Crafting an Evidence-Based, Accreditation Council of Graduate Medical Education-Compliant Lactation Policy for Residents and Fellows

Code Milk: Finding the Pulse of Lactation Culture, Practices, and Preferences of Pediatric Emergency Medicine Fellows

OBJECTIVES

The aim of the study is to characterize the lactation goals and practice of pediatric emergency medicine (PEM) fellows and to identify areas of improvement related to 1) policy awareness, 2) departmental culture and accommodations, and 3) lactation space and time.

METHODS

This study is a national, cross-sectional survey study of PEM fellows and program directors (PDs). Two surveys were developed via iterative review and distributed by the PEM-PD Survey Committee. Responses were collected anonymously via the Qualtrics survey platform. Data were summarized using descriptive statistics.

RESULTS

Survey responses from 60 PEM PDs (71%, 60/84) estimated that 67% (310/461) of their fellows had the ability to lactate. One hundred fifteen study-eligible fellows (37%) completed the survey. Most fellows (57%, 66/115) reported having lactated or expected to lactate during fellowship. Fellows reported an ideal lactation time of 11.5 months. Sixty-two percent (8/13) met their lactation goal and 42% (22/66) did not or did not know if they would meet their goal. Forty-three percent (50/115) of fellows and 57% (34/60) of PDs were aware of workplace lactation policies. Sixty-one percent (38/62) of fellows discussed a lactation plan with their PDs and 18% (7/39) reported their rotations upon returning to work were scheduled with lactation needs in mind. A dedicated lactation space was available to 67% (43/64) of fellows but used by 29% (11/28). Fellows lactated on average twice during an 8-hour shift, spending 7 minutes walking to and from their chosen lactation space and 21-minute pumping per session.

CONCLUSIONS

PEM fellows are likely to have lactation needs during fellowship but receive inconsistent support from their programs. Based on our findings, we advocate for the creation of more visible and PEM-specific workplace lactation policies, planning with PDs pre-return to work, and improved availability and usability of designated lactation spaces. Further optimization may help support PEM fellows' personal, clinical, and academic productivity.

Availability of Lactation Policies and Facilities for ACGME-Accredited Surgical Residency Training Programs

OBJECTIVE

We aimed to investigate availability of lactation policy and facility information among surgical residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

DESIGN

Between March 1, 2023 and October 31, 2023, websites of surgical residency training programs on the ACGME Accreditation System List of Programs by Specialty were reviewed for department lactation policies, links to institutional graduate medical education (GME) websites with lactation policies, lists of lactation facilities, and links to institutional GME websites listing lactation facilities. Scatter plots were generated and Pearson correlation coefficients were calculated to assess relationships of the percentages of female residents, fellows, and faculty in each surgical specialty with the percentage of residency program websites with available lactation information.

RESULTS

In total, 1847 websites were reviewed. Seventeen (0.9%) had lactation policies, 31 (1.7%) had lists of lactation facilities, 231 (12.5%) had links to institutional websites with lactation policies, and 295 (16.%) had links to institutional websites with lists of lactation facilities. The percentage of female residents and fellows and percentage of female faculty were positively correlated with the percentage of residency program websites with available lactation information.

CONCLUSION

Limited information on lactation policies and facilities is available to surgical residents.

Creating a national breastfeeding and lactation policy for Canadian surgical residents

Background

Despite known benefits of breastfeeding and challenges medical trainees face lactating at work, research specific to Canadian surgical trainees is lacking. Our objectives were to examine existing breastfeeding and lactation policies, query experiences and opinions of surgical trainees and program directors, and propose a comprehensive policy for programs nation-wide.

Methods

A multi-disciplinary team developed this two-part study. The scoping review used database and grey literature searches to find North American policies covering surgical residents. The survey study queried lactating Canadian surgical trainees and program directors about experiences and barriers, support provided, and interest in a breastfeeding and lactation policy.

Results

Ten policies were found. None comprehensively addressed lactation space and supplies, break times, supports, and resident responsibilities. Among ten PD survey respondents: 60% were female, 70% had lactating trainees during their tenure, 40% discussed lactation accommodations, and all were willing to instate a policy. Among 24 trainees: 45% met breastfeeding goals, 74% stopped breastfeeding prematurely due to work barriers, and 88% had little workplace support. Almost all trainees (96%) wanted a policy.

Conclusion

There is opportunity and appetite for a more comprehensive breastfeeding and lactation policy for Canadian surgical residents. Our policy highlights important areas where trainees can be better supported to meet breastfeeding goals.

Contexte

Malgré les avantages bien établis de l'allaitement et les difficultés auxquelles les apprenants en médecine sont confrontés pour allaiter sur leur lieu de travail, il n'existe aucune recherche spécifique qui concerne les apprenants en chirurgie au Canada. Nos objectifs étaient d'examiner les politiques existantes en matière d'allaitement et de lactation, d'interroger les expériences et opinions des apprenants en chirurgie et des directeurs de programmes, et de proposer une politique globale à l'échelle nationale.

Méthodes

Une équipe multidisciplinaire a développé cette étude qui comporte deux parties. L'examen de la portée s'est réalisée à l'aide des bases de données et de la littérature grise pour identifier les politiques nord-américaines relatives aux résidents en chirurgie. L'étude par sondage a permis de recueillir les expériences des apprenants en chirurgie canadiens qui allaitent, ainsi que les avis des directeurs de programmes sur les obstacles rencontrés, le soutien fourni et l'intérêt pour une politique d'allaitement et de lactation.

Résultats

Dix politiques ont été identifiées. Aucune ne couvrait de manière exhaustive les aspects relatifs à l'espace et aux fournitures d'allaitement, aux temps de pause, aux soutiens, et aux responsabilités des résidents. Parmi les dix directeurs de programmes ayant répondu au sondage : 60 % étaient des femmes, 70 % avaient encadré des résidents allaitant, 40 % avaient abordé la question des aménagements pour l'allaitement, et tous étaient favorables à l'instauration d'une politique. Parmi les 24 résidents interrogés : 45 % ont atteint leurs objectifs d'allaitement, 74 % ont cessé d'allaiter prématurément en raison d'obstacles professionnels, et 88 % ont signalé un faible soutien sur leur lieu de travail. Presque tous les résidents (96 %) étaient favorables à l'élaboration d'une politique.

Conclusion

Il existe une opportunité et un besoin pour une politique plus complète en matière d'allaitement et de lactation pour les résidents en chirurgie au Canada. Notre politique met en lumière les domaines clés où les résidents pourraient être mieux soutenus pour atteindre leurs objectifs d'allaitement.

One Pump at a Time: A Wearable Lactation Pump Pilot for Graduate Medical Education Trainees

Background: Despite the known benefits of lactation, lactating graduate medical education (GME) trainees encounter difficulties when returning to work. Wearable lactation pumps are known to be beneficial in lactating physicians, but the benefit for GME trainees in clinical care and education has not been explored. Objectives: The objective of this study was to examine the benefits of wearable lactation pumps on education and clinical care for GME trainees. Methods: In 2022-2023, all lactating GME trainees at a large academic center were invited to participate in a wearable pump pilot. Participants completed six baseline surveys with questions on lactation practices and individuals' perceptions before receiving the pump, repeated the six surveys after receiving the pump, and completed a monthly survey for 6 months after receiving the pump. A linear mixed methods model was used to compare reported experiences before and after receiving the wearable pump. Results: Twelve trainees participated in the pilot, with 10 completing pre- and post-surveys. When compared with experiences before receiving the wearable pump, there was a significant decrease in the perceived impact of lactation on clinical care (p = 0.03), medical education (p = 0.004), and missed pumping sessions (p = 0.02) after using the wearable pump. All participants who used the wearable pumps reported that it helped them to meet lactation goals. Conclusions: Wearable pumps are beneficial to trainees and may decrease the barriers to education and clinical care. GME sponsored pump programs may better support lactating trainees on their return to work.

Association of Women Surgeons' Comprehensive Initiative for Healthy Surgical Families During Residency and Fellowship Training

Importance

The lack of family-friendly policies continues to contribute to the underrepresentation and attrition of surgical trainees. Women in surgery face unique challenges in balancing surgical education with personal and family needs.

Observations

The Association of Women Surgeons is committed to supporting surgical families and developing equitable family-friendly guidelines. Herein we detail recommendations for adequate paid parental leave, access to childcare, breastfeeding support, and insurance coverage of fertility preservation and assisted reproductive technology.

Conclusions and Relevance

The specific recommendations outlined in this document form the basis of a comprehensive initiative for supporting surgical families.

Otolaryngology residents' experiences of pregnancy and return to work: A multisite qualitative study

Objectives

A paucity of literature exists about childbearing during otolaryngology residency. Pregnancy is a common part of many physician life cycles, but the timing of residency and the rigors of surgical training amplify the challenges. This study was designed to understand the experiences of childbearing otolaryngology residents and support them during this major life event. Unique challenges include long training, shortage of role models, combination surgical and clinical work, and higher rates of infertility.

Study Design

Qualitative research. IRB exempt.

Setting

United States.

Methods

To capture modern perspectives, 16 current and former otolaryngology residents that experienced pregnancy and childbirth during residency in all four geographic regions of the United States in the past 10 years were recruited to participate in individual structured qualitative interviews.

Results

Although there was significant training program and personal anxiety reported by childbearing otolaryngology residents, many surgeons experienced healthy pregnancies and postpartum recoveries with minimal disruption to clinical productivity and minimal disruption to their training programs. Multiple recurring themes were identified among the participants spanning the entire childbearing process: increased incidence of pregnancy complications and preterm labor, pregnancy stigma from leadership and coresidents, scheduling logistics regarding call and parental leave, and challenging transitions back to clinical work while navigating breastfeeding and childcare.

Conclusion

There are actional recommendations that programs can address to make childbearing during residency accessible and acceptable. Understanding these challenges is an important step to encouraging childbearing residents to prosper in academic otolaryngology, increasing the diversity at the highest levels of the field.

Level of Evidence

4.

Social Support, Social Isolation, and Burnout: Cross-Sectional Study of U.S. Residents Exploring Associations With Individual, Interpersonal, Program, and Work-Related Factors

PURPOSE

To examine associations of social support and social isolation with burnout, program satisfaction, and organization satisfaction among a large population of U.S. residents and fellows and to identify correlates of social support and social isolation.

METHOD

All residents and fellows enrolled in graduate medical education programs at Mayo Clinic sites were surveyed in February 2019. Survey items measured social support (emotional and tangible), social isolation, burnout, program satisfaction, and organization satisfaction. Factors of potential relevance to social support were collected (via the survey, institutional administrative records, and interviews with program coordinators and/or program directors) and categorized as individual, interpersonal, program, or work-related factors (duty hours, call burden, elective time, vacation days used before survey administration, required away rotations, etc.). Multivariable regression analyses were conducted to examine relationships between variables.

RESULTS

Of 1,146 residents surveyed, 762 (66%) from 58 programs responded. In adjusted models, higher emotional and tangible support were associated with lower odds of burnout and higher odds of program and organization satisfaction, while higher social isolation scores were associated with higher odds of burnout and lower odds of program satisfaction and organization satisfaction. Independent predictors of social support and/or social isolation included age, gender, relationship status, parental status, postgraduate year, site, ratings of the program leadership team, ratings of faculty relationships and faculty professional behaviors, satisfaction with autonomy, and vacation days used before survey administration.

CONCLUSIONS

This study demonstrates that social support and social isolation are strongly related to burnout and satisfaction among residents and fellows. Personal and professional relationships, satisfaction with autonomy, and vacation days are independently associated with social support and/or social isolation, whereas most program and work-related factors are not. Additional studies are needed to determine if social support interventions targeting these factors can improve well-being and enhance satisfaction with training.

Attitudes toward parental leave and breastfeeding during ophthalmology residency

INTRODUCTION

As mandated by the Accreditation Council for Graduate Medical Education (ACGME), residency programs are required to have parental leave policies. A lack of standardized requirements leads to a lack of uniformity among programs. We discuss resident and program director attitudes toward parental leave and examine the range of policies on parental leave and breastfeeding within ophthalmology residency programs.

METHODS

Two electronic surveys assessing perceptions toward parental leave during residency and breastfeeding on return to clinical duties were created individually for completion by ophthalmology residents or residency program directors, respectively, with responses collected over 4 weeks.

RESULTS

Of residents who took parental leave, 23 (87%) denied taking time off without pay. The most commonly reported effects on training by residents were missed surgical training and impact on research. Nearly 60% of residents (N = 26) reported receiving negative feedback or actions prior to or after the leave. The majority of residents felt program directors and coresidents were supportive (53.8%, 48.1%, respectively), but parental leave negatively affected their coresidents (46.2%). Twenty-five program directors reported that there are written parental leave policies in place at their institution. Sex disparities were noted, with program directors reporting more negative impacts on surgical training in female residents (p = 0.035). There was no statistically significant difference between program director attitudes on clinical training, well-being, or burnout by resident sex. All program directors were supportive of breastfeeding; half reported an institutional breastfeeding policy.

CONCLUSION

A national discussion on standardizing parental leave and breastfeeding policies over all ophthalmology residency programs is warranted.