Sculpting the good surgeon or excising the bad one: How clinical teachers could perpetuate attrition in surgical residency programmes

Attrition in surgical residencies remains a significant issue, with traditional research focusing mainly on individual and programme factors. This study explores the role of clinical teachers (CTs) in influencing attrition rates. CTs are essential in moulding residents' training, serving both as enablers of workplace learning and guardians of their medical fields. We employed a hermeneutic phenomenology framework to understand the sociocultural impacts on attrition. Data were collected through semi-structured interviews involving 19 CTs, 3 residents who left the programme and 2 who underwent remediation, following a six-step hermeneutic phenomenological analysis process. The entrenched 'good surgeon' narrative within the department demanded selflessness and total dedication, which CTs reinforced, thereby normalising a rigorous and challenging environment. This has led to attrition when residents fail to meet these challenges or choose to disengage from the system. We illustrated that CTs were pivotal in perpetuating these expectations, contributing significantly to resident attrition. CTs played a crucial role in resident attrition by enforcing a stringent cultural norm within surgical training programmes. Addressing this issue requires a visible change in CTs' role to foster a more supportive educational environment. Emphasising the beneficial aspects of the 'good surgeon' narrative and mitigating its adverse impacts is essential for reducing attrition rates and assisting all residents, including those facing challenges, in successfully completing their training.