all medical stakeholders.

scholarly journals Changes in prevalence of workplace violence against doctors in all medical specialties in Norway between 1993 and 2014: a repeated cross-sectional survey

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017757 ◽  
Author(s):  
Ingrid Hjulstad Johansen ◽  
Valborg Baste ◽  
Judith Rosta ◽  
Olaf G Aasland ◽  
Tone Morken
Keyword(s):  
Relative Risk ◽  
Workplace Violence ◽  
Medical Specialty ◽  
Cross Sectional Survey ◽  
Work Time ◽  
Cross Sectional ◽  
Medical Specialties ◽  
Work Settings ◽  
Representative Samples ◽  
Violence Against Doctors

ObjectivesThe aim of this study was to investigate whether reported prevalence of experienced threats, real acts of violence and debilitating fear of violence among Norwegian doctors have increased over the last two decades.DesignRepeated cross-sectional survey.SettingAll healthcare levels and medical specialties in Norway.ParticipantsRepresentative samples of Norwegian doctors in 1993 (n=2628) and 2014 (n=1158).Main outcome measuresRelative risk (RR) of self-reported prevalence of work-time experiences of threats and real acts of violence, and of being physically or psychologically unfit during the last 12 months due to fear of violence, in 2014 compared with 1993, adjusted by age, gender and medical specialty.ResultsThere were no differences in self-reported threats (adjusted RR=1.01, 95% CI 0.95 to 1.08) or real acts (adjusted RR=0.90, 95% CI 0.80 to 1.03) of violence when comparing 2014 with 1993. The proportion of doctors who had felt unfit due to fear of violence decreased from 1993 to 2014 (adjusted RR=0.53, 95% CI 0.39 to 0.73). Although still above average, the proportion of doctors in psychiatry who reported real acts of violence decreased substantially from 1993 to 2014 (adjusted RR=0.75, 95% CI 0.60 to 0.95).ConclusionsA substantial proportion of doctors experience threats and real acts of violence during their work-time career, but there was no evidence that workplace violence has increased over the last two decades. Still, the issue needs to be addressed as part of the doctors’ education and within work settings.

Abstract 78: Factors Associated with Thrombotic Events During Pregnancy in the United States: NIS 2000-2010

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ali Razmara ◽  
Steven Cen ◽  
Diana L Jin ◽  
Nerses Sanossian ◽  
Amytis Towfighi
Keyword(s):  
Risk Factors ◽  
The United States ◽  
The South ◽  
Targeted Interventions ◽  
Factors Associated ◽  
Thrombosis Risk ◽  
Significant Difference ◽  
Acute Mi ◽  
Hospital Factors ◽  
Peripartum Period

Intro: Thrombosis risk is increased during pregnancy and puerperium. There are no recent data on nationwide trends in thrombotic events during the delivery period. Objective: To determine risk factors for thrombotic events in women hospitalized for deliveries. Methods: Data from the Nationwide Inpatient Sample (2000-2010) were used to identify deliveries. Weighted proportion of pregnancy hospitalizations with comorbid thrombotic events, including TIA, ischemic stroke, hemorrhagic stroke, acute MI, and venous thromboembolism, was determined. Poisson regression was used to identify risk factors for thrombotic events. The first multivariable model adjusted for sociodemographic and hospital factors. The second model in addition adjusted for comorbid conditions. Results: There were 4,305,561 women hospitalized for delivery (21.5 million US deliveries), of which 7,242 (0.17%) had thrombotic events in the peripartum period. From 2000-2010, there was an increase in deliveries with associated thrombotic events observed from 7.46/10K to 34.8/10K. Compared to 2000, deliveries with thromboses was 8-fold more likely in 2010 (RR 7.94, 95% CI 1.98-31.93). There was no significant difference in rates from 2000 to 2010 after adjustment for sociodemographic and hospital factors. From 2000-2010, pregnant women with thrombotic events were older, more likely to be White, to smoke, to lack insurance, to be admitted to rural hospitals, and to be admitted in the South or Midwest. After multivariable adjustment for sociodemographics, hospital factors, and comorbidities, admissions in the South (RR 1.26, 95% CI 1.02-1.55) or Midwest (1.33, 95% CI 1.05-1.68), atrial fibrillation (1.28, 95% CI 1.01-1.62), pre-/eclampsia (5.78, 95% CI 4.37-7.66), dyslipidemia (1.72, 95% CI 1.42-2.09), atrial septal defect (14.38, 95% CI 6.76-30.58), and valvular heart disease (1.67, 95% CI 1.25-2.24) were independently associated with higher risk of thrombotic events. Conclusions: From 2000-2010, there was a sizeable increase in deliveries with associated thrombosis. Identification of factors associated with thrombotic events for women hospitalized for normal pregnancies will aid in targeted interventions to screen for, prevent and treat thrombosis related to pregnancy.

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