IMPORTANCE: Although family priorities influence specialty selection and resident attrition, few studies describe resident perspectives on pregnancy during surgical training. OBJECTIVE: To directly ...assess the resident experience of childbearing during training. DESIGN, SETTING, AND PARTICIPANTS: A self-administered 74-question survey was electronically distributed in January 2017 to members of the Association of Women Surgeons, to members of the Association of Program Directors in Surgery listserv, and through targeted social media platforms. Surgeons who had 1 or more pregnancies during an Accreditation Council for Graduate Medical Education–accredited US general surgery residency program and completed training in 2007 or later were included. Important themes were identified using focus groups of surgeons who had undergone pregnancy during training in the past 7 years. Additional topics were identified through MEDLINE searches performed from January 2000 to July 2016 combining the keywords pregnancy, resident, attrition, and parenting in any specialty. MAIN OUTCOMES AND MEASURES: Descriptive data on perceptions of work schedule during pregnancy, maternity leave policies, lactation and childcare support, and career satisfaction after childbirth. RESULTS: This study included 347 female surgeons (mean SD age, 30.5 2.7 years) with 452 pregnancies. A total of 297 women (85.6%) worked an unmodified schedule until birth, and 220 (63.6%) were concerned that their work schedule adversely affected their health or the health of their unborn child. Residency program maternity leave policies were reported by 121 participants (34.9%). A total of 251 women (78.4%) received maternity leave of 6 weeks or less, and 250 (72.0%) perceived the duration of leave to be inadequate. The American Board of Surgery leave policy was cited as a major barrier to the desired length of leave by 268 of 326 respondents (82.2%). Breastfeeding was important to 329 (95.6%), but 200 (58.1%) stopped earlier than they wished because of poor access to lactation facilities and challenges leaving the operating room to express milk. Sixty-four women (18.4%) had institutional support for childcare, and 231 (66.8%) reported a desire for greater mentorship on integrating a surgical career with motherhood and pregnancy. A total of 135 (39.0%) strongly considered leaving surgical residency, and 102 (29.5%) would discourage female medical students from a surgical career, specifically because of the difficulties of balancing pregnancy and motherhood with training. CONCLUSIONS AND RELEVANCE: The challenges of having children during surgical residency may have significant workforce implications. A deeper understanding is critical to prevent attrition and to continue recruiting talented students. This survey characterizes these issues to help design interventions to support childbearing residents.
In this study, the authors designed checklists to guide care during operating-room crises and evaluated them in a simulated operating room. The availability of checklists improved adherence to best ...practices by operating-room teams during simulations of surgical crises.
Operating-room crises (e.g., massive hemorrhage and cardiac arrest) are high-risk, stressful events that require rapid and coordinated care in a time-critical setting. The reported incidence may be rare for an individual practitioner,
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but the aggregate incidence for a hospital with 10,000 operations a year is estimated to be approximately 145 such events annually.
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These are situations in which the way the team cares for a patient will make the difference between life and death. Failure to effectively manage life-threatening complications in surgical patients has been recognized as the largest source of variation in surgical mortality among hospitals.
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IMPORTANCE: Although pregnancy during surgical residency is increasingly common, studies of surgical residents have identified challenges associated with pregnancy and motherhood. These include ...perceptions of different maternity leave policies among institutions, lack of mentorship, stigma, and desire for greater lactation support. OBJECTIVE: To describe the perspective and experience of US surgical program directors regarding maternity leave and postpartum support for surgical residents. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study included surgical program directors of US general surgery residency programs who were selected using purposive-stratified, criterion-based sampling. Transcripts were collected from semi-structured interviews, which were audio-recorded and transcribed verbatim, from October 21, 2018, to June 1, 2019. EXPOSURES: Maternity leave and postpartum support. MAIN OUTCOMES AND MEASURES: Perspectives of program directors regarding maternity leave and postpartum support were categorized into common themes identified using content analysis. RESULTS: A total of 40 US general surgical programs directors (28 70.0% male; mean SD age, 49.7 6.8 years) were interviewed, of whom 36 (90.0%) were from university-based programs. All reported having maternity leave policies allowing a duration of leave of 6 weeks or longer. Analysis of program director interviews identified 5 themes: (1) residents are reluctant to extend training despite being offered multiple leave options; (2) childbearing negatively impacts the quality of work of certain residents; (3) lack of formal lactation policies creates practical challenges in supporting residents who are nursing; (4) resentment from coresidents who are asked to provide maternity leave coverage varies based on the prepregnancy reputation of the resident on leave; and (5) lack of salary support limits the practicality of extended leave options. Complex interpersonal issues affected residents differently, including stigma, reluctance to change established surgical training patterns, and challenges with work-life balance. CONCLUSIONS AND RELEVANCE: This qualitative study found that sociopolitical issues within surgical training culture and fiscal constraints created obstacles against program directors supporting pregnant residents. These findings suggest that a multidimensional approach to supporting residents through written maternity and lactation policies, structured mentorship and coaching programs, and efforts by leadership to enforce family priorities is needed to promote a surgical culture that normalizes pregnancy and motherhood during training.
IMPORTANCE: Although men are increasingly involved in childrearing, little is known about paternity leave in surgical residency. Conflict between professional and family duties contribute to burnout ...and decreased career satisfaction for surgeons of both sexes. With men more likely than women to have children during their clinical years of surgical training, understanding the issues surrounding paternity leave is imperative to ensuring the longevity of our workforce. OBJECTIVE: To explore surgical program directors’ perspectives on the challenges of providing paternity leave. DESIGN, SETTING, AND PARTICIPANTS: This qualitative descriptive study of transcripts collected from semistructured interviews of US surgical program directors was performed from October 2018 to June 2019. Program directors were selected using purposive-stratified criterion-based sampling. Interviews were audio-recorded and transcribed verbatim, with emergent themes identified using content analysis. EXPOSURE: Paternity leave. MAIN OUTCOMES AND MEASURES: Program directors’ perspectives on paternity leave were categorized into common themes. RESULTS: A total of 40 US general surgery program directors were interviewed (28 male 70%; mean SD age, 49.7 6.8 years; 36 90% were university-based programs). Twenty (50%) reported providing paternity leave of 1-week duration. Five major themes were identified: (1) paternity leave policies are poorly defined by many programs and require self-initiation by residents; (2) residents often do not take the full amount of time offered for leave; (3) stigma against male residents taking parental leave is common and may be even greater than that facing women taking maternity leave; (4) paternity leave has little to no impact on colleagues’ workload owing to the brevity of time taken; and (5) men desire longer leave than what they are currently offered and wish to receive equal time off compared with childbearing parents. CONCLUSIONS AND RELEVANCE: Surgical program directors report male residents take brief paternity leave despite a desire for more time off, which may be influenced by fear of stigma and surgical culture that avoids handing off work, even for short periods of time. A cultural shift toward supporting family planning as a normal part of young adult life, rather than a medical condition to be accommodated, is necessary to promote life balance and behaviors that will sustain a long career in surgery. Implementation of defined leave policies at individual programs for the nonchildbearing parent is critical to make parental leave socially acceptable among surgical residents.
Background There is increasing attention on the coaching of surgeons and trainees to improve performance but no comprehensive review on this topic. The purpose of this review is to summarize the ...quantity and the quality of studies involving surgical coaching methods and their effectiveness. Methods We performed a systematic literature search through PubMed and PsychINFO by using predefined inclusion criteria. Evidence for main outcome categories was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and the Medical Education Research Study Quality Instrument (MERSQI). Results Of a total 3,063 articles, 23 met our inclusion criteria; 4 randomized controlled trials and 19 observational studies. We categorized the articles into 4 groups on the basis of the outcome studied: perception, attitude and opinion; technical skills; nontechnical skills; and performance measures. Overall strength of evidence for each outcome groups was as follows: Perception, attitude, and opinion (Grading of Recommendations Assessment, Development, and Evaluation: Very Low, Medical Education Research Study Quality Instrument MERSQI: 10); technical skills (randomized controlled trials: High, 13.1; Observation studies: Very Low, 11.5); nontechnical skills (Very Low, 12.4) and performance measures (Very Low, 13.6). Simulation was the most used setting for coaching; more than half of the studies deployed an experienced surgeon as a coach and showed that coaching was effective. Conclusion Surgical coaching interventions have a positive impact on learners' perception and attitudes, their technical and nontechnical skills, and performance measures. Evidence of impact on patient outcomes was limited, and the quality of research studies was variable. Despite this, our systematic review of different coaching interventions will benefit future coaching strategies and implementation to enhance operative performance.
IMPORTANCE: Previous work shows women who have children during surgical residency face difficulty balancing childbearing with training, which negatively affects residency and career satisfaction. ...Little is known about the factors that drive professional discontent. OBJECTIVE: To determine factors associated with professional dissatisfaction for childbearing residents. DESIGN, SETTING, AND PARTICIPANTS: Self-administered survey questionnaire electronically distributed through the Association of Program Directors in Surgery, the Association of Women Surgeons, and targeted Twitter and Facebook platforms. The survey was distributed in January 2017 to surgeons who delivered at least 1 child during a US general surgery residency and was available online for 4 weeks. MAIN OUTCOMES AND MEASURES: Respondents were reported to be dissatisfied with their residency if they indicated agreement that they considered leaving residency owing to challenges surrounding childbearing (considered leaving). Respondents were reported to be unhappy with their career if they indicated agreement with statements that (1) given an opportunity to revisit their job choice, they would choose a nonsurgical career more accommodating of motherhood (revisit career choice) or (2) they would advise a female medical student against a surgical career owing to difficulties balancing motherhood with the profession (advise against surgery). Logistic regression was used to determine predictors of agreement with each of the 3 statements of professional dissatisfaction. RESULTS: In total, 347 women responded to the survey and reported 452 pregnancies, and the mean (SD) age was 30.5 (2.7) years. One hundred seventy-nine respondents (51.6%) agreed with at least 1 statement of residency or career dissatisfaction. Lack of a formal maternity leave policy was associated with “considered leaving” (odds ratio OR, 1.83; 95% CI, 1.07-3.10). Perception of stigma during pregnancy was associated with “revisit career choice” (OR, 1.79; 95% CI, 1.01-3.19). Changing fellowship plans owing to perceived difficulty balancing motherhood with the originally chosen subspecialty was associated with all 3 markers of residency and career dissatisfaction (“considered leaving” OR, 2.68; 95% CI, 1.30-5.56; “revisit career choice” OR, 2.23; 95% CI, 1.13-4.43; and “advise against surgery” OR, 2.44; 95% CI, 1.23-4.84). CONCLUSIONS AND RELEVANCE: Surgery residents who perceived stigma during pregnancy, did not have a formal institutional maternity leave policy, or altered their fellowship training plans because of challenges of childbearing expressed greater professional dissatisfaction. Mentorship in subspecialty selection and work-life integration, interventions to reduce workplace bias, and identification of obstacles to establishment of maternity leave policies are needed to enhance professional fulfillment for childbearing residents.
Background Because operating room crises are rare events, failure to adhere to critical management steps is common. We sought to develop and pilot a tool to improve adherence to lifesaving measures ...during operating room crises. Study Design We identified 12 of the most frequently occurring operating room crises and corresponding evidence-based metrics of essential care for each (46 total process measures). We developed checklists for each crisis based on a previously defined method, which included literature review, multidisciplinary expert consultation, and simulation. After development, 2 operating room teams (11 participants) were each exposed to 8 simulations with random assignment to checklist use or working from memory alone. Each team managed 4 simulations with a checklist available and 4 without. One of the primary outcomes measured through video review was failure to adhere to essential processes of care. Participants were surveyed for perceptions of checklist use and realism of the scenarios. Results Checklist use resulted in a 6-fold reduction in failure of adherence to critical steps in management for 8 scenarios with 2 pilot teams. These results held in multivariate analysis accounting for clustering within teams and adjusting for learning or fatigue effects (11 of 46 failures without the checklist vs 2 of 46 failures with the checklist; adjusted relative risk = 0.15, 95% CI, 0.04–0.60; p = 0.007). All participants rated the overall quality of the checklists and scenarios to be higher than average or excellent. Conclusions Checklist use can improve safety and management in operating room crises. These findings warrant broader evaluation, including in clinical settings.
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