Risk assessment for withdrawal from surgical training in South African academic institutions
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Date
2020-09
Authors
Shabalala, Ayanda
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Introduction: Countries world-wide, including South Africa are facing a huge problem of few graduating surgical professionals and high attrition rates. The loss of a training registrar represents a waste of resources and effort as well as having implications for future workforce planning. Furthermore, South African already has a problem of few surgical professionals; hence the high attrition rate puts a severe strain on an already inadequate health system and this in turn impact, health delivery, health outcomes, and dissatisfaction for both patients and healthcare staff. This suggests that aggressive interventions are urgently needed to address this problem so that trainees can be retained. Hence this study aimed to investigate the risk factors that contribute to surgical trainee’s attrition by 1) determining the contemplated attrition rate of general surgical registrars; 2) investigating reasons for considering leaving training before completing; and 3) investigating the overall attitude and satisfaction of South African surgical registrars towards their training program. Method: The study enrolled 80 general surgery registrars who had attended the 47th Surgical Research Society Meeting and annual registrar symposium that was held at the University of Pretoria in June 2019. Our study comprised a fair representation of registrars from the different medical schools across South Africa. The data was collected using questionnaires which were administered over four days, which was the duration of the meeting. 75 of 80 Registrars (94%) completed the questionnaire. The data were analyzed using SAS software and (FREQ procedure) to determine statistical significance. The level of significance for all test was P < 0.05. Differences in outcome between categorical groups was analyzed using Chi-square or Fisher’s Exact Test if cell count is < 5. Analysis of data was done by the University of Free State Biostatistics department. Results: The study found that 60% of the participants were contemplating withdrawing from surgical training. The study also found that majority of the participants who contemplated withdrawing were in their 2nd year (39%) and 1st year (35%) of study. Suggesting that surgical trainees are most likely to contemplate withdrawal on their 1st and 2nd year of surgical training. Our study also revealed that the most common reasons for potential withdrawal were poor lifestyle and quality of life during surgical training (16%), excessive working hours, workload /intensity/hours (29%), lack of support (12%), high level of stress/anxiety and pressure (15%). Interestingly, when looking at job satisfaction as the reason for contemplating to withdraw, we found that only 3% of the surgical trainees indicated job dissatisfaction as the reason to contemplate withdrawing. Conclusion: This study has demonstrated that surgical trainees are most likely to withdraw from the training in their first and second year of training, suggesting that interventions to retain surgical trainees should prioritize first and second-year trainees. Additionally, this study demonstrated that majority of the surgical registrars were satisfied with their jobs, suggesting that the main reasons for withdrawing was not due to job dissatisfaction but mostly the intensity of the workload, the long hours, the lack of support and high stress/pressure. Findings of these study can be used to improve the overall general surgery training programs and lifestyle to prevent future catastrophic events of the shortage of general surgeons.
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Keywords
Dissertation (M.Med.Sc. (Surgery))--University of the Free State, 2020, Attrition, Registrar, Burnout, Surgeon, Attitude, Satisfaction, Catastrophe, Emotional exhaustion, Withdrawal, Surgical workforce, Crisis