American Council of Academic Plastic Surgeons
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Attrition in academia: why does interest in craniofacial surgery, microsurgery, and academic practice decrease during plastic surgery residency training?
Jenna R. Stoehr BA1, Sarah A. Applebaum MD1, Jonathan T. Bacos MD2, Elbert E. Vaca MD1, Yuyang Chu BA1, Arun K. Gosain MD1
1Northwestern University Feinberg School of Medicine, Chicago, IL, USA 2Medical College of Wisconsin, Milwaukee, WI, USA

Background: Many plastic surgery applicants indicate interest in academic subspecialties, such as craniofacial surgery and microsurgery. However, a much smaller percentage of graduating residents pursue academic practice. It is unclear what factors contribute to this shift. By identifying reasons for attrition, training programs may be able to provide support and mentorship opportunities that address these concerns.
Methods: In May 2020, a survey was sent to plastic surgery residents nationwide via the American Society of Plastic Surgeons Resident Council. The survey assessed interest in six subspecialties of plastic surgery during their junior years (PGY 1-3) and senior years (PGY4-6), the characteristics of the specialty that contributed to their interest, and if a resident indicated changing interests, reasons for change. Specialties with decreased interest over time were identified. The perceived characteristics of the specialty were analyzed with paired t-tests, and reasons for change were analyzed with two-sample t-tests.
Results: Out of 150 senior residents, 60 residents reported changing interests from their junior to senior years. Craniofacial surgery (-63%) and microsurgery (-45%) were identified as the two specialties with the highest attrition of interest. For residents who left craniofacial surgery, job opportunities, preferred practice environment, and compensation were identified as characteristics that contributed to their departure (Table 1). The same characteristics, plus two others (patient population and mentor influence), were identified as significant for those who left microsurgery. Residents who left craniofacial surgery reported finding passion in another specialty, while residents who left microsurgery cited academic responsibilities, work/life balance, and a misalignment of expectations of the specialty with its reality as reasons for change.
Conclusion: Plastic surgical subspecialties associated with academia, craniofacial and microsurgery, suffer from resident attrition due to a variety of factors. It is important for program directors and educators to be aware of these trends. Increased retention of trainees in academia, microsurgery, and craniofacial surgery could be improved through dedicated mentorship and exposure to role models, as well as expansion of the role of these specialties as foundational principles to the broader practice of plastic surgery.

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