Journal of Educational Evaluation for Health Professions

Research articles

Decline in attrition rates in United States pediatric residency and fellowship programs, 2007–2020: a repeated cross-sectional study: Emma Omoruyi, Greg Russell, Kimberly Montez; J Educ Eval Health Prof. 2025;22:24. Published online September 5, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.24

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Abstract PDF Supplementary Material: Purpose
Declining fill rates in US pediatric residency and subspecialty programs requires trainee retention. Attrition, defined as transfers, withdrawals, dismissals, unsuccessful completions, or deaths, disrupts program function and impacts the pediatric workforce pipeline. It aims to evaluate attrition trends among pediatric residents and fellows in Accreditation Council for Graduate Medical Education (ACGME)-accredited programs from 2007 to 2020.
Methods
This repeated cross-sectional study analyzed publicly available ACGME Data Resource Book records. Attrition rates and 95% confidence intervals (CIs) were calculated overall and by subspecialty. Logistic regression assessed temporal changes; odds ratios (ORs) compared 2020 to 2007.
Results
From 2007–2020, pediatric residents increased from 8,145 to 9,419 and fellows from 2,875 to 4,279. Aggregate annual resident attrition averaged 1.71% (range, 0.93%–2.64%), and fellow attrition ranged from 12.39%–30.87%. Transfer rates declined from 18.05 to 5.20 per 1,000 trainees (P<0.0001), withdrawals from 5.65 to 2.76 (P=0.030), and dismissals from 3.14 in 2010 to 1.27 in 2020 (P=0.0068). Odds of unsuccessful completion significantly decreased in categorical pediatrics (OR, 0.41; 95% CI, 0.29–0.58), pediatric cardiology (OR, 0.08; 95% CI, 0.01–0.64), pediatric critical care (OR, 0.14; 95% CI, 0.06–0.35), and neonatal-perinatal medicine (OR, 0.46; 95% CI, 0.20–1.08).
Conclusion
Although attrition has improved, premature trainee loss can still disrupt program operations and threaten workforce development. Attrition may reflect educational environment quality, support structures, or selection processes. Greater data transparency is needed to understand demographic trends and inform equitable retention strategies, ultimately strengthening training programs and sustaining the United States pediatric workforce.

Can incoming United States pediatric interns be entrusted with the essential communication skills of informed consent?: Nicholas Sevey, Michelle Barratt, Emma Omoruyi; J Educ Eval Health Prof. 2020;17:18. Published online June 29, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.18

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Purpose
According to the entrustable professional activities (EPA) for entering residency by the Association of American Medical Colleges, incoming residents are expected to independently obtain informed consent for procedures they are likely to perform. This requires residents to not only inform their patients but to ensure comprehension of that information. We assessed the communication skills demonstrated by 372 incoming pediatric interns between 2007 and 2018 at the University of Texas Health Science Center at Houston, obtaining informed consent for a lumbar puncture.
Methods
During a simulated case in which interns were tasked with obtaining informed consent for a lumbar puncture, a standardized patient evaluated interns by rating 7 communication-based survey items using 5-point Likert scale from “poor” to “excellent.” We then converted the scale to a numerical system and calculated intern proficiency scores (sum of ratings for each resident) and average item performance (average item rating across all interns).
Results
Interns received an average rating of 21.6 per 28 maximum score, of which 227 interns (61.0%) achieved proficiency by scoring 21 or better. Notable differences were observed when comparing groups before and after EPA implementation (76.97% vs. 47.0% proficient, respectively). Item-level analysis showed that interns struggled most to conduct the encounter in a warm and friendly manner and encourage patients to ask questions (average ratings of 2.97/4 and 2.98/4, respectively). Interns excelled at treating the patient with respect and actively listening to questions (average ratings of 3.16, each). Both average intern proficiency scores and each average item ratings were significantly lower following EPA implementation (P<0.001).
Conclusion
Interns demonstrated moderate proficiency in communicating informed consent, though clear opportunities for improvement exist such as demonstrating warmth and encouraging questions.

Citations

Citations to this article as recorded by

Current Practices, Limitations, and Recommendations for Informed Consent Education in Medical Students and Physicians: A Scoping Review
Sophia Chryssofos, Cynthia Glickman, Cyrus Mowdawalla, Amanda Burden, Yingcheng Elaine Xu
Journal of Medical Education and Curricular Development.2025;[Epub] CrossRef

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