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Musilli MG, Fuller SM, Wyatt B, Ryals TR, Haischer-Rollo G, Drumm CM, Vereen RJ, Plowden TC, Blevins EM, Spalding CN, Konopasky A, Lutgendorf MA. Qualitative Analysis of the Lived Experience of Reproductive and Pediatric Health Care in the Military Health Care System. Mil Med 2024:usae238. [PMID: 38781008 DOI: 10.1093/milmed/usae238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/15/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. MATERIALS AND METHODS This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. RESULTS Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). CONCLUSIONS The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.
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Affiliation(s)
- Megan G Musilli
- Department of Gynecologic Surgery & Obstetrics, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Shara M Fuller
- Department of Gynecologic Surgery & Obstetrics, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Brelahn Wyatt
- Department of Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Teri R Ryals
- Department of Obstetrics and Gynecology, Navy Medicine Readiness and Training Command Bremerton, Bremerton, WA 98312, USA
| | - Gayle Haischer-Rollo
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Caitlin M Drumm
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Rasheda J Vereen
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Torie C Plowden
- Department of Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Erin M Blevins
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Carmen N Spalding
- Department of Nursing, Sharp Healthcare System, San Diego, CA 92123, USA
| | - Abigail Konopasky
- Department of Medical Education, Geisel School of Medicine at Dartmouth , Hanover, NH 03755, USA
| | - Monica A Lutgendorf
- Department of Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Kuo AM, Dusza SW, Minkis K, Pugliano-Mauro M, Stevenson M, Yu S, Lee EH. Family Planning Experiences and Challenges of Mohs Fellowship Trainees. Dermatol Surg 2024; 50:331-336. [PMID: 38147436 DOI: 10.1097/dss.0000000000004064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND There is a paucity of literature describing family planning challenges faced by Mohs fellows. OBJECTIVE To characterize perceptions about and experiences with family planning, fertility, lactation, and parental leave and identify ways to support parental health and family planning for Mohs fellows. MATERIALS AND METHODS A voluntary, anonymous survey was distributed to Mohs surgeons who recently completed fellowship. RESULTS In total, 116 Mohs surgeons completed the survey. Their mean age was 34.5 years old, and more were female ( n = 81, 69.8%) than male ( n = 35, 30.2%). Most had children before completion of their Mohs training ( n = 73, 62.9%). The most significant barrier to having children during fellowship was "loss of education or training time." Over 20% ( n = 23) of respondents or their partner had experienced infertility. Half of the 20 respondents ( n = 10) who breastfed or pumped did not have a convenient place to do so. CONCLUSION This study elucidates trainee perceptions and gaps in parental support for Mohs fellowship trainees. In addition, barriers to implementing a universal family planning policy in Mohs surgery are discussed.
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Affiliation(s)
- Alyce M Kuo
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kira Minkis
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Melissa Pugliano-Mauro
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary Stevenson
- Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York; and
| | - Siegrid Yu
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Erica H Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Dason ES, Maxim M, Gesink D, Yee M, Chan C, Baxter NN, Shapiro H, Simpson AN. Medical Students' Perspectives on Family Planning and Impact on Specialty Choice. JAMA Surg 2024; 159:170-178. [PMID: 38090998 PMCID: PMC10719828 DOI: 10.1001/jamasurg.2023.6392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/31/2023] [Indexed: 12/17/2023]
Abstract
Importance Physicians are known to delay childbearing compared with nonphysicians and to experience higher rates of age-related pregnancy complications. Delay of childbearing is more pronounced in surgical specialties, and family planning and building goals may influence specialty choice. Objective To assess medical students' perspectives on the development of family planning goals and the timing of family building within a medical career to elucidate how these perceptions impact their choice of specialty. Design, Setting, and Participants This qualitative study included fourth-year medical students at the University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada, and was conducted between May and August 2021. Participants were purposively sampled to maximize diversity of gender and specialty choice. Interviews were conducted via videoconferencing software that were recorded, transcribed verbatim, and verified for accuracy. Thematic analysis was completed independently by 2 researchers and consensus on final themes was reached through discussion among study investigators. Data were analyzed between September and December 2021. Main Outcomes and Measures Participants were asked to share their perceptions of personal family planning goals, support currently in place, family planning education in medicine and factors contributing to their choice of specialty and program. Thematic analysis was completed. Results A total of 34 fourth-year medical students (median [range] age, 26 [24-33] years; 23 females [67.6%]) were interviewed. Four main themes were identified: (1) there is no ideal time to family build in a medical career, (2) family planning is a taboo topic, (3) surgical specialties offer less support for family building, and (4) residents who have children are perceived to place a burden on their colleagues. Medical students considered their family planning while deliberating among specialty choices and their experiences were highly influential in shaping their specialty selection. Conclusions and Relevance Results of this qualitative study suggest that medical students perceive that family building during training may have unfavorable implications for team dynamics and relationships with colleagues, and these perceptions may affect specialty choice and family planning goals. Integration of family planning discussions and support for family building into medical curricula is needed along with efforts to improve culture by supporting team dynamics and workload when students take parental leave.
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Affiliation(s)
- Ebernella Shirin Dason
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Madalina Maxim
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Yee
- Department of Emergency Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Crystal Chan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nancy N. Baxter
- Li Ka Shing Knowledge Institute, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Heather Shapiro
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrea N. Simpson
- Li Ka Shing Knowledge Institute, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, St Michael’s Hospital/Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
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Liu XX, Zhao DY, Zhao X, Zhang XA, Yu ZL, Sun LH. The effect of China's birth policy changes on birth defects-A large hospital-based cross-sectional study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:1156-1167. [PMID: 37158781 DOI: 10.1080/09603123.2023.2207469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
A retrospective analysis of birth data hospital-based obtained from 14 monitoring areas in the Huaihe River Basin from 2009 to 2019 was conducted. Trend in the total prevalence of birth defects (BDs) and subgroups were analyzed using the Joinpoint Regression model. The incidence of BDs increased gradually from 118.87 per 10,000 in 2009 to 241.18 per 10,000 in 2019 (AAPC = 5.91, P < 0.001). Congenital heart diseases were the most common subtype of BDs. The proportion of maternal age younger than 25 decreased but the age 25-40 years increased significantly (AAPC<20=-5.58; AAPC20-24=-6.38; AAPC25-29 = 5.15; AAPC30-35 = 7.07; AAPC35-40 = 8.27; All P < 0.05). Compared with the one-child policy period, the risk of BDs was greater for groups among maternal age younger than 40 years during the partial and universal two-child policy period (P < 0.001). The incidence of BDs and the proportion of women with advanced maternal age in Huaihe River Basin is increasing. There was an interaction between changes in birth policy and the mother's age on the risk of BDs.
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Affiliation(s)
- Xin-Xin Liu
- The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Dan-Yang Zhao
- The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xin Zhao
- The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiao-An Zhang
- The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Zeng-Li Yu
- The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Li-Huan Sun
- The Third Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
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Ofshteyn A, Steinhagen E. Surgical Education: Disparities in Education May Impact the Quality and Likelihood of Completion of Training. Clin Colon Rectal Surg 2023; 36:315-320. [PMID: 37564350 PMCID: PMC10411215 DOI: 10.1055/s-0043-1763519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Female surgical trainees experience bias that begins at the preclinical stages of medical school, extending into their surgery clerkships, and then into their residency training. There are important implications in terms of training opportunities and career advancement, mentorship, sponsorship, and ultimately burnout. Childbearing and lactation also impact the experiences and perceptions of female trainees who have children. There are limited interventions that have improved the experience of women in surgical training. Mentorship appears to play an important role in ameliorating some of the negative consequences of the training environment and improving outcomes for women surgeons.
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Affiliation(s)
- Asya Ofshteyn
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Emily Steinhagen
- Division of Colorectal, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Morgan C, Li L, Kasetti PR, Varma R, Liddle AD. Pregnancy, parenthood, and fertility in the orthopaedic surgeon. Bone Joint J 2023; 105-B:857-863. [PMID: 37524342 DOI: 10.1302/0301-620x.105b8.bjj-2023-0253.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Aims As an increasing number of female surgeons are choosing orthopaedics, it is important to recognize the impact of pregnancy within this cohort. The aim of this review was to examine common themes and data surrounding pregnancy, parenthood, and fertility within orthopaedics. Methods A systematic review was conducted by searching Medline, Emcare, Embase, PsycINFO, OrthoSearch, and the Cochrane Library in November 2022. The Preferred Reporting Items for Systematic Reviews and Meta Analysis were adhered to. Original research papers that focused on pregnancy and/or parenthood within orthopaedic surgery were included for review. Results Of 1,205 papers, 19 met the inclusion criteria. Our results found that orthopaedic surgeons have higher reported rates of obstetric complications, congenital abnormalities, and infertility compared to the general population. They were noted to have children at a later age and voluntarily delayed childbearing. Negative perceptions of pregnancy from fellow trainees and programme directors were identified. Conclusion Female orthopaedic surgeons have high rates of obstetric complications and infertility. Negative perceptions surrounding pregnancy can lead to orthopaedic surgeons voluntarily delaying childbearing. There is a need for a pregnancy-positive culture shift combined with formalized guidelines and female mentorship to create a more supportive environment for pregnancy within orthopaedic surgery.
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Affiliation(s)
| | - Lily Li
- Imperial College NHS Foundation Trust, London, UK
| | | | - Ria Varma
- Imperial College NHS Foundation Trust, London, UK
| | - Alexander D Liddle
- Department of Surgery and Cancer, The MSk Lab, Imperial College London, London, UK
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Bakkensen JB, Smith KS, Cheung EO, Moreno PI, Goldman KN, Lawson AK, Feinberg EC. Childbearing, Infertility, and Career Trajectories Among Women in Medicine. JAMA Netw Open 2023; 6:e2326192. [PMID: 37498595 PMCID: PMC10375303 DOI: 10.1001/jamanetworkopen.2023.26192] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Importance Although women are increasingly represented within medicine, gender disparities persist in time to promotion, achievement of academic rank, and appointment to leadership positions, with no narrowing of this gap over time. Career-specific fertility and family building challenges among women physicians may contribute to ongoing disparities and academic attrition. Objective To evaluate delayed childbearing and infertility among women in medicine and investigate the extent to which women physicians may alter career trajectories to accommodate family building and parenthood. Design, Setting, and Participants This survey study was conducted among women physicians, with surveys distributed through medical society electronic mailing lists (listserves) and social media from March to August 2022. Main Outcomes and Measures Baseline demographic information and fertility knowledge were assessed. Descriptive data on delayed childbearing, infertility, use of assisted reproductive technology, and career alterations to accommodate parenthood were collected. Factors associated with timing of pregnancy and family building regret were assessed using Likert-type scales. Group differences in fertility knowledge, delayed childbearing, infertility, and family building regret were evaluated using χ2 analyses. Results A total of 1056 cisgender women (mean [SD] age, 38.3 [7.7] years) were surveyed across level of training (714 attending physicians [67.6%] and 283 residents or fellows [26.8%]), specialty (408 surgical [38.6%] and 638 nonsurgical [60.4%] specialties), and practice setting (323 academic [45.2%], 263 private [24.9%], and 222 community [21.0%] settings). Among respondents, 1036 individuals [98.1%] resided in the US. Overall, 910 respondents (86.2%) were married or partnered and 690 respondents (65.3%) had children. While 824 physicians (78.0%) correctly identified the age of precipitous fertility decline, 798 individuals (75.6%) reported delaying family building and 389 individuals (36.8%) had experienced infertility. Concerning measures taken to accommodate childbearing or parenthood, 199 women (28.8%) said they had taken extended leave, 171 women (24.8%) said they had chosen a different specialty, 325 women (47.1%) said they had reduced their work hours, 171women (24.8%) said they had changed their practice setting, and 326 women (47.2%) said they had passed up opportunities for career advancement among those with children. Additionally, 30 women with children (4.3%) had left medicine entirely. Conclusions and Relevance In this survey study, women physicians reported that career-related pressures influenced the timing of childbearing and led to marked alterations to career trajectories to accommodate family building and parenthood. These findings suggest that fertility and family building concerns among women in medicine may contribute to ongoing gender disparities and attrition and represent a potentially critical area for policy reform and future change.
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Affiliation(s)
- Jennifer B Bakkensen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kathryn S Smith
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elaine O Cheung
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Hinge, New York, New York
| | - Patricia I Moreno
- Department of Public Health Sciences at the University of Miami Miller School of Medicine, Miami, Florida
| | - Kara N Goldman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Angela K Lawson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eve C Feinberg
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Legister CS, Morgan SJ, Samora JB, Weiss JM, Caird MS, Miller DJ. Policies, Practices, and Attitudes Related to Parental Leave for Practicing Pediatric Orthopaedic Surgeons. J Pediatr Orthop 2023; 43:337-342. [PMID: 36827610 DOI: 10.1097/bpo.0000000000002360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Parental leave impacts family engagement, bonding, stress, and happiness. Because parental leave benefits are important to all surgeons regardless of sex, understanding parental leave practices in pediatric orthopaedic surgery is critical to promote equity within the profession and supporting balance in work and family life. The aim of this study was to survey pediatric orthopaedic surgeons about their knowledge of parental leave policies, attitudes towards parental leave, and their individual experiences taking leave. METHODS A 34-question anonymous survey was distributed to the Pediatric Orthopaedic Society of North America membership. Eligible respondents were attending pediatric orthopaedic surgeons practicing in the United States or Canada. The survey gathered information about employer parental leave policies, perceptions about and experiences with parental leave while practicing as a surgeon, and demographic information about respondents. RESULTS A total of 77 responses were completed and used for analysis. Most respondents were men (59.7%), <50 years old (67.5%), married (90.9%), and in urban communities (75.3%). A large majority were practicing in the United States (97.4%). Most respondents were unfamiliar with employer parental leave policies (maternity: 53.3%; paternity: 67.5%; and adoption: 85.7%). Those familiar with policies reported that employers offered 7 to 12 weeks for maternity leave (45.7%) and <1 week for paternity leave (50%) and adoption leave (45.5%). Most respondents believed 7 to 12 weeks should be offered for maternity leave (66.2%), 1 to 6 weeks for paternity leave (54.6%), and 7 to 12 weeks for adoption leave (46.8%). Many respondents reported taking 1 to 6 weeks of parental leave as a surgeon (53.3%) and that their colleagues were supportive of their parental leave (40.3%). CONCLUSIONS Most pediatric orthopaedic surgeons were unfamiliar with parental leave benefits provided by employers. Respondents who were familiar with these policies believed that more parental leave should be provided, especially for men who may feel social pressure to take less time for leave. Although respondents reported that their work environments were supportive, this study identified opportunities for improvement to support surgeons who wish to balance parental experiences with work responsibilities. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
| | - Sara J Morgan
- Research Department
- Department of Rehabilitation Medicine
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Julie B Samora
- Orthopaedics, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer M Weiss
- Orthopaedics Department, Southern California Permanente Medical Group, Los Angeles, CA
| | - Michelle S Caird
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Daniel J Miller
- Department of Orthopaedics, Gillette Children's, St. Paul
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
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Roberts LW. Considering the Effects of the Dobbs Decision on Clinical Training and Practice and on the Lives of Medical Professionals. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:425-428. [PMID: 36989405 DOI: 10.1097/acm.0000000000005155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
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10
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Kevric J, Suter K, Hodgson R, Chew G. Surgeons have a high infertility rate and pregnancy complications - what are we doing about it in Australia? ANZ J Surg 2023; 93:13-14. [PMID: 36645805 DOI: 10.1111/ans.18278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/20/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023]
Affiliation(s)
- Jasmina Kevric
- Division of Surgery, Northern Health, Epping, Australia.,Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Australia
| | | | - Russell Hodgson
- Division of Surgery, Northern Health, Epping, Australia.,Department of Surgery, University of Melbourne, Epping, Australia
| | - Grace Chew
- Division of Surgery, Northern Health, Epping, Australia.,Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Australia.,BreastScreen Victoria, St Vincent's Hospital, Melbourne, Australia
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Worthington RO, Adams DR, Fritz CDL, Tusken M, Volerman A. Supporting Breastfeeding Physicians Across the Educational and Professional Continuum: A Call to Action. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:21-28. [PMID: 35921171 PMCID: PMC10423406 DOI: 10.1097/acm.0000000000004898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The benefits of breastmilk and lactation are well established for both infants and women. National organizations recommend exclusively breastfeeding for the first 6 months of life and continued breastfeeding for the first 1-2 years of life. For physicians, childbearing years often coincide with key periods of training and their early career. Physician mothers have high rates of initiating breastfeeding but low success in maintaining breastfeeding. Breastfeeding discontinuation among physicians is a well-described, multifactorial issue that has persisted for decades. Reasons for discontinuation include inadequate access to pumping rooms, insufficient workplace and coworker support, and constrained schedules. Pumping is viewed as a burden to teammates and superiors, and physicians are often required to make up time spent pumping. Vague or absent policies to support breastfeeding by accreditation organizations and institutions create workplace conflict and impose additional stress on breastfeeding physicians, who devote significant time, energy, and mental reserves navigating clinical responsibilities, workplace relationships, and licensing requirements to pump. The authors propose several recommendations to improve the environment, support, and resources for breastfeeding physicians with a focus on what individuals, institutions, and professional organizations can do. Creating lactation policies that allow breastfeeding physicians equitable participation in the workplace is a matter of reproductive justice. Improving the collective awareness and support for breastfeeding trainees and physicians is a critical step in recruiting, retaining, and supporting women in medicine.
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Affiliation(s)
- Rebeca Ortiz Worthington
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center / Veterans Affairs Pittsburgh Healthcare, Pittsburgh, PA
| | - Dara R. Adams
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Cassandra D. L. Fritz
- Division of Gastroenterology, Director of Diversity, Equity, and Inclusion for Internal Medicine Residency Program, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Megan Tusken
- Department of Psychiatry, University of Texas at Southwestern, Dallas, TX
| | - Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, IL
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Parental leave during pediatric fellowship training: A national survey. PLoS One 2022; 17:e0279447. [PMID: 36548290 PMCID: PMC9779013 DOI: 10.1371/journal.pone.0279447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Until recently, no uniform requirements for parental leave (PL) existed in graduate medical education. We implemented a national survey, with the objective of ascertaining fellows' perceptions of PL policies and their impact. This is the first study to focus exclusively on pediatric subspecialty fellows. METHODS An online survey instrument was created targeting pediatric fellows. RESULTS The survey was accessed by 1003 (25%) of the estimated 4078 pediatric subspecialty fellows and 853 (21%) submitted surveys. Respondent demographic data paralleled the data reported by the American Board of Pediatrics. Half of respondents did not know whether their program had a written PL policy. Over 40% reported ≥ 5 weeks of paid PL. Most indicated that fellows use vacation, sick leave, and unpaid time for PL. Almost half of respondents (45%) indicated that their program's PL policy increases the stress of having a child. Fellows chose establishing/extending paid leave and intentionally fostering a more supportive program culture as the most crucial candidate improvements. The importance of equitable PL polices between parent fellows and co-fellows was an important theme of our qualitative data. Fellows feel there is a moral misalignment between the field of pediatrics' dedication to maternal and child health and current PL policies governing pediatric trainees. CONCLUSIONS PL policies vary widely among pediatric fellowship programs and are often not known by fellows. Fellows are not satisfied with PL policies, which often exacerbate stress for new parents and burden their co-fellows. Targeted modification of several aspects of PL policies may improve their acceptance.
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13
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Fertility knowledge and views on egg freezing and family planning among surgical specialty trainees. AJOG GLOBAL REPORTS 2022; 2:100096. [DOI: 10.1016/j.xagr.2022.100096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Castillo-Angeles M, Atkinson RB, Easter SR, Gosain A, Hu YY, Cooper Z, Kim ES, Rangel EL. Pregnancy During Surgical Training: Are Residency Programs Truly Supporting Their Trainees? JOURNAL OF SURGICAL EDUCATION 2022; 79:e92-e102. [PMID: 35842402 DOI: 10.1016/j.jsurg.2022.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/10/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Despite recent national improvements in family leave policies, there has been little focus on program-level support for surgical trainees. Trainees who may require clinical duty adjustments during pregnancy, who experience pregnancy loss, or who struggle with balancing work obligations with the demands of a new infant may face stigma when seeking schedule accommodations. The aim of this study was to describe program and colleague support of surgical trainees for pregnancy-related and postpartum health needs. DESIGN Survey questionnaire. Participants responded to multiple-choice questions about their history of pregnancy loss, their experience with reduction of clinical duties during pregnancy, and their breastfeeding experience. Those who took time off after miscarriages or reduced their clinical duties during pregnancy were asked whether they perceived their colleagues and/or program leadership to be supportive using a 4-point Likert scale (1-strongly agree, 4-strongly disagree) which was dichotomized to agree/disagree. SETTING Electronically distributed through social media and surgical societies from November 2020 to January 2021. PARTICIPANTS Female surgical residents and fellows. RESULTS 258 female surgical residents and fellows were included. Median age was 32 (IQR 30-35) years and 76.74% were white. Of the 52 respondents (20.2%) who reported a miscarriage, 38 (73.1%) took no time off after pregnancy loss, including 5 of 10 women (50%) whose loss occurred after 10 weeks' gestation. Of the 14 residents who took time off after a miscarriage, 4 (28.6%) disagreed their colleagues and/or leadership were supportive of time away from work. Among trainees who reported at least 1 live birth, only 18/114 (15.8%) reduced their work schedule during pregnancy. Of these, 11 (61.1%) described stigma and resentment from colleagues and 14 (77.8%) reported feeling guilty about burdening their colleagues. 100% of respondents reported a desire to breastfeed their infants, but nearly half (46.0%) were unable to reach their breastfeeding goals. 46 (80.7%) cited a lack of time to express breastmilk and 23 (40.4%) cited inadequate lactation facilities as barriers to achieving their breastfeeding goals. CONCLUSIONS A minority of female trainees takes time off or reduces their clinical duties for pregnancy or postpartum health needs. National parental leave policies are insufficient without complementary program-level strategies that support schedule adjustments for pregnant trainees without engendering a sense of resentment or guilt for doing so. Surgical program leaders should initiate open dialogue, proactively offer clinical duty reductions, and ensure time and space for lactation needs to safeguard maternal-fetal health and improve the working environment for pregnant residents.
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Affiliation(s)
- Manuel Castillo-Angeles
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rachel B Atkinson
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah Rae Easter
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ankush Gosain
- Department of Surgery, University of Tennessee Health Science Center, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Yue-Yung Hu
- Division of Pediatric Surgery, Ann & Robert Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Zara Cooper
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eugene S Kim
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Erika L Rangel
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
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Saleh M, Blank SV. Female Oncologists' Perceptions on Family and Career-Does It Have to Be a Choice? JAMA Netw Open 2022; 5:e2242367. [PMID: 36315152 DOI: 10.1001/jamanetworkopen.2022.42367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Affiliation(s)
- Mona Saleh
- Department of Obstetrics, Gynecology and Reproductive Science, Tisch Cancer Institute, Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephanie V Blank
- Department of Obstetrics, Gynecology and Reproductive Science, Tisch Cancer Institute, Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Ponce SB, Bajaj A, Baniel C, Seldon C, Sim A, Franco I, Pinnix C, Fields E, Jimenez RB. Protecting our Patients and Trainees: The Complex Consequences of the Dobbs v. Jackson Women's Health Organization Ruling. Int J Radiat Oncol Biol Phys 2022; 114:393-395. [PMID: 35963469 DOI: 10.1016/j.ijrobp.2022.07.1846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Sara Beltrán Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amishi Bajaj
- Department of Radiation Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Claire Baniel
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Crystal Seldon
- Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital Radiation Oncology, Miami, Florida
| | - Austin Sim
- Department of Radiation Oncology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Idalid Franco
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chelsea Pinnix
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emma Fields
- Department of Radiation Oncology, Virginia Commonwealth University Health Sciences, Richmond, Virginia
| | - Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
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Stack SW, Finn KM, Kisielewski M, Law KL, Milne CK, Best JA. Parental Leave Policies in Residency: A National Survey of Internal Medicine Program Directors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1021-1028. [PMID: 35020617 DOI: 10.1097/acm.0000000000004593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To characterize the existence, accessibility, and content of parental leave policies, as well as barriers to program-level policy implementation among internal medicine (IM) program directors (PDs) and to assess the willingness of PDs to implement a national standardized policy. METHOD In 2019, the Association of Program Directors in Internal Medicine conducted a survey of 422 IM PDs. Along with other content, 38 questions addressed 4 primary outcomes: parental leave policy existence, accessibility, content, and barriers. The authors compared programs with and without a program-level policy and applied qualitative content analysis to open-ended questions about barriers to policy implementation and openness to a national standard. RESULTS The response rate was 69.4% (293/422). Of responding programs, 86% (250/290) reported a written parental leave policy with 43% (97/225) of these originating at the program level. Program-level policies, compared with policies at other levels, were more likely to address scheduling during pregnancy (38%, 36/95 vs 22%, 27/124; P = .018); peer coverage (24%, 21/89 vs 15%, 16/109; P = .037), how the duration of extended training is determined (81%, 72/89 vs 44%, 48/109; P < .001), and associated pay and benefits 61%, 54/89 vs 44%, 48/109; P = .009). PDs without program-level policy reported lacking guidance to develop policy, deferring upward to institutional policies, and wishing to retain flexibility. More than half of PDs (60%, 170/282) expressed agreement that a national standard for a residency program-level parental leave policy should exist. Those not in favor cited organization equity, lack of resources, implementation challenges, loss of flexibility, and potentially disadvantaging recruitment. CONCLUSIONS While existing program-level policies included important content, most PDs reported not having them. A national standard to guide the development of program-level parental leave policies could be embraced if it provided flexibility for programs with limited resources.
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Affiliation(s)
- Shobha W Stack
- S.W. Stack is assistant professor of medicine and associate director, Medicine Student Programs, University of Washington School of Medicine, Seattle, Washington; ORCID: https://orcid.org/0000-0001-6586-9266
| | - Kathleen M Finn
- K.M. Finn is assistant professor of medicine and senior associate program director, Resident Development, Massachusetts General Hospital Internal Medicine Residency Program, Harvard Medical School, Boston, Massachusetts
| | - Michael Kisielewski
- M. Kisielewski is assistant director, Surveys and Research, Alliance for Academic Internal Medicine, Alexandria, Virginia
| | - Karen L Law
- K.L. Law is associate professor of medicine, program director, Internal Medicine Residency Program, and associate vice chair of education, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Caroline K Milne
- C.K. Milne is professor of medicine, program director, Internal Medicine Residency Program, and vice chair for education, University of Utah School of Medicine, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0002-4782-1901
| | - Jennifer A Best
- J.A. Best is associate professor of medicine, associate program director, Internal Medicine Residency Program, and associate dean, Graduate Medical Education, University of Washington School of Medicine, Seattle, Washington
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Smith KS, Bakkensen JB, Hutchinson AP, Cheung EO, Thomas J, Grote V, Moreno PI, Goldman KN, Jordan N, Feinberg EC. Knowledge of Fertility and Perspectives About Family Planning Among Female Physicians. JAMA Netw Open 2022; 5:e2213337. [PMID: 35583866 PMCID: PMC9118076 DOI: 10.1001/jamanetworkopen.2022.13337] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Pervasive gender disparities exist in medicine regarding promotion, achievement of academic rank, and appointment to leadership positions. Fertility and childbearing concerns may contribute to these disparities. OBJECTIVE To assess fertility knowledge and concerns and evaluate barriers to family building and impact on academic attrition reported by female physicians. DESIGN, SETTING, AND PARTICIPANTS This qualitative study used mixed methods; first, structured 1:1 interviews exploring fertility knowledge and family-building concerns were conducted among 16 female physicians between November 2019 and May 2020. Transcripts were coded in Dedoose and used to develop a survey instrument with subsequent pilot testing conducted among 24 female physicians between April 2020 and September 2020. Data analysis was performed from January 2021 to March 2021. MAIN OUTCOMES AND MEASURES Fertility knowledge, perceptions of peer and institutional support surrounding childbearing, factors contributing to delayed childbearing, and impact of family planning on career decisions. RESULTS Among 16 women who completed qualitative interviews, 4 (25%) were Asian, 1 (6%) was Black, 1 (6%) was multiracial, and 10 (63%) were White; mean (SD) age was 34.9 (4.0) years. Evaluation of fertility knowledge revealed 3 notable themes: (1) inadequate formal fertility education, (2) informal learning through infertility experiences of patients, peers, or personal struggles, and (3) desire to improve medical education through early introduction and transparent discussions about infertility. Exploration of childbearing concerns similarly revealed several salient themes: (1) high incidence of delayed childbearing, (2) perceived lack of peer and administrative support, and (3) impact of family building on career trajectory. These themes were borne out in pilot testing of the survey instrument: of 24 female physicians (7 Asian women [27%], 1 Black woman [4%], 1 Hispanic or Latinx woman [4%], 1 multiracial woman [4%], 15 White women [58%]; mean [SD] age, 36.1 [6.7] years), 17 (71%) had delayed childbearing and 16 (67%) had altered their career for family-building reasons. CONCLUSIONS AND RELEVANCE Qualitative interviews identified fertility and family building concerns among female physicians and were used to develop a tailored survey for women in medicine. These findings suggest that female physicians may delay childbearing and make substantial accommodations in their careers to support family building. A large-scale national survey is needed to better characterize the unique fertility, childbearing, and parenting needs of women in academic medicine to better understand how these concerns may contribute to academic attrition.
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Affiliation(s)
- Kathryn S. Smith
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer B. Bakkensen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anne P. Hutchinson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Shady Grove Fertility in Philadelphia, Philadelphia, Pennsylvania
| | | | - Jessica Thomas
- Preventive Medicine at Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Veronika Grote
- Osher Center for Integrative Medicine at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patricia I. Moreno
- Department of Public Health Sciences at the University of Miami Miller School of Medicine, Miami, Florida
| | - Kara N. Goldman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Neil Jordan
- Institute for Public Health and Medicine-Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center of Innovation for Complex Chronic Healthcare at the Edward J. Hines, Jr. VA Hospital, Hines, Illinois
| | - Eve C. Feinberg
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Krier CR, Quinn K, Kaljo K, Farkas AH, Ellinas EH. The Effect of COVID-19 on the Medical School Experience, Specialty Selection, and Career Choice: A Qualitative Study. JOURNAL OF SURGICAL EDUCATION 2022; 79:661-667. [PMID: 34863674 PMCID: PMC8606003 DOI: 10.1016/j.jsurg.2021.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/01/2021] [Accepted: 11/10/2021] [Indexed: 06/01/2023]
Abstract
OBJECTIVE While COVID-19 had a profound impact on healthcare, its effects on medical students are less clear. This study explored the effects of COVID-19 safety measures on medical students' specialty selection and career choices. It further considers the potential differential effects of COVID by gender. DESIGN Between June and November 2020 at a Midwestern medical university, medical students with an anticipated graduation in 2021 through 2023 participated in virtual focus group sessions, which explored students' transition to remote learning during COVID-19, perception of gender bias within medical education, and personal and professional goals. Nine focus groups were held, with two to six students per session (n = 22). Focus groups were video recorded, transcribed verbatim, and data were deidentified. Transcripts were coded and analyzed using consensual qualitative analysis to identify themes. RESULTS Our analysis captured 3 themes: (1) Impact of Institutional Decision-Making due to COVID-19, (2) Impact of Unstructured Time on Professional and Personal Decision Making, and (3) Impact of Societal Pressures, Gender Bias, and Mentorship on Career Planning. CONCLUSIONS COVID-19 disrupted important learning opportunities for medical students. Mentorship and shadowing are critical in helping students make career and specialty decisions, particularly for women. The loss of these opportunities may have lasting career impacts for all students.
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Affiliation(s)
| | | | | | - Amy H Farkas
- Medical College of Wisconsin, Milwaukee, Wisconsin; MCW Center for the Advancement of Women in Science and Medicine, Wisconsin
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20
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Cole AG, Camp ME. Supporting Our Parent-Trainees: Exploring Curricular and Cultural Challenges That Limit the Utilization of Parental Leave by Residents. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:157-161. [PMID: 35229245 PMCID: PMC8884516 DOI: 10.1007/s40596-022-01601-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Affiliation(s)
| | - Mary E Camp
- UT Southwestern Medical Center, Dallas, TX, USA
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21
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Han W, Pan YN, Han Z, Huang D, Hong S, Song X, Cheng L, Jiang L. Advanced maternal age impairs synaptic plasticity in offspring rats. Behav Brain Res 2022; 425:113830. [DOI: 10.1016/j.bbr.2022.113830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 11/02/2022]
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22
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Blalock AE, Smith MC, Patterson BR, Greenberg A, Smith BRG, Choi C. "I might not fit that doctor image": Ideal worker norms and women medical students. MEDICAL EDUCATION 2022; 56:339-348. [PMID: 34862660 DOI: 10.1111/medu.14709] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 06/13/2023]
Abstract
Despite the increasing numbers of women students in medical schools, focused attention on their perceptions about medical school and the medical profession remain underexamined. These perceptions are important to understand, particularly since women students are likely burdened with a host of gender norms related to work, family, and their future roles as physicians. Early experiences in medical school offer important insights into the larger student experience and are tied to academic outcomes and feelings of belonging. To examine early experiences of women medical students, this qualitative study used sensemaking theory to describe the current context and "story" of ideal worker norms. Critical qualitative interviews of 38 women students were performed during their first 2 months of medical school and explored both how the students perceived and experienced ideal worker norms, and how they made sense of the "story" of ideal worker norms. The participants described ways they encountered gendering and ideal worker norms through displays of nurturing behaviour, expectations to balance a future family, and whether they looked or acted the part of a doctor. This article highlights the challenges women medical students are already aware they will face, the opportunities they look forward to, and the strengths they anticipate leaning on to navigate their profession. Results from this study have implications for women medical students' learning experiences and transitions into medical school and for faculty, staff, and scholars concerned with challenging gendering norms that shape medical education.
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Affiliation(s)
- A Emiko Blalock
- Office of Medical Education Research and Development, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | | | - B R Patterson
- Premed, University of North Carolina System, Chapel Hill, North Carolina, USA
| | - Amy Greenberg
- Office of Medical Education Research and Development, Office of Academic Affairs, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Brandon R G Smith
- Higher Adult and Lifelong Education, Michigan State University, East Lansing, Michigan, USA
| | - Christine Choi
- Student Affairs, Michigan State University, East Lansing, Michigan, USA
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Abstract
Residency and fellowship are unique occupational time periods for many early career physicians, generally consisting of long duty hours. Many early career physicians have or are in the process of building their families during this time period. The literature suggests many medical and psychosocial benefits of protected parental leave for both parents and children, which necessitates parental leaves of absence. The Institutional Requirements of the Accreditation Council for Graduate Medical Education require training programs to provide written policies regarding leaves of absence, including parental leave, and these policies must comply with current legislation such as the Family Medical Leave Act. The length of leave has considerable variability among residency programs. This policy statement aims to navigate and outline the challenges of parental leave policies in training programs and to put forth recommendations to protect trainees and their families. The definition of families should also be expanded to include all types of families.
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Affiliation(s)
- Jennifer Takagishi
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida
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24
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Jamorabo DS, Khander A, Koulouris V, Feith JE, Briggs WM, Renelus BD. Fellowship program directors and trainees across the United States find parental leave policies to be inconsistent, inaccessible, and inadequate. PLoS One 2021; 16:e0260057. [PMID: 34788326 PMCID: PMC8598025 DOI: 10.1371/journal.pone.0260057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/31/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Determine the consistency, accessibility, and adequacy of parental leave policies for adult and pediatric medicine fellowship programs. Methods We administered a 40-question survey to fellowship program directors (PDs) and trainees in adult and pediatric cardiology, hematology/oncology, gastroenterology, and pulmonology/critical care fellowship programs in the United States. We used Chi-square tests to compare proportions for categorical variables and t-tests to compare means for continuous variables. Results A total of 190 PDs from 500 programs (38.0%) and 236 trainees from 142 programs (28.4%) responded. Most respondents did not believe that parental leave policies were accessible publicly (322/426; 75.6%), on password-protected intranet (343/426; 80.5%), or upon request (240/426; 56.3%). The PDs and trainees broadly felt that parental leave for fellows should be 5–10 weeks (156/426; 36.6%) or 11–15 weeks (165/426; 38.7%). A majority of PDs felt that there was no increased burden upon other fellows (122/190; 64.2%) or change in overall well-being (110/190; 57.9%). When asked about the biggest barrier to parental leave support, most PDs noted time constrains of fellowship (101/190; 53.1%) and the limited number of fellows (43/190; 22.6%). Trainees similarly selected the time constraints of training (88/236; 37.3%), but nearly one-fifth chose the culture in medicine (44/236; 18.6%). There were no statistically significant differences in answers based on the respondents’ sex, specialty, or subspecialty. Discussion Parental leave policies are broadly in place, but did not feel these were readily accessible, standardized, or of optimum length. PDs and trainees noted several barriers that undermine support for better parental leave policies, including time constraints of fellowship, the limited number of fellows for coverage, and workplace culture. Standardization of parental leave policies is advisable to allow trainees to pursue fellowship training and care for their newborns without undermining their educational experiences.
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Affiliation(s)
- Daniel Sabido Jamorabo
- Department of Medicine, Stony Brook Medicine, Stony Brook, New York, United States of America
- * E-mail: ,
| | - Amrin Khander
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, United States of America
| | - Vasilios Koulouris
- Department of Medicine, Montefiore Medical Center, Bronx, New York, United States of America
| | - Jeremy Eli Feith
- Department of Neurosciences, State University of New York-Binghamton, Binghamton, New York, United States of America
| | - William Matthew Briggs
- Department of Biostatistics, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America
| | - Benjamin Dwight Renelus
- Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, United States of America
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Ng AK, Yashar CM, Davis BJ, Suh JH, Alektiar KM, Wallner PE. Implications of Medical Board Certification Practices on Family Planning and Professional Trajectory for Early Career Female Radiation Oncologists: In Response to Dover et al. Pract Radiat Oncol 2021; 12:103-105. [PMID: 34775126 DOI: 10.1016/j.prro.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Andrea K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Catheryn M Yashar
- Department of Radiation Oncology, University of California San Diego, San Diego, California
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Medical School, Rochester, Minnesota
| | - John H Suh
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Paul E Wallner
- GenesisCare USA, Fort Myers, Florida; The American Board of Radiology, Tucson, Arizona.
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Dundon KM, Powell WT, Wilder JL, King B, Schwartz A, McPhillips H, Best JA. Parenthood and Parental Leave Decisions in Pediatric Residency. Pediatrics 2021; 148:peds.2021-050107. [PMID: 34584002 DOI: 10.1542/peds.2021-050107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The demands of residency training may impact trainees' decision to have children. We examined characteristics of pediatric residents' decisions regarding childbearing, determinants of resident parental leave, and associations with well-being. METHODS A survey of 845 pediatric residents at 13 programs was conducted between October 2019 and May 2020. Survey items included demographics, desire for future children, and logistics of parental leave. Outcomes included parental leave length, burnout and depression screening results, satisfaction with duration of breastfeeding, and satisfaction with parental leave and parenthood decisions. RESULTS Seventy-six percent (639 of 845) of residents responded to the survey. Fifty-two percent (330) of respondents reported delaying having children during residency, and 29% (97) of those were dissatisfied with their decision to do so. Busy work schedule (89.7%), finances (50.9%), and a desire not to extend residency (41.2%) were the most common reasons for delay. Of respondents, 16% were parents and 4% were pregnant or had pregnant partners. Sixty-one parental leaves were reported, and 67% of parents reported dissatisfaction with leave length. The most frequently self-reported determinant of leave duration was the desire not to extend residency training (74%). Program mean leave length was negatively associated with burnout, measured as a dichotomous outcome (odds ratio = 0.81 [95% confidence interval 0.68-0.98]; P = .02). CONCLUSIONS Many pediatric trainees delay parenthood during residency and are not satisfied with their decision to do so. Pediatric resident parental leave remains short and variable in duration, despite the positive association between longer leaves and overall well-being.
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Affiliation(s)
| | - Weston T Powell
- Pediatric Pulmonary and Sleep Medicine, Seattle Children's Hospital and University of Washington, Seattle, Washington
| | - Jayme L Wilder
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Beth King
- Association of Pediatric Program Directors, McLean, Virginia
| | - Alan Schwartz
- Association of Pediatric Program Directors, McLean, Virginia.,Departments of Medical Education and Pediatrics, University of Illinois at Chicago, Chicago, Illinois
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27
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Smithson SD, Greene NH, Esakoff TF. Pregnancy outcomes in very advanced maternal age women. Am J Obstet Gynecol MFM 2021; 4:100491. [PMID: 34543752 DOI: 10.1016/j.ajogmf.2021.100491] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Advanced maternal age is associated with adverse pregnancy and delivery outcomes. Few studies have directly compared outcomes between women of advanced maternal age (35-44 years old) and women of very advanced maternal age (≥45 years old). OBJECTIVE We aimed to determine the differences in outcomes between women of advanced maternal age and women of very advanced maternal age. STUDY DESIGN This was a retrospective cohort study conducted at a large urban US medical center. Demographic and obstetrical data were collected in all patients who delivered within the study window (2012-2018). Characteristics and outcomes were compared between women of advanced maternal age and women of very advanced maternal age. Chi-square analyses were used to compare categorical variables. The Student t test or Wilcoxon tests were used, depending on the distribution, to compare continuous variables. RESULTS A total of 45,435 women had delivery data for analysis. Of these women, 26,700 (59%) were not of advanced maternal age, 18,286 (40%) were of advanced maternal age, and 449 (1%) were of very advanced maternal age. Race and ethnicity varied significantly by age group. Nulliparity and postpartum hemorrhage were statistically higher in the very advanced maternal age group. Of note, cesarean delivery rates were 69.5% in the very advanced maternal age group and 39.5% in the advanced maternal age group (P<.001). Chronic hypertension, gestational hypertension, preeclampsia with and without severe features, superimposed preeclampsia, and eclampsia were all statistically significantly higher (at least 2-fold) in the very advanced maternal age group than the advanced maternal age group (P<.001). There was no significant difference in the rates of hemolysis, elevated liver enzymes, and low platelet count between the 2 groups. Rates of neonatal intensive care unit admission, Apgar score of <7 at 5 minutes, and neonatal length of stay of >5 days after cesarean delivery were higher in neonates from mothers of very advanced maternal age. Birthweights of neonates were significantly lower in mothers of very advanced maternal age. CONCLUSION There were several important significant differences in the outcomes between women of very advanced maternal age women and women of advanced maternal age, especially concerning hypertensive disorders and cesarean delivery rates. These findings may influence patient counseling and strategies for antepartum surveillance.
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Affiliation(s)
- Sarah D Smithson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Naomi H Greene
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Tania F Esakoff
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA
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Time out! We must address fertility preservation for surgical trainees. Am J Surg 2021; 223:594-595. [PMID: 34517967 DOI: 10.1016/j.amjsurg.2021.08.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022]
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Roberts LW. Contributions and Sacrifices of Medical Students and Health Care Workers With Family Responsibilities Deserve Our Attention and Respect. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1227-1228. [PMID: 34432656 DOI: 10.1097/acm.0000000000004211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Camero K. We Must Normalize and Better Support Parenting During Medical Training. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:935-936. [PMID: 34183485 DOI: 10.1097/acm.0000000000004100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Karen Camero
- Postdoctoral fellow, general pediatrics, Children's Hospital of Los Angeles, Los Angeles, California;
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Sharpe EE, Ku C, Malinzak EB, Kraus MB, Chandrabose R, Hartlage SEH, Hanson AC, Schulte PJ, Pearson ACS. A cross-sectional survey study of United States residency program directors' perceptions of parental leave and pregnancy among anesthesiology trainees. Can J Anaesth 2021; 68:1485-1496. [PMID: 34159567 DOI: 10.1007/s12630-021-02044-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Little is known about program directors' knowledge, attitudes, and beliefs regarding parental leave policies in anesthesiology training. This study sought to understand program director perceptions about the effects of pregnancy and parental leave on resident training, skills, and productivity. METHODS An online 43-question survey was developed to evaluate United States anesthesiology program directors' perceptions of parental leave policies. The survey included questions regarding demographics, anesthesiology program characteristics, parental leave policies, call coverage, and the perceived effects of parental leave on resident performance. Data were collected by Qualtrics (Qualtrics, Provo, UT, USA). RESULTS Fifty-six of 145 (39%) anesthesiology program directors completed the survey. Forty-eight of 54 (89%) program directors had a female resident take maternity leave in the past three years. When asked how parental leave affects residents' futures, 24/50 (48%) program directors felt it delayed board certification and 28/50 (56%) thought it affected fellowship opportunities. Program directors were split on their perceived impact of becoming a parent on a trainee's work. Yet, when compared with male trainees, program directors perceived that becoming a parent negatively affected female trainees' timeliness, technical skills, scholarly activities, procedural volume, and standardized test scores and affected training experience of co-residents. Program directors perceived no difference in impact on female trainees' dedication to patients and clinical performance. CONCLUSIONS Program directors perceived that becoming a parent negatively affects the work performance of female but not male trainees. These negative perceptions could impact evaluations and future plans of female residents.
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Affiliation(s)
- Emily E Sharpe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Cindy Ku
- Department of Anesthesiology, Queen's Medical Center, Honolulu, HI, USA
| | | | - Molly B Kraus
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Rekha Chandrabose
- Department of Anesthesiology, University of California San Diego, San Diego, CA, USA
| | - Sarah E H Hartlage
- Department of Public Health and Wellness, Louisville Metro, Louisville, KY, USA
| | - Andrew C Hanson
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Phillip J Schulte
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Amy C S Pearson
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA
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Roberts LW. Women and Academic Medicine, 2020. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1459-1464. [PMID: 33002898 DOI: 10.1097/acm.0000000000003617] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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DeAngelis CD. A Long, Adventurous Journey: Reflecting on 50 Years as a Woman in Academic Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1472-1474. [PMID: 32520752 DOI: 10.1097/acm.0000000000003541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
As part of a special collection of articles on women in academic medicine, the author reflects on her 50 years in medicine as a trainee, faculty member, administrator, and editor-in-chief of the Journal of the American Medical Association (JAMA). She uses personal experiences to illustrate several lessons learned. First, good leaders share 4 characteristics, each of which begins with the letter "T" (tenacity, tough mindedness-not toughness, thick skin, and tender heart). Second, never underestimate the ability to change things. Third, always keep a paper trail. Fourth, people will not remember what was said, but they will never forget how they were made to feel. Fifth, support that comes only from the top is actually a hanging. Sixth, losing one's vision might be worse than losing one's sight. And finally, some things can only be seen through eyes that have cried. The author closes with advice for women negotiating a first or a new position, and a reminder that whatever position one holds in medicine, it is part of the greatest profession in the world, affording its members the honor and joy of taking care of sick people.
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Affiliation(s)
- Catherine D DeAngelis
- C.D. DeAngelis is University Distinguished Service Professor Emerita and professor of pediatrics emerita, Johns Hopkins University School of Medicine, professor of health policy and management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and editor-in-chief emerita of JAMA, the Journal of the American Medical Association
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