Program Director Retention and Attrition Rates in International Graduate Medical Education

Dora J. Stadler, Halah Ibrahim, Debalina Dutta, Joseph Cofrancesco, Sophia Archuleta

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Program directors (PDs) are integral to the education of the next generation of physicians. Yet, administrative burdens, substantial patient care responsibilities, and lack of protected time for teaching may contribute to work-life imbalance and physician burnout, leading to high rates of attrition. Data on international residency program leadership turnover are lacking. Objective: This study aimed to quantify PD turnover in Accreditation Council for Graduate Medical Education-International (ACGME-I) accredited programs in Singapore, United Arab Emirates (UAE), and Qatar, and to compare to US PD attrition rates. Methods: Data on PD turnover in international programs was extracted from the ACGME-I Accreditation Data System for academic years 2010-2011 through 2018-2019 for Singapore and 2013-2014 through 2018-2019 for UAE and Qatar. Rates of PD turnover were calculated by country and by ACGME-I medical-, surgical-, and hospital-based specialty groupings and compared using χ2 test. Annual US PD turnover data was extracted from the ACGME's Data Resource Book. Results: Seventy programs met inclusion criteria. International PD attrition was high, with 56 programs (80%) changing PDs since program inception, and 16 programs (29%) having 2 or more PD turnovers. There was no significant difference between PD turnover rates in hospital (83%), medical (79%), or surgical (78%) specialties. International PD attrition rates varied from 7% to 20% annually and were comparable to PD turnover in US programs (range 12%-15%). Conclusions: High PD turnover rates in newly accredited international residency programs were noted, although annual attrition rates were comparable to US residency programs.

Original languageBritish English
Pages (from-to)624-627
Number of pages4
JournalJournal of graduate medical education
Issue number5
StatePublished - 1 Oct 2020


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