The Source for Neurovascular News and Education

June 13, 2024


Dishonesty, poor medical knowledge, and poor technical skills are the main reasons many drop out, according to researchers.

Nearly one in five individuals in neurosurgical training programs are identified as “problem residents,” with half of those dropping out of their training altogether, according to research published online March 2, 2018, ahead of print in the Journal of Neurosurgery.


“Neurosurgery residency is a particularly challenging training experience, requiring a significant amount of time and effort on behalf of both the resident and faculty.” write the authors, led by Hari S. Raman, BS (Washington University School of Medicine, St. Louis, MO). “Program leadership must ensure that the resident is effectively progressing in both surgical skill and clinical knowledge while also ensuring optimal patient care for an often critically ill patient population.”


They point out that little is known about the specific challenges neurosurgical residency programs face when training residents and dealing with those who prove difficult.


To help fill this knowledge gap, the investigators sent an anonymous nationwide survey to all 108 neurosurgical training programs in the United States that was designed to assess their 20-year history of overall attrition as well as how they managed problem residents. The survey included questions about the specific deficiencies of problem residents, management strategies used by faculty, and the eventual outcome of each resident’s training.


They received responses from 36 centers that covered a total of 1,537 residents, with the programs providing a mean of 17.4 years’ worth of data, Overall, a mean of 18.1% those participating in the training programs were identified as “problem residents.” The most common deficiencies recognized by program directors were poor communication skills (59.9%), inefficiency in tasks (40.1%), and poor fund of medical knowledge (39.1%).


To deal with these issues, most often programs held additional meetings to provide detailed feedback (93.9%), gave verbal warnings (78.7%), and developed formal written remediation plans (61.4%).


For the 194 out of 197 problem residents whose trajectories were known, 50% already graduated or are on track to graduate and 50% ultimately left their residency program. Of those who departed their programs, 65% left voluntarily (most commonly for another specialty) and 35% were terminated (often ultimately training in another neurosurgery program).


Multivariable analysis revealed that independent predictors of residents leaving their residency program were dishonesty (OR 3.23; 95% CI 1.67-6.25), poor fund of medical knowledge (OR 2.54; 95% CI 1.47-4.40), and poor technical skill (OR 2.37; 95% CI 1.37-4.12).


“Identification of predictive risk factors . . . may enable program directors to preemptively act and address such deficiencies in residents before departure from the program occurs,” conclude the authors. “As half of the problem residents departed their programs, there remains an unmet need for further research regarding effective remediation strategies.”





Raman HS, Limbrick DD Jr., Ray WZ, et al. Prevalence, management, and outcome of problem residents among neurosurgical training programs in the United States. J Neurosurg. 2018;Epub ahead of print.


Raman reports no relevant conflicts of interest.