Causes of attrition from a structured anaesthesia training program in a developing country

The residency training programme in Anaesthesiology at the Aga Khan University in Pakistan was started in 1986. This was an attempt to provide structured training over a four year period. One of the problems faced in establishing the programme has been a high attrition rate among the trainees. The attrition rate for the last ten years has been looked at and analyzed in order to identify factors affecting it. Each trainee, who decided to leave the programme without completing residency was interviewed by the residency director. The reasons for attrition have been found to be multifactorial ranging from the inability to adjust into a new speciality (33.8%), to a different ethnic environment (21.1%), migration abroad (21.1%) and preference for government jobs (9.8%). 8.4% were asked to leave the programme and for 5.6% the reason for attrition could not be ascertained. In conclusion the two major factors identified in this group of trainees which decreased the attrition were previous exposure to anaesthesia as a specialty and the attainment of postgraduate examination.