Session Design Submission Review

Yes

• Citizenship and Global Responsibility
• Diversity, Equity and Inclusion (DEI)

Although the number of female surgical interns is approaching 50%, the lack of family-friendly policies and concerns about the feasibility of balancing the demands of a surgical career and family responsibilities continue to factor significantly into both medical students’ choice of career and the estimated 25% attrition rate of female surgical residents.  Roughly 35% of female surgeons who have completed residency since 2000 have opted to have children during their training (Frangou 2017), forcing program directors to adapt to accommodate more frequent family leave and lactation needs.  According to a 2018 study, a majority of female surgical residents worried about facing negative stigma during pregnancy, particularly if they needed a lighter schedule for their health or the health of their baby (Rangel). A recent survey of US surgical program directors also found that more than 60% believe motherhood adversely affects a trainee’s work and nearly half suggested that the research years are the optimal time for a woman to have a child.

Since July 2021, the American Board of Surgery has allowed greater flexibility for family leave by allowing a minimum of six weeks off once during training for either parental, caregiver, or medical leave without using vacation time or sick leave and without requiring an extension of time in training. Although this change in policy was an improvement, it does not provide adequate support for trainees who either have multiple pregnancies during training or experience complications during their pregnancy(ies).

Trainee concerns about potential pregnancy-related complications are justified. Existing data has shown that female surgeons tend to be older, have fewer children than their male counterparts and work significantly longer hours during pregnancy than the female partners of male surgeons.  Additionally, roughly 25% of female surgeon moms use assisted reproductive technology.  Female surgeons also have higher rates of C-section and pre-eclampsia and are more likely to experience postpartum depression than the female partners of male surgeons (Ranger, 2021).  Data has also shown that rates of obstetrical complications in residents increases markedly with more than 6 call nights per month and/or operating more than 8 hours per week—both extremely common occurrences for clinical surgical residents.

Following childbirth, lactation is an important concern for resident moms.  In a 2018 survey, a majority of female surgical resident mothers felt that having more accessibly lactation facilities would have allowed them to focus more on work and more than half either truncated breastfeeding or avoided it altogether, likely because a similar percentage witness derogatory comments about pumping or breastfeeding at work.  A significant minority felt comfortable asking their attendings to scrub out of a case to pump and many perceived that their attendings would mind if they did so (Rangel, 2018).

To promote a more inclusive workplace, surgical education leaders must continue to innovate to increase support for surgeon moms during and after pregnancy.  This panel will explore some of the current controversies and recommendations about family leave and lactation policies for trainees.

Discuss the pros and cons of further expanding allowances for family leave during surgical training.

Identify options for modifying resident schedules to support healthy pregnancies while balancing patient care and work hours for co-residents.

Consider the barriers to use of assisted reproductive technology as a surgical trainee.

Articulate best practices in lactation support.