The causes and effects of attrition from Post-graduate residency programs at the Aga Khan University Hospital, Nairobi.
Date of Award
Master of Medicine (MMed)
Dr. Abdalla Abdullkarim
Dr. Dorothy Kamya
Dr. Miriam Mutebi
General Surgery (East Africa)
Background: Resident attrition is a global problem affecting most postgraduate residency training programs. It not only disrupts the educational and workload balance in the program but also results in loss of valuable time invested by the resident who has to leave before completion. AKUHN has similarly been affected with a worrying increase in resident attrition numbers over the last few years. There is however a lack of local studies on resident attrition which would inform measures to address modifiable risk factors for resident attrition and thus prevent future attrition.
Objectives: To explore factors attributable to attrition amongst residents in Aga Khan University Hospital since inception and explore the effects it has had on the various programs over the years. We also seek to establish the reasons behind the recent upsurge in attrition numbers and the current fate of the residents who left.
Methods: In-depth interviews, both face to face and telephone were carried out with the residents who left before completion of training and all current program directors. Different interview guides were used for each group. Data was collected using tape recording and later transcribed. Note-taking was also utilized during the interviews. Data collected was analyzed using the thematic framework fronted by Ritchie and Spencer for qualitative research.
Results: Sixteen ex-residents and all eight current program directors were interviewed. The reasons mentioned for attrition in decreasing frequency included excessive workload, health problems, specialty/career change, financial strain, academic nonperformance, fellow resident harassment and foreign student challenges. Increased workload over the years and introduction of tuition fees were implicated as possible causes for the increased attrition rate. Others included generational differences, waning faculty support and recent institutional and administrative changes. The main effect of resident attrition was an increased workload to the remaining residents and finally most ex-residents seemed to have gone on to do well in new vocations including joining other residency programs and completing the training.
Conclusion: Residents fail to complete training due to a varied number of reasons. The most commonly cited reason is excessive workload interfering with academic engagements. Establishing a balance between the workload assigned to residents and their academic engagements is paramount to ensure residents do not suffer burnout which would ensure more resident retention.
Wamalwa, D. (2018). The causes and effects of attrition from Post-graduate residency programs at the Aga Khan University Hospital, Nairobi. (Unpublished master's dissertation). Aga Khan University, East Africa.