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Decline in attrition rates in United States pediatric residency and fellowship programs, 2007–2020: a repeated cross-sectional study
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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
- 1,599 View
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Abstract
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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.
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Empirical effect of the Dr LEE Jong-wook Fellowship Program to empower sustainable change for the health workforce in Tanzania: a mixed-methods study
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Masoud Dauda
, Swabaha Aidarus Yusuph, Harouni Yasini, Issa Mmbaga, Perpetua Mwambinngu, Hansol Park, Gyeongbae Seo, Kyoung Kyun Oh - J Educ Eval Health Prof. 2025;22:6. Published online January 20, 2025
- DOI: https://doi.org/10.3352/jeehp.2025.22.6
- 5,323 View
- 344 Download
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Abstract
PDFSupplementary Material
- Purpose
This study evaluated the Dr LEE Jong-wook Fellowship Program’s impact on Tanzania’s health workforce, focusing on relevance, effectiveness, efficiency, impact, and sustainability in addressing healthcare gaps.
Methods
A mixed-methods research design was employed. Data were collected from 97 out of 140 alumni through an online survey, 35 in-depth interviews, and one focus group discussion. The study was conducted from November to December 2023 and included alumni from 2009 to 2022. Measurement instruments included structured questionnaires for quantitative data and semi-structured guides for qualitative data. Quantitative analysis involved descriptive and inferential statistics (Spearman’s rank correlation, non-parametric tests) using Python ver. 3.11.0 and Stata ver. 14.0. Thematic analysis was employed to analyze qualitative data using NVivo ver. 12.0.
Results
Findings indicated high relevance (mean=91.6, standard deviation [SD]=8.6), effectiveness (mean=86.1, SD=11.2), efficiency (mean=82.7, SD=10.2), and impact (mean=87.7, SD=9.9), with improved skills, confidence, and institutional service quality. However, sustainability had a lower score (mean=58.0, SD=11.1), reflecting challenges in follow-up support and resource allocation. Effectiveness strongly correlated with impact (ρ=0.746, P<0.001). The qualitative findings revealed that participants valued tailored training but highlighted barriers, such as language challenges and insufficient practical components. Alumni-led initiatives contributed to knowledge sharing, but limited resources constrained sustainability.
Conclusion
The Fellowship Program enhanced Tanzania’s health workforce capacity, but it requires localized curricula and strengthened alumni networks for sustainability. These findings provide actionable insights for improving similar programs globally, confirming the hypothesis that tailored training positively influences workforce and institutional outcomes.
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