74.05 Impact of Medical School Experience on Attrition from General Surgery Residency

Posted on January 18, 2018

J. S. Abelson1, H. L. Yeo1,4, M. Symer1, N. Wong1, F. Michelassi1, R. Bell5, J. A. Sosa2  1Weill Cornell Medical College,Surgery,New York, NY, USA 2Duke University Medical Center,Surgery,Durham, NC, USA 3American Board Of Surgery, Inc,Philadelphia, PA, USA 4Weill Cornell Medical College,Healthcare Policy And Research,New York, NY, USA 5Temple University,Lewis Katz School Of Medicine,Philadelphia, PA, USA

Introduction: Medical school experience plays a role in the decision to pursue graduate surgical education.  However, no studies have examined the effect of medical school experiences on a resident’s likelihood of completing general surgery training.

Methods:  This is a national prospective longitudinal cohort study of all categorical general surgery (GS) interns who entered training in the 2007-2008 academic year. Interns were asked a series of questions related to their medical school experience and reasons for pursuing general surgery residency. Responses were linked with American Board of Surgery residency completion data. The primary outcome was completion of residency training. Multivariable Cox proportional hazards modeling was used to evaluate the association between medical school experiences and residency attrition. 

Results: 792/1043 (76%) GS interns had complete survey data; 287 (36%) were female, 252 (32%) non-White, and 70 (8.8%) Hispanic. The overall attrition rate was 20%. After multivariable adjustment for survey respondent gender, race/ethnicity and residency program type and size, two factors related to medical experience were found to be associated with completion of training. Residents who had medical school experiences with surgery attendings who were happy with their careers were more likely to complete training than those who did not (Hazard Ratio [HR] = 0.60; p=0.01). In addition, residents who matched at their first choice training program were more likely to complete their residency compared to those who did not match at their top choice (HR = 0.69; p = 0.04).  Having completed a sub-internship in surgery or having spent more time (0-8 wks vs. 9-12+ weeks) on surgical clerkships in the 3rd and 4th year were not associated with lower rates of attrition.

Conclusion: This is the first prospective national study to evaluate the potential association between medical school experiences and completion of general surgery residency.  These findings offer important insight into how exposure to surgery during medical school may impact a learner’s likelihood of finishing residency training and underlines the importance of positive role models and mentors for the development of trainees. 

 

30.02 Gender Disparities in Retention and Promotion of Academic Surgeons: A Prospective National Cohort

Posted on January 18, 2018

N. Z. Wong1, J. S. Abelson1, M. Symer1, H. L. Yeo1,2  1Weill Cornell Medicine,Surgery,New York, NY, USA 2Weill Cornell Medicine,Healthcare Policy And Research,New York, NY, USA

Introduction: Women comprise 38.3% of general surgery residents in the U.S., but only 9.8% of full professors in academic general surgery. Previous studies have identified factors contributing to the underrepresentation of women in academic surgery, but no study has quantified the rates of retention and promotion of early and mid-career female academic surgeons.  As a result, we used data from the American Association of Medical Colleges (AAMC) Faculty Roster to track a national cohort of academic surgeons over time to evaluate gender disparities in retention and promotion.

Methods: Data were extracted from the AAMC Faculty Roster for all first-time appointments of full-time assistant and associate professors of surgery starting their academic careers between January 1, 2003 and December 31, 2006; these faculty were individually followed over 10 years to determine if they stayed in full time academic practice (retained) or were promoted.  Cumulative counts of retained or promoted faculty at the end of the 10-year follow up period were compared using Fisher’s exact test. The impact of gender on retention and promotion during the study period was analyzed with survival analysis by log-rank test.

Results: The analysis included retention and promotion data for 3,966 early and mid-career (assistant and associate professors) academic surgeons. Over the 10-year follow up, there were no differences in retention rates between women and men for assistant professors (50% vs. 46%, p=0.10) or associate professors (39% vs. 35%, p=0.27). Survival analysis did not demonstrate a significant difference in retention rates by gender for either academic level (assistant/associate). However, when comparing rates of promotion, women both at the assistant (29% vs 34%, p=0.02) and associate (32% vs. 42% p=0.01) level were promoted at significantly lower rates compared to their male collogues. Furthermore, 10-year survival analysis demonstrated a significant difference in promotion rates in full-time academic surgery for both assistant and associate professors (log-rank p=0.03 and p=0.03, respectively).

Conclusion: This study is the first to quantify gender disparities in retention and promotion rates among U.S. academic surgeons using a comprehensive and prospective national database. Findings suggest that academic surgery retention rates are similarly low between women and men, while promotion rates are significantly lower for women faculty. These findings demonstrate that women surgeons are at increased likelihood of non-promotion in academia, likely contributing to decreased gender diversity at the full professor level. We should consider strategies to improve retention of junior faculty (both men and women) over time.  Additional research on the relationship between gender and promotion will be critical to effectively increasing and maintaining workforce diversity.
 

20.06 Gender Disparities in Retention and Promotion of Academic Surgeons: A Prospective National Cohort

Posted on January 18, 2018

N. Z. Wong1, J. S. Abelson1, M. Symer1, H. L. Yeo1,2  1Weill Cornell Medicine,Surgery,New York, NY, USA 2Weill Cornell Medicine,Healthcare Policy And Research,New York, NY, USA

Introduction: Women comprise 38.3% of general surgery residents in the U.S., but only 9.8% of full professors in academic general surgery. Previous studies have identified factors contributing to the underrepresentation of women in academic surgery, but no study has quantified the rates of retention and promotion of early and mid-career female academic surgeons.  As a result, we used data from the American Association of Medical Colleges (AAMC) Faculty Roster to track a national cohort of academic surgeons over time to evaluate gender disparities in retention and promotion.

Methods: Data were extracted from the AAMC Faculty Roster for all first-time appointments of full-time assistant and associate professors of surgery starting their academic careers between January 1, 2003 and December 31, 2006; these faculty were individually followed over 10 years to determine if they stayed in full time academic practice (retained) or were promoted.  Cumulative counts of retained or promoted faculty at the end of the 10-year follow up period were compared using Fisher’s exact test. The impact of gender on retention and promotion during the study period was analyzed with survival analysis by log-rank test.

Results: The analysis included retention and promotion data for 3,966 early and mid-career (assistant and associate professors) academic surgeons. Over the 10-year follow up, there were no differences in retention rates between women and men for assistant professors (50% vs. 46%, p=0.10) or associate professors (39% vs. 35%, p=0.27). Survival analysis did not demonstrate a significant difference in retention rates by gender for either academic level (assistant/associate). However, when comparing rates of promotion, women both at the assistant (29% vs 34%, p=0.02) and associate (32% vs. 42% p=0.01) level were promoted at significantly lower rates compared to their male collogues. Furthermore, 10-year survival analysis demonstrated a significant difference in promotion rates in full-time academic surgery for both assistant and associate professors (log-rank p=0.03 and p=0.03, respectively).

Conclusion: This study is the first to quantify gender disparities in retention and promotion rates among U.S. academic surgeons using a comprehensive and prospective national database. Findings suggest that academic surgery retention rates are similarly low between women and men, while promotion rates are significantly lower for women faculty. These findings demonstrate that women surgeons are at increased likelihood of non-promotion in academia, likely contributing to decreased gender diversity at the full professor level. We should consider strategies to improve retention of junior faculty (both men and women) over time.  Additional research on the relationship between gender and promotion will be critical to effectively increasing and maintaining workforce diversity.