The pregnant female surgical resident

Residents' Perspectives of Pregnancy and Growing a Family During Surgical Training: A Review of the Literature

As more female surgical residents choose to start families during training, concerns regarding program support and peer perceptions emerge. Delayed parenthood, stress, and even attrition can result from inadequate support systems. Database search (MEDLINE, PubMed, EMBASE) in June 2022 identified 17 relevant studies published between 2012-2022, including systematic reviews and qualitative surveys, focused on surgical residents/fellows and program directors. The thematic analysis explored themes related to supporting residents navigating parenthood. Thematic analysis of 17 studies (systematic reviews and qualitative surveys with residents/fellows and program directors) identified key recurring themes related to challenges experienced by surgical residents navigating parenthood. The themes included modified work schedules, mentorship programs, cross-coverage plans, lactation support, childcare options, and clear leave policies. By understanding these challenges and implementing tailored support strategies, surgical residency programs can foster a more inclusive and supportive environment for residents starting families. This can improve resident well-being, reduce attrition, and create a significantly more enjoyable training experience for all involved. This review aims to provide insight into residents' difficulties while pregnant or considering pregnancy and identify changes programs could implement to promote a more supportive culture for pregnant residents.

Fertility and Pregnancy: How Do These Affect Family Planning and Surgeon Health?

There are unique considerations to fertility and pregnancy for women surgeons. Women surgeons often decide to delay pregnancy and childbearing due to concerns of conflict with work and training. This is particularly true for surgical trainees who face many obstacles, including bias from peers and program directors, and work-life conflict. As such, rates of infertility are higher compared with the general population. Women surgeons require assisted reproductive technologies more often than the general population. During pregnancy, there are also additional occupational hazards that are unique to a surgical career. Overall, we must be aware of these issues to support surgeons who decide to become parents during a surgical career.

Prospective Factors that Predict American Board of Surgery In-Training Examination Performance: A Systematic Review

INTRODUCTION

American Board of Surgery In-Training Examination (ABSITE) performance has become an important factor when monitoring resident progress. Understanding which prospective factors predict performance can help identify residents at risk.

METHODS

A literature search was conducted searching PubMed, EMBASE, and JAMA Network from June 2011 to June 2021, in accordance with the PRISMA guidelines. Searches were performed for the terms "ABSITE" and "American Board of Surgery In-Training Examination." Prospective factors such as prior examination performance, clinical evaluations, and demographics were evaluated.

RESULTS

A final 35 studies were included. The prospective factor most consistently found to predict ABSITE performance is performance on prior knowledge-based examinations such as the USMLE step exams. The ACGME Medical Knowledge 1 milestone evaluation also appears to correlate to ABSITE performance, although clinical evaluations, in general, do not. Demographics have no significant correlation to ABSITE performance.

DISCUSSION

Using performance on prior knowledge-based examinations programs may be able to identify residents at risk for failing ABSITE. It may be possible to initiate early intervention before rather than only remediation after poor performance.

A cross-sectional survey study of United States residency program directors' perceptions of parental leave and pregnancy among anesthesiology trainees

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.

Baby Steps in the Right Direction: Toward a Parental Leave Policy for Gastroenterology Fellows

The American Board of Medical Specialties announced in July 2020 the adoption of a parental leave policy for residents and fellows allows for a minimum of 6 weeks of leave. This policy includes caveats: vacation and/or sick leave can be applied toward these 6 weeks, this leave can only be utilized once during training (whether for parental, caregiver, or medical leave), and this policy only applies to training programs of 2 or more years' duration. Although the new existence of a parental leave policy is a step in the right direction, trainees are in need of a more robust and evidence-based policy. There are particular challenges to be addressed in the male-dominated and procedural field of gastroenterology, in which women are underrepresented and female gastroenterology trainees are more likely to have career decisions limited around the availability of parental leave. This article reviews the evidence supporting the creation of a parental leave policy for gastroenterology fellows, with potential benefits to individual trainees as well as the field, in order to promote equity, recruitment, retention, and advancement of women in gastroenterology.

Pregnancy and Parenthood Remain Challenging During Surgical Residency: A Systematic Review

PURPOSE

To examine common themes and synthesize data surrounding pregnancy and parenthood during surgical residency training.

METHOD

The authors conducted a systematic search of the literature in March 2019. They searched MEDLINE, EMBASE, and Scopus, seeking articles published from 2003 to 2018 that focused on pregnancy, parenthood, and the experience of surgical residents. They excluded articles that examined nonsurgical programs, as well as editorials, abstracts, and commentaries. Two investigators independently reviewed all citations, selected articles for full-text review, and extracted data from the selected articles.

RESULTS

Of 523 titles and abstracts screened, 27 were included. Overall, female surgical residents had fewer children during residency training than their male counterparts (18%-28% vs 32%-54%). As compared with the general population, surgical residents had their first child later in life (30-34 vs 25 years old), and had fewer children overall (0.6-2.1 vs 2.7). Infertility rates were higher among female surgeons than in the general population (30%-32% vs 11%), as were assisted reproductive technology rates (8%-13% vs 1.7%). Pregnant surgical residents experienced a high rate of obstetrical complications; working more than 6 overnight calls shifts per month or 60 hours per week were predictors of increased complication rates. The authors noted no differences in attrition, caseload, or exam pass rates amongst female surgical residents who had become pregnant as compared with other residents. Despite these similar academic outcomes, negative attitudes and perceptions toward pregnancy during residency were consistently identified.

CONCLUSIONS

Female surgical residents experience high rates of infertility and obstetrical complications, contend with negative attitudes and stigma during their pregnancies, and voluntarily delay childbearing. Formal maternity policies, a shift in surgical culture, and ongoing discussion with all stakeholders are needed to attract and retain female surgical residents.

Distribution of General Surgery Residencies in the United States and Gender Inequality: Are We There Yet?

OBJECTIVE

Surgeons are unevenly distributed across the United States (U.S.), possibly as a result of disproportionately distributed General Surgery (GS) residencies. This study primarily aimed to examine the relationship between the distribution of GS residency positions and population by U.S. region and states. Differences in the distribution by race and gender were also examined.

DESIGN

A review of the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) National Residency Matching Program (NRMP) data over 5 years. Categorical Surgery Residency PGY1 positions (SurgPGY1) were categorized into Northeast, Midwest, South, and West regions. SurgPGY1 to population ratios were compared by region. The distribution of SurgPGY1s by race/gender was also compared.

PARTICIPANTS

Medical students who match into SurgPGY1 positions through the NRMP.

RESULTS

The mean SurgPGY1s per 10⁶ population was 4.18 ± 0.52 for 2018. Most commonly, SurgPGY1s are concentrated in the Northeast (5.79 ± 0.64) then the South (5.12 ± 1.41), then the Midwest (4.22 ± 0.37), and lastly the West (1.91 ± 0.39). NY, MA, and DC had significantly higher SurgPGY1s ratios, with DC topping at 27.05. Four States had no SurgPGY1s (AK, ID, MT, WY), while AR, MS, and UT were under 2 SurgPGY1s/10⁶. From 2014 to 2018, the percent of ACGME positions given to females increased 2.93%, while the AOA positions increased 11.84%. When adjusted for the population the race with the most residencies for their population was Asian (482.42% ACGME, 324.52% AOA).

CONCLUSION

There is a significant disproportion in the distribution of GS residencies and not proportional to population, race or gender.

Supporting New Physicians and New Parents: A Call to Create a Standard Parental Leave Policy for Residents

Parents taking leave after the birth of a child is associated with significant benefits for infants, mothers, and fathers. Although nearly 40% of residents have or plan to have children during residency, there is no standard parental leave policy for these trainees. In this Perspective, the authors discuss the benefits of parental leave, synthesize findings about maternity bias and other negative effects of the current variable approaches to parental leave during residency, and explore underlying causes of the lack of a standard parental leave policy for residents. They also call on the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties to work together to address this issue, recommending a standard parental leave policy that ensures a minimum of 8 weeks of paid leave for all residents without requiring them to extend training or making them ineligible to sit for board certification exams. Creating evidence-based and family-friendly guidelines for parental leave is important to the progress of academic medicine in the modern era, as it supports parental and child health, promotes resident wellness, and reduces gender disparities in medicine to the benefit of all.

Maternal wellbeing and pregnancy outcomes in anaesthetic trainees

The importance of supporting and maintaining doctors’ health and wellbeing cannot be overstated. Combined with the undisputed status of work in medicine as both strenuous and stressful, pregnancy is a unique time during which the mother and unborn baby may be at risk of adverse outcomes.

A narrative literature review is presented with a focus on studies of relevance to pregnancy in anaesthesia trainees, however much of the evidence is drawn from studies involving anaesthetic consultants, trainees in other specialties and pregnant workers in general. After a brief exploration into historical concepts in occupational hazards and adverse pregnancy outcomes, further discussion ensues on more recent evidence in relation to specialist training (or ‘residency’), the impact of work stressors and maternal psychological state on pregnancy outcomes and attitudes towards pregnancy during specialist training. Finally, occupational guidelines are considered along with the rationale for ‘pregnancy-friendly’ workplaces and suggestions for future research in this area for both the profession and employers.