ORIGINAL REPORTS Failure-to-Progress Through Surgical Residency: A 9-Year Analysis Charalampos Siotos, MD,* Rachael M. Payne, MD,* Amr Mirdad, MBBS,* Kalliopi Siotou, DDS, † Scott D. Lifchez, MD,* Damon S. Cooney, MD, PhD,* Gedge D. Rosson, MD,* and Carisa M. Cooney, MPH* * Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland; and † National and Kapodistrian University of Athens, Athens, Greece OBJECTIVE: General surgery and surgical subspecialty residents account for nearly 19% of US medical residents; however, it is well known that many surgical residents fail to graduate from their residency training program. We sought to comprehensively evaluate recent trends in nonprogression rates among surgical residents. DESIGN: This is a retrospective study on residents during the 2007 to 2016 academic years. We calculated the annu- alized progression failure rate by extracting the total num- ber of residents who progress to the next level of training per year, total number of residents who failed to progress per year, and reasons for discontinuing residency. Propor- tions of residents who failed to progress were calculated to estimate potential differences in progression failure rates among different specialties across time. SETTING: We evaluated information provided by the Accreditation Council for Graduate Medical Education during the 2007 to 2016 academic years. PARTICIPANTS: Surgical and nonsurgical residents of Accreditation Council for Graduate Medical Education accredited programs during the period 2007 to 2016. RESULTS: Overall, 2.67% of surgical residents did not progress to the next level each year. This proportion is higher in surgical specialties than in nonsurgical ones. Nonprogression rates for individual surgical specialties ranged from 0.4% to 4.1% on average per year. In addi- tion, observed changes in rates and reasons for attrition varied across individual specialties. Of the surgical resi- dents who failed to progress, more than 50% transferred to a different program, 40% withdrew, and 9% were dismissed. CONCLUSIONS: Our findings indicate that surgical resi- dents are more likely to leave their initial residency pro- gram prior to completion than residents in medical specialties. Annualized ratios among subspecialties vary. General surgeons were the most likely and otolaryngology residents the least likely to discontinue their training. ( J Surg Ed 000:111. Ó 2019 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) KEY WORDS: Training, Education, Residency, Special- ties, Surgical COMPETENCIES: Professionalism, Practice-Based Learn- ing and Improvement, Systems-Based Practice INTRODUCTION Approximately 19% of resident physicians are enrolled in general surgery and surgical subspecialty training pro- grams, which are among the most competitive residen- cies. 1 Rigorous selection criteria are aimed at selecting candidates capable of coping with the demands of a sur- gical residency and surgeon lifestyle. Despite this, gen- eral surgery programs have higher attrition rates compared to other specialties. 2,3 Resident attrition is defined as the voluntary or invol- untary discontinuation of a training program prior to completion. Numerous factors are associated with attri- tion including long work hours, heavy clinical duties, lifestyle dissatisfaction, and inability to meet the pro- gram’s educational objectives. 4-6 Several previous attri- tion studies have focused on general surgery residents. Topics addressed include identifying factors associated with acceptance into residency programs, preresidency The present work has been presented at the American College of Surgeons Clini- cal Congress (October 2226, 2017, San Diego, California). Funding: None. Ethical approval: The study is based on already published material and deidenti- fied information, and conforms with the Declaration of Helsinki. Correspondence: Inquiries to Carisa M. Cooney, MPH, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 North Caroline Street. Balti- more, MD 21287; e-mail: ccooney3@jhmi.edu 1 Journal of Surgical Education  1931-7204/$30.00 © 2019 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jsurg.2019.07.017 ARTICLE IN PRESS