Program Director Retention and Attrition Rates in International Graduate Medical Education

Abstract

Background Program directors (PDs) are integral to the education of the next generation of physicians. Yet, administrative burdens, substantial patient care responsibilities, and lack of protected time for teaching may contribute to work-life imbalance and physician burnout, leading to high rates of attrition. Data on international residency program leadership turnover are lacking. Objective This study aimed to quantify PD turnover in Accreditation Council for Graduate Medical Education-International (ACGME-I) accredited programs in Singapore, United Arab Emirates (UAE), and Qatar, and to compare to US PD attrition rates. Methods Data on PD turnover in international programs was extracted from the ACGME-I Accreditation Data System for academic years 2010–2011 through 2018–2019 for Singapore and 2013–2014 through 2018–2019 for UAE and Qatar. Rates of PD turnover were calculated by country and by ACGME-I medical-, surgical-, and hospital-based specialty groupings and compared using χ2 test. Annual US PD turnover data was extracted from the ACGME's Data Resource Book. Results Seventy programs met inclusion criteria. International PD attrition was high, with 56 programs (80%) changing PDs since program inception, and 16 programs (29%) having 2 or more PD turnovers. There was no significant difference between PD turnover rates in hospital (83%), medical (79%), or surgical (78%) specialties. International PD attrition rates varied from 7% to 20% annually and were comparable to PD turnover in US programs (range 12%–15%). Conclusions High PD turnover rates in newly accredited international residency programs were noted, although annual attrition rates were comparable to US residency programs.

Practical tips for navigating a program director transition

“…So critical is the role, the Accreditation Council for Graduate Medical Education (ACGME) requires programs to “demonstrate retention of the program director for a length of time adequate to maintain continuity of leadership and program stability” ( ACGME, 2022 ). Despite this mandate, there are concerns of rapid attrition for this important role and the resultant negative impact of attrition on resident training ( Brown & Gerkin, 2019 ; Fletcher et al , 2020 ; O’Connor et al , 2019 ; Stadler et al , 2020 ).…”

International Residency Program Directors on Implementing Educational Transformation: A Qualitative Study of Their Experiences and Strategies for Overcoming Challenges

“…We are encouraged that the PDs who were interviewed reflected positively on their roles, even though all admitted that the role was challenging and there was a steep learning curve. This conflicts with the high PD attrition rates observed in these countries, 4 and this study provides potential strategies for PD retention. To foster continuous learning and self-improvement, academic institutions can offer mentoring opportunities for PDs, along with professional development programs in educational leadership, focusing on communication skills, networking, and negotiation techniques.…”

“…These diverse roles and day-to-day challenges make PDs particularly vulnerable to stress and burnout, leading to high rates of PD attrition. [2][3][4] Studies estimate that onethird to half of PDs have been in the role for less than 3 years. [3][4][5] Understanding how PDs perceive and manage the stress of educational transformation may help minimize PD turnover in change management processes.…”

“…[2][3][4] Studies estimate that onethird to half of PDs have been in the role for less than 3 years. [3][4][5] Understanding how PDs perceive and manage the stress of educational transformation may help minimize PD turnover in change management processes. Most studies addressing this topic have been conducted in the United States and are Western-centric-less is known about the challenges faced by PDs in international institutions, where the transformation to competency-based frameworks is relatively new.…”

“…11 Long-term analysis of PDs in these international programs did, indeed, find a high rate of attrition, with 80% of programs changing PDs since inception. 4 The purpose of our study was to better understand how international PDs perceive and manage the challenges related to implementing competency-based medical education as part of their educational leadership roles.…”