Surgical Resident Attrition and the Menninger Morale Curve

Jack Contessa, Tassos Kyriakides
DOI: 10.4236/ss.2011.27087                

Abstract

BACKGROUND: Attrition in surgical residency programs continues to be a significant challenge. Ap-proximately 20% of residents who begin a categorical surgery residency fail to complete it. A number of studies speculated reasons for this including work hours, life style, family pressures, and resident feelings of inadequacy including fear of termination. To date no research has been conducted investigating the relation-ship between resident morale and attrition. This study sought to determine if this linkage exists in surgery residents. METHODS: The Morale Assessment in General Practice Index (MAGPI) was administered to 21 PGY 1, 2, 3, and 5 surgical residents to assess level of morale. Non-parametric methods were carried out to assess if there were differences in morale among the four PGY groups. Additionally, analyses of the four factors comprising the MAGPI were also conducted. RESULTS: Although differences did not reach statis-tical significance, analysis of the data reveals that residents demonstrate different trends in their levels of morale based on the amount of time they spend in a residency and in a way that approximates the morale curve described by W. Walter Menninger, M.D. Additionally, two of the four factors comprising the MAGPI also indicate trends similar to that described by the Menninger morale curve. CONCLUSIONS: Although no statistically significant results were achieved, the data reveal trends that approximate shifts in morale similar to those described by the Menninger morale curve, with residents at the PGY 2 and 3 levels present-ing lower morale levels than at the PGY 1 and 5 levels. This may be due in part to the size of the population studied. Future research should be continued in this area with a larger sample size.

Keywords

Morale Assessment in General Practice Index (MAGPI), Menninger Morale Curve, Surgery Resident Attrition

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	R. Bell, M. Banker, R. Rhodes, T. Biester and F. Lewis, “Graduate Medical Education in Surgery in the United States,” Surgical Clinics of North America, Vol. 87, No. 4, 2007, pp. 811-823. doi:10.1016/j.suc.2007.06.005
[2]	D. A. Andriole, et al., “Attrition during Graduate Medical Education,” Archives of Surgery, Vol. 143, No. 12, 2008, pp. 1172-1177. doi:10.1001/archsurg.143.12.1172
[3]	T. F. Dodson and A. L. Webb, “Why do Residents Leave General Surgery? The Hidden Problem in Today’s Programs,” Current Surgery, Vol. 62, No. 1, 2005, pp. 128-131. doi:10.1016/j.cursur.2004.07.009
[4]	R. P. McAlister, D. A. Andriole, S. E. Brotherton and D. B. Jeffe, “Attrition in Residents Entering U.S. Obstetrics and Gynecology Residencies: Analysis of GME Census Data,” American Journal of Obstetrics and Gynecology, Vol. 199, No. 5, 2008, pp. 574e1-574e6.
[5]	W. Longo, J. Seashore, A. Duffy and R. Udelsman, “Attrition of Categoric General Surgery Residents: Results of a 20-Year Audit,” The American Journal of Surgery, Vol. 197, No. 6, 2009, pp. 774-778. doi:10.1016/j.amjsurg.2008.06.038
[6]	D. C. Lynge, E. H. Larson, M. J. Thompson, R. A. Rosenblatt and L. G. Hart, “A Longitudinal Analysis of the General Surgery Workforce in the United States 1981-2005,” Archives of Surgery, Vol. 143, No. 4, 2008, pp. 345-350. doi:10.1001/archsurg.143.4.345
[7]	C. B. Everett, S. D. Helmer, J. S. Osland and R. S. Smith, “General Surgery Resident Attrition and the 80-Hour Workweek,” The American Journal of Surgery, Vol. 194, No. 6, 2007, pp. 751-757. doi:10.1016/j.amjsurg.2007.08.033
[8]	T. J. Leibrandt, C. M. Pezzi, S. A. Fassler, E. F. Reilly and J. B. Morris, “Has the 80-Hour Work Week Had an Impact on Voluntary Attrition in General Surgery Residency Programs?” Journal of The American College of Surgeons, Vol. 202, No. 2, 2006, pp. 340-344. doi:10.1016/j.jamcollsurg.2005.09.018
[9]	H. Yeo, et al., “Attitudes, Training Experiences, and Professional Expectations of US General Surgery Residents,” Journal of the American Medical Association, Vol. 302, No. 12, 2009, pp. 1301-1308. doi:10.1001/jama.2009.1386
[10]	W. W. Menninger, “Adaptation and Morale, Predictable Responses to Life Changes,” Bulletin of the Menninger Clinic, Vol. 52, No. 3, 1988, pp. 198-210.
[11]	B. McKinstry, M. Porter, R. Wrate, R. Elton and J. Shaw, “The MAGPI (Morale Assessment in General Practice Index): A New Way for Doctors to Self-Assess Their Morale,” Education for Primary Care, Vol. 15, No. 2, 2004, pp. 231-241.