Attrition

Attrition is an important consideration in a longitudinal study and the effects of attrition can be assessed by the CONSORT diagram.

Attrition is a term used to describe the reduction or decrease in the size of a group or population over time, as a result of various factors such as retirement, resignation, death, or termination. Attrition is commonly used in the context of human resources, where it refers to the loss of employees from an organization.

Attrition can have a significant impact on an organization, as it can result in a loss of valuable knowledge, skills, and experience. High levels of attrition can also lead to increased recruitment and training costs, decreased productivity, and reduced morale among remaining employees.

There are several factors that can contribute to attrition, including poor working conditions, low job satisfaction, limited career advancement opportunities, inadequate compensation and benefits, and conflicts with management or coworkers. Additionally, external factors such as changes in the economy or job market can also impact attrition rates.

Employers can take steps to mitigate attrition, such as improving working conditions, offering competitive compensation and benefits packages, providing opportunities for career development and advancement, and creating a positive work culture that values and supports employees. Regular employee engagement surveys and exit interviews can also provide valuable insights into the reasons for attrition and help employers develop strategies to reduce turnover.

Surgical specialties consistently remain among the most competitive residency and fellowship programs with some of the highest rates of unmatched applicants. Attrition in surgical specialties is as high as 30% and particularly problematic given the extended duration of the training and a limited number of positions. Applicants are traditionally evaluated using a streamlined set of objective metrics, such as board scores, class rank, leadership, letters of recommendation, research productivity, and volunteerism. Consumer credit scores have been shown to be predictors of personality and work performance, however, the literature has yet to explore consumer credit histories in the context of surgical resident and fellow performance. This study aims to determine whether consumer credit scores of surgery residents and fellows are predictive of academic and professional performance. Methods This is a multi-institutional observational survey study across all American Council of Graduate Medical Education and Royal College of Physicians and Surgeons accredited surgical residency and fellowship programs in the United States and Canada. Ninety-nine surgical residents and fellows with the educational status of post-graduate year two or higher participated in this study. Dichotomous (yes or no) survey items were formulated to assess performance indicators in the domains of notable achievements and awards, research output, written examination performance, professionalism, and surgical/technical skills. Three-digit Fair Isaac Corporation (FICO) credit scores, a widely accepted consumer reporting score, were collected to avoid calculation variability between algorithms. Results Surgical residents and fellows reported credit scores between 611( fair) and 853 (exceptional) with a median (interquartile range) of 774 (715-833). The majority of participants 51.5%(51) reported very good credit scores. Those with higher credit scores (very good/exceptional) were 377% more likely to have one or more positive performance indicators OR (95% CI) = 3.77 (1.43-9.97). Similarly, residents with lower credit scores (fair/good) were only 40% more likely to have one or more negative performance indicators. The credit score has a moderate ability to distinguish between the presence and absence of positive performance indicators (area under the curve {AUC} = 0.70, p = 0.001). The use of 753 as a credit score cutoff is 78.9% sensitive and 52.4% specific for discerning surgery residents and fellows with one or more positive performance indicators. The credit score did not significantly discern those with negative performance indicators. Conclusions While credit score was significantly functional in discerning those with and without positive performance indicators, sensitivity and specificity rates leave much to be desired. This study suggests credit score may have a utility as a companion to traditional metrics used in identifying candidates for surgery residencies and fellowships who will have positive performance in the domains of research productivity, written examination performance, and professional awards and recognition. Additional studies are needed to assess this utility on a larger scale ¹⁾.