{"id":"https://openalex.org/W7201929458","doi":null,"title":"Incidence, reasons and solutions to attrition in accredited residency programs at a university teaching hospital \u2013 a mixed-method study","display_name":"Incidence, reasons and solutions to attrition in accredited residency programs at a university teaching hospital \u2013 a mixed-method study","publication_year":2025,"publication_date":"2025-09-19","ids":{"openalex":"https://openalex.org/W7201929458"},"language":"en","primary_location":{"id":"pmh:oai:ecommons.aku.edu:etd_pk_mc_mhpe-1085","doi":null,"is_oa":false,"landing_page_url":"https://ecommons.aku.edu/etd_pk_mc_mhpe/86","pdf_url":null,"source":{"id":"https://openalex.org/S4377196301","display_name":"eCommons - AKU (Aga Khan University)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I118185606","host_organization_name":"Aga Khan University","host_organization_lineage":["https://openalex.org/I118185606"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Master of Health Professions Education","raw_type":"text"},"volume":null,"type":"article","is_traditional":true,"indexed_in":[],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5146001640","display_name":"Hameed Ullah","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I118185606","display_name":"Aga Khan University","ror":"https://ror.org/03gd0dm95","country_code":"PK","type":"education","lineage":["https://openalex.org/I118185606","https://openalex.org/I4210114929"]}],"countries":["PK"],"is_corresponding":true,"raw_author_name":"Ullah, Hameed","raw_affiliation_strings":["Aga Khan University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Aga Khan University","institution_ids":["https://openalex.org/I118185606"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5146001640"],"corresponding_institution_ids":["https://openalex.org/I118185606"],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10795","display_name":"Healthcare professionals\u2019 stress and burnout","score":0.39969998598098755,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10795","display_name":"Healthcare professionals\u2019 stress and burnout","score":0.39969998598098755,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10843","display_name":"Diversity and Career in Medicine","score":0.3463999927043915,"subfield":{"id":"https://openalex.org/subfields/3318","display_name":"Gender Studies"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10254","display_name":"Innovations in Medical Education","score":0.17149999737739563,"subfield":{"id":"https://openalex.org/subfields/3304","display_name":"Education"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/resident-attrition","display_name":"resident attrition","score":0.9419999718666077},{"id":"https://openalex.org/keywords/postgraduate-medical-education","display_name":"graduate medical education","score":0.847000002861023},{"id":"https://openalex.org/keywords/residency-training","display_name":"residency training","score":0.671999990940094},{"id":"https://openalex.org/keywords/resident-retention","display_name":"resident retention","score":0.9610000252723694},{"id":"https://openalex.org/keywords/resident-well-being","display_name":"resident well-being","score":0.5789999961853027},{"id":"https://openalex.org/keywords/working-hours","display_name":"working hours","score":0.5609999895095825},{"id":"https://openalex.org/keywords/supervision","display_name":"supervision","score":0.6299999952316284},{"id":"https://openalex.org/keywords/gender-balance","display_name":"gender balance","score":0.5230000019073486},{"id":"https://openalex.org/keywords/parental-leave","display_name":"parental leave","score":0.4000000059604645},{"id":"https://openalex.org/keywords/university-teaching-hospital","display_name":"university teaching hospital","score":0.781000018119812},{"id":"https://openalex.org/keywords/program-directors","display_name":"program directors","score":0.45500001311302185},{"id":"https://openalex.org/keywords/faculty-perspectives","display_name":"faculty perspectives","score":0.5139999985694885},{"id":"https://openalex.org/keywords/resident-perspectives","display_name":"resident perspectives","score":0.824999988079071},{"id":"https://openalex.org/keywords/academic-environment","display_name":"academic environment","score":0.6140000224113464},{"id":"https://openalex.org/keywords/pakistan","display_name":"Pakistan","score":0.35100001096725464}],"concepts":[{"id":"https://openalex.org/C2780553607","wikidata":"https://www.wikidata.org/wiki/Q684868","display_name":"Attrition","level":2,"score":0.9225000143051147},{"id":"https://openalex.org/C509550671","wikidata":"https://www.wikidata.org/wiki/Q126945","display_name":"Medical education","level":1,"score":0.666700005531311},{"id":"https://openalex.org/C61521584","wikidata":"https://www.wikidata.org/wiki/Q705899","display_name":"Accreditation","level":2,"score":0.6482999920845032},{"id":"https://openalex.org/C2779767262","wikidata":"https://www.wikidata.org/wiki/Q5592059","display_name":"Graduate medical education","level":3,"score":0.5182999968528748},{"id":"https://openalex.org/C5395021","wikidata":"https://www.wikidata.org/wiki/Q1061410","display_name":"Program evaluation","level":2,"score":0.3928000032901764},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.39169999957084656},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.39149999618530273},{"id":"https://openalex.org/C100776233","wikidata":"https://www.wikidata.org/wiki/Q2532492","display_name":"Bridge (graph theory)","level":2,"score":0.3709999918937683},{"id":"https://openalex.org/C2993838110","wikidata":"https://www.wikidata.org/wiki/Q494230","display_name":"Medical school","level":2,"score":0.3531000018119812},{"id":"https://openalex.org/C2780510313","wikidata":"https://www.wikidata.org/wiki/Q178706","display_name":"Institution","level":2,"score":0.34299999475479126},{"id":"https://openalex.org/C190248442","wikidata":"https://www.wikidata.org/wiki/Q839486","display_name":"Qualitative research","level":2,"score":0.3395000100135803},{"id":"https://openalex.org/C120912362","wikidata":"https://www.wikidata.org/wiki/Q136822","display_name":"Higher education","level":2,"score":0.31529998779296875},{"id":"https://openalex.org/C27548731","wikidata":"https://www.wikidata.org/wiki/Q88272","display_name":"Investment (military)","level":3,"score":0.31040000915527344},{"id":"https://openalex.org/C3020528894","wikidata":"https://www.wikidata.org/wiki/Q20820271","display_name":"Graduate students","level":2,"score":0.3018999993801117},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.29420000314712524},{"id":"https://openalex.org/C2994303106","wikidata":"https://www.wikidata.org/wiki/Q635067","display_name":"Program director","level":2,"score":0.2881999909877777},{"id":"https://openalex.org/C112758219","wikidata":"https://www.wikidata.org/wiki/Q16038819","display_name":"Duration (music)","level":2,"score":0.28040000796318054},{"id":"https://openalex.org/C87156501","wikidata":"https://www.wikidata.org/wiki/Q7268708","display_name":"Qualitative property","level":2,"score":0.2750000059604645},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.2712000012397766},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.2651999890804291},{"id":"https://openalex.org/C3018587665","wikidata":"https://www.wikidata.org/wiki/Q7268696","display_name":"Qualitative analysis","level":3,"score":0.25040000677108765}],"mesh":[],"locations_count":1,"locations":[{"id":"pmh:oai:ecommons.aku.edu:etd_pk_mc_mhpe-1085","doi":null,"is_oa":false,"landing_page_url":"https://ecommons.aku.edu/etd_pk_mc_mhpe/86","pdf_url":null,"source":{"id":"https://openalex.org/S4377196301","display_name":"eCommons - AKU (Aga Khan University)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I118185606","host_organization_name":"Aga Khan University","host_organization_lineage":["https://openalex.org/I118185606"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Master of Health Professions Education","raw_type":"text"}],"best_oa_location":null,"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.9763000011444092,"display_name":"Good health and well-being"},{"id":"https://metadata.un.org/sdg/4","score":0.5385000109672546,"display_name":"Quality education"}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W2946687105","https://openalex.org/W2991464773","https://openalex.org/W244809121","https://openalex.org/W2054857083","https://openalex.org/W4281969209","https://openalex.org/W2749002978","https://openalex.org/W3119665112","https://openalex.org/W4411505717","https://openalex.org/W2063088499","https://openalex.org/W4392767203"],"abstract_inverted_index":{"Introduction:":[0],"Residency":[1,205],"programs":[2,206,232,293,354,374,462],"bridge":[3],"the":[4,58,61,68,99,114,156,195,211,217,329,339,343,350,373,386,402,440,455,464],"gap":[5,398],"between":[6],"a":[7,12,44,49,149,162,171,234],"medical":[8,90],"school":[9],"graduate":[10,24,89],"and":[11,16,35,54,60,109,123,181,184,226,249,337,346,349,375,418,466],"fully":[13],"trained":[14],"professional":[15,21],"hence":[17],"are":[18,426],"crucial":[19],"for":[20,56,105,186,248,279,333,367,416,420,444,469],"development.":[22],"Post":[23],"education":[25],"requires":[26],"significant":[27],"investment":[28],"from":[29,174,216,292],"an":[30,141,272],"institution":[31],"to":[32,77,83,101,116,126,153,193,207,241,251,262,320,362,365,428,435,442,450,454,458],"recruit,":[33],"train":[34],"supervise":[36],"residents.":[37],"Attrition":[38],"negatively":[39],"impacts":[40],"successful":[41],"running":[42],"of":[43,51,94,158,199,230,256,275,283,287,296,303,306,331,405],"residency":[45,188,258],"program":[46,179,182,196,270,377],"by":[47],"causing":[48],"loss":[50],"time,":[52],"resources,":[53],"morale,":[55],"both":[57],"trainees":[59],"training":[62,353],"program.":[63],"A":[64,396],"deeper":[65],"understanding":[66],"into":[67],"reasons":[69,247,366,415],"behind":[70],"attrition,":[71,368],"as":[72,74,132,134,432,434,447,449],"well":[73,133,433,448],"formulating":[75],"mechanisms":[76],"reduce":[78],"it":[79],"would":[80],"confer":[81],"benefit":[82],"all":[84,280,312],"stakeholders":[85],"involved":[86],"in":[87,130,161,210,238,265,300,372,399],"post":[88],"education.":[91],"The":[92,315],"lack":[93,330],"robust,":[95],"context-specific":[96],"evidence":[97],"limits":[98],"ability":[100],"design":[102,146],"effective":[103],"strategies":[104],"resident":[106,159],"retention,":[107],"support,":[108],"wellness.":[110],"Our":[111],"study":[112,147,388,411],"was":[113,168,191],"first":[115,387],"be":[117,208,263],"conducted":[118,140,222,310,389],"at":[119,325,390],"institutional":[120,391],"level":[121,392],"nationally":[122],"we":[124,289,323],"aimed":[125],"address":[127,252],"existing":[128],"gaps":[129],"literature":[131,400],"recommending":[135],"feasible":[136],"solutions.":[137],"Methods:":[138],"We":[139],"explanatory,":[142],"sequential":[143],"mixed-methods":[144],"(QUAN-qual)":[145],"over":[148,201],"6":[150],"month":[151],"period":[152],"comprehensively":[154],"understand":[155],"issue":[157],"attrition":[160,200,273,295,321,406,417,471],"university":[163],"teaching":[164],"hospital.":[165],"Quantitative":[166],"data":[167,243,438],"collected":[169],"on":[170,233,246],"predesigned":[172],"form":[173],"PGME":[175],"office,":[176],"HR":[177],"department,":[178],"office":[180],"directors,":[183],"CPSP":[185,457],"eligible":[187],"programs.":[189],"This":[190,384,410],"analyzed":[192],"get":[194],"specific":[197,378],"incidence":[198],"three":[202,281],"consecutive":[203],"years.":[204],"included":[209,231,264,290],"qualitative":[212],"phase":[213],"were":[214,221,309,328,356,381],"identified":[215,324],"quantitative":[218,266],"phase.":[219,267],"Interviews":[220],"with":[223,393,461],"residents,":[224],"faculty,":[225],"PD":[227],"/":[228],"APD":[229],"pre-defined":[235],"interview":[236],"guide":[237],"number":[239],"sufficient":[240],"achieve":[242],"saturation":[244],"focusing":[245],"solutions":[250,363],"attrition.":[253],"Results:":[254],"Out":[255],"34":[257],"programs,":[259],"18":[260],"qualified":[261],"Only":[268],"one":[269],"had":[271],"rate":[274],"more":[276,297,437],"than":[277,298],"10%":[278,299],"years":[282],"study.":[284,304],"For":[285],"enrichment":[286],"data,":[288],"participants":[291],"having":[294,369],"any":[301],"year":[302],"Total":[305],"11":[307],"interviews":[308],"involving":[311],"four":[313],"groups.":[314],"major":[316,397],"rectifiable":[317],"issues":[318],"attributing":[319],"that":[322,352],"our":[326,430],"institute":[327],"support":[332],"residents":[334],"during":[335],"pregnancy":[336],"child-care,":[338],"academic":[340],"environment,":[341],"mainly":[342],"working":[344],"hours":[345],"supervision":[347],"level,":[348],"fact":[351],"abroad":[355],"considered":[357],"better":[358],"opportunities.":[359],"In":[360],"addition":[361],"corresponding":[364],"gender":[370],"balance":[371],"introducing":[376],"induction":[379],"criteria":[380],"suggested.":[382],"Conclusion:":[383],"is":[385],"robust":[394],"methodology.":[395],"regarding":[401],"primary":[403],"definition":[404],"has":[407],"been":[408],"identified.":[409],"highlights":[412],"several":[413],"important":[414],"suggestions":[419],"reducing":[421,470],"its":[422],"incidence.":[423],"Further":[424],"studies":[425],"required":[427],"validate":[429],"results":[431],"gather":[436],"across":[439],"country":[441,465],"account":[443],"demographic":[445],"bias":[446],"provide":[451],"reasonable":[452],"incentive":[453],"governing":[456],"work":[459],"closely":[460],"throughout":[463],"introduce":[467],"measures":[468]},"counts_by_year":[],"updated_date":"2026-10-28T10:33:24.094632","created_date":"2026-08-08T00:00:00"}