Attrition Rate in Military General Surgery GME and Effect on Quality of Military Programs.

INTRODUCTION: The attrition rate in civilian general surgery Graduate Medical Education (GME) is estimated at 20%, while estimates of attrition in military general surgery (MGS) GME programs using the same methodology are nearly twice that. We sought to identify the true attrition rate in MGS GME, identify factors influencing attrition, and examine the relationship between attrition and quality of MGS GME. METHODS: Deidentified data were collected on categorical general surgery residents matriculating from 2010 to 2013 from all 12 MGS residency programs. Information gathered included gender, medical degree, marital status, location of program, presence of a military-related interruption in training, and age at start of the categorical contract. For those who did not graduate, data on postgraduate year at time of attrition, reasons for attrition, and deficiencies in core competencies were solicited. To assess the effect of true attrition rate on graduate performance, we compared the published 5-year American Board of Surgery qualifying exam/certifying exam first time pass rates between military and civilian programs. RESULTS: One hundred eighty-four categorical residents matriculated from 2010 to 2013. Fifty six (31.5 %) were women, 151 (62.1%) were MD's, 103 (56%) were married, 172 (93.5%) were less than 35 years old, and 33 (17.9%) had a military-related interruption in training. Nineteen individuals left residency prior to graduation (15 resigned, 2 resigned in lieu of termination, 2 terminated) for an overall attrition rate of 10.3%. The most common year for attrition was PGY-3 (31.6%) and most common reason for resignation was changing to a different subspecialty (73.3%). Men and women had equal attrition rates (10.3%), and there was no meaningful difference between MD's and DO's (9.9% vs 12.1%, p = 0.71) or region of training (10.6% East vs 9.1% West, p = 0.73). However, those who were not married, had a militarily mandated interruption in training and started their categorical training over the age of 35 had higher attrition rates (married 5.6%, not married 15%, p = 0.04, interruption 16% vs no interruption 9%, p = 0.1; Age ≥ 35 33.3% vs age < 35 6.7%, p < 0.01). Comparison of American Board of Surgery (ABS) first time pass rates over a similar time period showed that military programs performed statistically discernibly better than civilian programs (82% ± 12 vs 75% ± 13, p = 0.047). CONCLUSIONS: Previous used methodology over estimates the attrition rate in MGS GME. The lower rate in MGS programs results in a high level of graduate performance as measured by ABS pass rates. Interruption in training and especially marital status and age ≥ 35 appear to be potential predictors of attrition. Components of MGS GME training and selection processes might inform efforts to reduce attrition and improve performance in civilian surgical GME.

Endogenous and exogenous estrogens during embryonic development affect timing of hatch and growth in the American alligator (Alligator mississippiensis).

Prenatal exposure to estrogenic endocrine disrupting chemicals (EDCs) can affect length of gestation and body mass and size of offspring. However, the dose, timing, and duration of exposure as well as sex and strain of the experimental animals determine the direction and magnitude of these effects. In this study, we examined the effects of a one-time embryonic exposure to either 17 ß-estradiol (E2) or bisphenol A (BPA) on rate of development and growth in American alligators (Alligator mississippiensis). Our results indicate that BPA and E2-treated alligators hatched approximately 1.4 days earlier than vehicle-treated (control) alligators, suggesting that estrogenic chemicals hasten hatching in these animals. We assessed growth rates, growth allometry, and body condition for 21 weeks after hatching and found that BPA-treated alligators grew more quickly shortly after hatching but more slowly thereafter compared to control alligators. Conversely, E2-treated alligators grew more slowly shortly after hatching but more quickly thereafter compared to control alligators. As a result of differences in growth rate, BPA-treated alligators were heavier, longer, and fatter than control alligators at age 5 weeks but were similar in size and leaner than control alligators at age 21 weeks. Biochemical analytes were examined at the end of the 21-week study to assess overall metabolic condition. We found that E2-treated alligators had significantly higher circulating plasma concentrations of cholesterol and triglycerides than control alligators while BPA-treated alligators had blood profiles comparable to control alligators. Our results provide important insights into the effects of exogenous estrogens on morphology and metabolism in an oviparous, semi-aquatic reptile.