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1.
Ann Surg ; 2024 Aug 07.
Artículo en Inglés | MEDLINE | ID: mdl-39109430

RESUMEN

OBJECTIVE: To describe the impact of lack of workplace support (LOWS) for obstetric health on surgeon distress and career satisfaction. BACKGROUND: Although most pregnant surgeons desire clinical duty reductions to mitigate obstetric risk, few modify their schedules due to low workplace support. METHODS: US surgeons with at least one live birth completed an electronic survey. LOWS during pregnancy was defined as (1) disagreeing that colleagues/leadership were supportive of obstetric-mandated bedrest; (2) feeling unable to reduce clinical duties despite health concerns due to risk of financial penalties, requirement to make up missed call shifts, being perceived as "weak", burdening colleagues, or accommodations being denied by the workplace. Multivariate logistic regression determined the association between LOWS and burnout, low quality of life, plans to leave clinical practice or to reduce work hours, and likelihood of recommending a surgical career to one's child. RESULTS: Of 557 surgeons, the 360 (64.6%) who reported LOWS during pregnancy were more likely to report burnout (OR:2.57; 95%CI:1.60-4.13), low quality of life (OR:1.57; 95%CI:1.02-2.41), a desire to leave their practice (OR:2.74; 95%CI: 1.36-5.49), plans to reduce clinical hours in the next year (OR:4.25; 95%CI:1.82-9.90), and were less likely to recommend their career to their child (OR:0.44; 95%CI:0.28-0.70). CONCLUSIONS: LOWS for maternal-fetal health concerns is associated with burnout, low quality of life, and career dissatisfaction. The work environment is a modifiable factor requiring system-level interventions to limit clinical work during pregnancy and provide fair compensation for covering surgeons. Supporting surgeons during pregnancy is a short-term investment with long-term implications for improving longevity and diversity of the workforce.

2.
Ann Surg ; 277(6): 938-943, 2023 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-35837953

RESUMEN

OBJECTIVE: This study aimed to investigate the transparency of parental benefits available to US surgical residency applicants. BACKGROUND: Medical students prioritize work-family balance in specialty selection. Those applying to surgical residency programs also place a significant value on parental leave policies when deciding where to train. However, little is known about the amount of information that surgical training programs publicly offer to potential applicants regarding family support policies. METHODS: Publicly available websites for 264 general surgery training programs were accessed to determine the availability of information on parental benefits. Twenty-six "items of transparency" included types of leave, contract flexibility, salary, lactation, and childcare support. Programs with fewer than the median items of transparency were contacted to inquire about additional public resources. Academic programs were stratified by their associated medical school rankings in the US News & World Report. RESULTS: A total of 144 (54%) programs were academic and 214 (81.4%) had male program directors. The median number of items of transparency was 8 (29.6%). Of the 131 programs contacted, 33 (25.9%) replied, and 2 (6.1%) improved their transparency score. Academic programs associated with medical schools in the upper third of the rankings were more likely to have ≥8 items of transparency (70.8% vs. 45.6%; P =0.002). In the adjusted analysis, academic programs [odds ratio (OR): 3.44, 95% confidence interval (95% CI): 1.87-6.34], those with female program directors (OR: 2.09, 95% CI: 1.01-4.33), and those located in the Western (OR: 3.13, 95% CI: 1.31-7.45) and Southern (OR: 2.45, 95% CI: 1.21-4.98) regions of the country were more likely to have ≥8 items of transparency. CONCLUSIONS: There are significant deficits in publicly available information related to parental benefits for many surgical training programs, which may impact applicants' decision making. Attracting the most talented candidates requires programs to create and share policies that support the integration of professional and personal success.


Asunto(s)
Internado y Residencia , Humanos , Masculino , Femenino , Políticas , Lactancia Materna , Empleo , Padres , Permiso Parental
3.
Ann Surg ; 277(3): 367-372, 2023 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-36250327

RESUMEN

OBJECTIVE: This survey study aims to determine the prevalence of pregnancy complications and infertility in female physicians in comparison to the general population. Risk factors, workplace environment, and education are also examined. BACKGROUND: Physicians undertake long training and have stressful work environments during optimal childbearing years. While growing literature indicates increased rates of pregnancy complications and infertility in female surgeons, the prevalence in female physicians of all specialties is unknown. METHODS: An anonymous, voluntary survey was distributed to female physicians via private physician social media groups. It queried pregnancy demographics and complications, infertility diagnosis and treatment, workplace environment, and prior education on these topics. Results were compared with general population data, between medical and surgical subspecialties, and between physicians who were and were not educated on the risks of delaying pregnancy. RESULTS: A total of 4533 female physicians completed the survey. Compared with the general population, female physicians were older at first pregnancy, more often underwent infertility evaluation and treatment, and had higher rates of miscarriage and preterm birth. During training, only 8% of those surveyed received education on the risks of delaying pregnancy. Those who were educated were significantly less likely to experience miscarriage or seek infertility evaluation or treatment. Compared with physicians in nonsurgical specialties, surgeons had fewer children, were older at first pregnancy, had more preterm births and fetal growth problems, and were more likely to be discouraged from starting a family during training and practice. CONCLUSIONS: Female physicians, particularly surgeons, have a significantly greater incidence of miscarriage, infertility, and pregnancy complications compared with the general population. The culture of medicine and surgery must continue to evolve to better support women with family planning during their training and careers.


Asunto(s)
Aborto Espontáneo , Infertilidad Femenina , Infertilidad , Complicaciones del Embarazo , Nacimiento Prematuro , Cirujanos , Embarazo , Niño , Femenino , Recién Nacido , Humanos , Infertilidad/complicaciones , Complicaciones del Embarazo/epidemiología , Infertilidad Femenina/epidemiología , Infertilidad Femenina/etiología , Infertilidad Femenina/terapia
4.
J Surg Res ; 288: A1-A8, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-37055286

RESUMEN

Although surgical training programs have nearly reached gender parity, pregnancy and parenthood remain challenging for female surgeons, with obstetric risks related to occupational demands, stigma, inconsistent and brief parental leaves, a paucity of postpartum support for lactation and childcare, and little mentorship on work-family integration. This work environment causes many to postpone starting a family, which leads to higher risks of infertility among female surgeons compared to their male peers. Perception of work-family incompatibility jeopardizes recruitment and retention of our surgical workforce, as it deters medical students from the profession, increases risk of resident attrition, and leads to burnout and career dissatisfaction. The challenges of parenthood for female surgeons was the focus of a Hot Topics session during the 2022 Academic Surgical Congress, the discussion of which is presented herein with recommendations for policy change to better support maternal-fetal health and the needs of surgeons with young children.


Asunto(s)
Agotamiento Profesional , Cirujanos , Embarazo , Niño , Humanos , Masculino , Femenino , Preescolar , Padres , Estigma Social , Actitud del Personal de Salud , Encuestas y Cuestionarios
5.
Ann Surg ; 276(3): 491-499, 2022 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-35758469

RESUMEN

OBJECTIVE: We sought to assess whether lack of workplace support for clinical work reductions during pregnancy was associated with major pregnancy complications. BACKGROUND: Surgeons are at high risk of major pregnancy complications. Although rigorous operative schedules pose increased risk, few reduce their clinical duties during pregnancy. METHODS: An electronic survey was distributed to US surgeons who had at least 1 live birth. Lack of workplace support was defined as: (1) desiring but feeling unable to reduce clinical duties during pregnancy due to failure of the workplace/training program to accommodate and/or concerns about financial penalties, burden on colleagues, requirement to make up missed call, being perceived as weak; (2) disagreeing colleagues and/or leadership were supportive of obstetrician-prescribed bedrest. Multivariate logistic regression determined the association between lack of workplace support and major pregnancy complications. RESULTS: Of 671 surgeons, 437 (65.13%) reported lack of workplace support during pregnancy and 302 (45.01%) experienced major pregnancy complications. Surgeons without workplace support were at higher risk of major pregnancy complications than those who had workplace support (odds ratio: 2.44; 95% confidence interval: 1.58-3.75). Bedrest was prescribed to 110/671 (16.39%) surgeons, 38 (34.55%) of whom disagreed that colleagues and/or leadership were supportive. Of the remaining surgeons, 417/560 (74.5%) desired work reductions but were deterred by lack of workplace support. CONCLUSIONS: Lack of workplace support for reduction in clinical duties is associated with adverse obstetric outcomes for surgeons. This is a modifiable workplace obstacle that deters surgeons from acting to optimize their infant's and their own health. To ensure the health of expectant surgeons, departmental policies should support reduction of clinical workload in an equitable manner without creating financial penalties, requiring payback for missed call duties, or overburdening colleagues.


Asunto(s)
Complicaciones del Embarazo , Cirujanos , Emociones , Femenino , Humanos , Embarazo , Complicaciones del Embarazo/epidemiología , Encuestas y Cuestionarios , Lugar de Trabajo
6.
Ann Surg ; 275(1): 106-114, 2022 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-34914662

RESUMEN

OBJECTIVE: We sought to characterize demographics, costs, and workplace support for surgeons using assisted reproductive technology (ART), adoption, and surrogacy to build their families. SUMMARY BACKGROUND DATA: As the surgical workforce diversifies, the needs of surgeons building a family are changing. ART, adoption, and surrogacy may be used with greater frequency among female surgeons who delay childbearing and surgeons in same-sex relationships. Little is known about costs and workplace support for these endeavors. METHODS: An electronic survey was distributed to surgeons through surgical societies and social media. Rates of ART use were compared between partners of male surgeons and female surgeons and multivariate analysis used to assess risk factors. Surgeons using ART, adoption, or surrogacy were asked to describe costs and time off work to pursue these options. RESULTS: Eight hundred and fifty-nine surgeons participated. Compared to male surgeons, female surgeons were more likely to report delaying children due to surgical training (64.9% vs. 43.5%, P < 0.001), have fewer children (1.9 vs. 2.4, p < 0.001), and use ART (25.2% vs. 17.4%, P = 0.035). Compared to non-surgeon partners of male surgeons, female surgeons were older at first pregnancy (33 vs 31 years, P < 0.001) with age > 35 years associated with greater odds of ART use (odds ratio 3.90; 95% confidence interval 2.74-5.55, P < 0.001). One-third of surgeons using ART spent >$40,000; most took minimal time off work for treatments. Forty-five percent of same-sex couples used adoption or surrogacy. 60% of surgeons using adoption or surrogacy spent >$40,000 and most took minimal paid parental leave. CONCLUSIONS: ART, adoption, or surrogacy is costly and lacks strong workplace support in surgery, disproportionately impacting women and same-sex couples. Equitable and inclusive environments supporting all routes to parenthood ensure recruitment and retention of a diverse workforce. Surgical leaders must enact policies and practices to normalize childbearing as part of an early surgical career, including financial support and equitable parental leave for a growing group of surgeons pursuing ART, surrogacy, or adoption to become parents.


Asunto(s)
Adopción , Técnicas Reproductivas Asistidas , Cirujanos/psicología , Madres Sustitutas , Factores de Edad , Costos y Análisis de Costo , Femenino , Humanos , Infertilidad Femenina , Infertilidad Masculina , Masculino , Permiso Parental/economía , Técnicas Reproductivas Asistidas/economía , Minorías Sexuales y de Género , Padres Solteros , Encuestas y Cuestionarios
7.
J Surg Res ; 276: 31-36, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-35334381

RESUMEN

INTRODUCTION: Necrotizing soft tissue infections (NSTIs) are surgical emergencies associated with high morbidity and mortality. Identifying risk factors for poor outcome is a critical part of preoperative decision-making and counseling. Sarcopenia, the loss of lean muscle mass, has been associated with an increased risk of mortality and can be measured using cross-sectional imaging. Our aim was to determine the impact of sarcopenia on mortality in patients with NSTI. We hypothesized that sarcopenia would be associated with an increased risk of mortality in patients with NSTI. METHODS: This is a retrospective cohort study of NSTI patients admitted from 1995 to 2015 to two academic institutions. Operative and pathology reports were reviewed to confirm the diagnosis in all cases. Average bilateral psoas muscle cross-sectional area at L4, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography (CT). Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was in-hospital mortality. Multivariate logistic regression was performed to assess the association between sarcopenia and in-hospital mortality. RESULTS: There were 115 patients with preoperative imaging, 61% male and a median age of 57 y interquartile range (IQR 46.6-67.0). Overall in-hospital mortality was 12.1%. There was no significant difference in sex, body mass index (BMI), comorbidities and American Society of Anesthesiologists classification (Table 1). After multivariate analysis, sarcopenia was independently associated with increased in-hospital mortality (Odds ratio, 3.5; 95% Confidence Interval [CI], 1.05-11.8). CONCLUSIONS: Sarcopenia is associated with increased risk of in-hospital mortality in patients with NSTIs. Sarcopenia identifies patients with higher likelihood of poor outcomes, which can possibly help surgeons in counseling their patients and families.


Asunto(s)
Sarcopenia , Infecciones de los Tejidos Blandos , Femenino , Humanos , Masculino , Músculos Psoas/diagnóstico por imagen , Músculos Psoas/patología , Estudios Retrospectivos , Factores de Riesgo , Sarcopenia/complicaciones , Sarcopenia/diagnóstico por imagen , Infecciones de los Tejidos Blandos/complicaciones , Infecciones de los Tejidos Blandos/patología
10.
Am Surg ; 90(4): 494-501, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-37975740

RESUMEN

BACKGROUND: Long years of school/training have shown to be associated with infertility and pregnancy complications. Rates of infertility and pregnancy complications were compared among women in demanding professional careers to better understand career differences impacting family planning. METHODS: Inclusion criteria : English-speaking, childbearing professional women in surgery, medicine, law, and engineering. Exclusion criteria: men and women not in professional careers mentioned and non-childbearing women. Male-dominated fields identified to select non-medical female professionals. Top medical, law, and engineering schools' female faculty were surveyed from October 2022 to December 2022. Descriptive analysis and chi-squared tests were performed. RESULTS: 2302 surveys were distributed and 268 responses were obtained (11.6%): 121 non-surgeon physicians, 120 lawyers/other doctorate degree holders, and 27 other/unknown. Data analysis included prior study's surgeon data. The median age (IQR = 25%, 75%) of the surgeons was 40y (36,45), non-surgeon physicians 43y (37,50), and law/other doctorates 38y (35,46). Delayed childbearing was observed in 65.0% surgeons, 66.1% non-surgeon physicians, and 57.5% law/other doctorates (P < .001). Pregnancy loss <10wks was observed in 35.3% surgeons, 33.9% non-surgeon physicians, and 30.8% law/other doctorates (P < .001). Infertility testing was performed in 43.0% non-surgeon physicians and 34.2% law/other doctorates (P < .001). Assisted reproductive technology was utilized by 24.9% surgeons, 43.0% non-surgeon physicians, and 21.7% law/other doctorates (P < .001). DISCUSSION: Surgeons/physicians suffer more childbearing complications than other professional women.


Asunto(s)
Infertilidad , Medicina , Complicaciones del Embarazo , Cirujanos , Embarazo , Humanos , Femenino , Masculino , Instituciones Académicas
11.
JAMA Surg ; 2024 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-39018050

RESUMEN

Importance: The ability to pursue family planning goals is integral to gender equity in any field. Procedural specialties pose occupational risks to pregnancy. As the largest procedural specialty, general surgery provides an opportunity to understand family planning, workplace support for parenthood, obstetric outcomes, and the impact of these factors on workforce well-being, gender equity, and attrition. Objective: To examine pregnancy and parenthood experiences, including mistreatment and obstetric outcomes, among a cohort of US general surgical residents. Design, Setting, and Participants: This cohort study involved a cross-sectional national survey of general surgery residents in all programs accredited by the Accreditation Council for Graduate Medical Education after the 2021 American Board of Surgery In-Training Examination. Female respondents who reported a pregnancy and male respondents whose partners were pregnant during clinical training were queried about pregnancy- and parenthood-based mistreatment, obstetric outcomes, and current well-being (burnout, thoughts of attrition, suicidality). Main Outcomes and Measures: Primary outcomes included obstetric complications and postpartum depression compared between female residents and partners of male residents. Secondary outcomes included perceptions about support for family planning, pregnancy, or parenthood; assisted reproductive technology use; pregnancy/parenthood-based mistreatment; neonatal complications; and well-being, compared between female and male residents. Results: A total of 5692 residents from 325 US general surgery programs participated (81.2% response rate). Among them, 957 residents (16.8%) reported a pregnancy during clinical training (692/3097 [22.3%] male vs 265/2595 [10.2%] female; P < .001). Compared with male residents, female residents more frequently delayed having children because of training (1201/2568 [46.8%] females vs 1006/3072 [32.7%] males; P < .001) and experienced pregnancy/parenthood-based mistreatment (132 [58.1%] females vs 179 [30.5%] males; P < .001). Compared with partners of male residents, female residents were more likely to experience obstetric complications (odds ratio [OR], 1.42; 95% CI, 1.04-1.96) and postpartum depression (OR, 1.63; 95% CI, 1.11-2.40). Pregnancy/parenthood-based mistreatment was associated with increased burnout (OR, 2.03; 95% CI, 1.48-2.78) and thoughts of attrition (OR, 2.50; 95% CI, 1.61-3.88). Postpartum depression, whether in female residents or partners of male residents, was associated with resident burnout (OR, 1.93; 95% CI, 1.27-2.92), thoughts of attrition (OR, 2.32; 95% CI, 1.36-3.96), and suicidality (OR, 5.58; 95% CI, 2.59-11.99). Conclusions and Relevance: This study found that pregnancy/parenthood-based mistreatment, obstetric complications, and postpartum depression were associated with female gender, likely driving gendered attrition. Systematic change is needed to protect maternal-fetal health and advance gender equity in procedural fields.

12.
Abdom Radiol (NY) ; 48(2): 796-805, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36383241

RESUMEN

BACKGROUND: Risk stratification is challenging in the growing population of geriatric patients requiring emergency surgery. Sarcopenia, which assesses muscle bulk, is a surrogate for frailty and predicts 1-year mortality, but does not incorporate potentially valuable additional information about muscle quality. OBJECTIVE: To describe five different CT methods of measuring sarcopenia and muscle quality and to determine which method has the greatest sensitivity for predicting 1-year mortality following emergency abdominal surgery in elderly patients. METHODS: This retrospective study includes 297 patients 70 years and older who underwent "urgent" or "emergent" laparotomy or laparoscopy for acute abdominal disease between 2006 and 2011 at a single quaternary academic medical center. All patients received a CT abdomen and pelvis with intravenous contrast within 1 month of surgery. Five different methods were applied to the psoas muscles on CT: method 1 (total psoas index TPI, which is total psoas area TPA normalized by height), method 2 ("pseudoarea" = anterior-posterior × transverse dimensions), method 3 (average HU), method 4 (TPA × HU), and method 5 ("pseudoarea" × HU). RESULTS: For all five CT measures, mortality was greatest for the lowest quartile by univariate and adjusted Cox proportional hazard analyses at all time points up to 1-year. The C-statistic was highest for Method 4, using a composite index of TPA and Hounsfield Units, indicating the greatest predictive ability to estimate mortality at all time points. CONCLUSION: Muscle quality and muscle size can be used in tandem to refine risk assessment of older patients undergoing emergency abdominal surgery. Routine calculation of the composite score of psoas cross-sectional area and HU in the emergency room setting may provide surgeons and patients valuable insight on the risk of 1-year mortality to guide preoperative decision-making and counseling. CLINICAL IMPACT: Muscle quality and size, both strong independent predictors of surgical outcomes in older patients undergoing emergency abdominal surgery, may be used in tandem to refine risk assessment. A composite score of psoas muscle cross-sectional area and Hounsfield units on CT may provide insight on 1-year mortality in this patient population.


Asunto(s)
Sarcopenia , Humanos , Anciano , Proyectos Piloto , Estudios Retrospectivos , Factores de Riesgo , Sarcopenia/diagnóstico por imagen , Sarcopenia/epidemiología , Abdomen/cirugía , Tomografía
13.
J Surg Educ ; 80(6): 817-825, 2023 06.
Artículo en Inglés | MEDLINE | ID: mdl-36973156

RESUMEN

OBJECTIVE: Improvements to the medical student surgical learning environment are limited by lack of granular data and recall bias on end-of-clerkship evaluations. The purpose of this study was to identify specific areas for intervention using a novel real-time mobile application. DESIGN: An application was designed to obtain real-time feedback from medical students regarding the learning environment on their surgical clerkship. Thematic analysis of student experiences was performed at the conclusion of 4 consecutive 12-week rotation blocks. SETTING: Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts. RESULTS: Fifty-four medical students at a single institution were asked to participate during their primary clerkship experience. Students submitted 365 responses over 48 weeks. Multiple themes emerged which were dichotomized into positive and negative emotions centered on specific student priorities. Approximately half of responses were associated with positive emotions (52.9%) and half with negative emotions (47.1%). Student priorities included the desire to feel included in the surgical team (resulting in feeling engaged/ignored), to have a positive relationship with members of the team (perceiving kind/rude interactions), to witness compassionate patient care (observing empathy/disrespect for patients), to have a well-planned surgical rotation (experiencing organization/disorganization within teams), and to feel that student well-being is prioritized (reporting opportunities/disregard for student wellness). CONCLUSION: A novel, user-friendly mobile application identified several areas to improve the experience and engagement of students on their surgery clerkship. Allowing clerkship directors and other educational leaders to collect longitudinal data in real time may allow for more targeted, timely improvements to the medical student surgical learning environment.


Asunto(s)
Aplicaciones Móviles , Estudiantes de Medicina , Femenino , Humanos , Prácticas Clínicas/métodos , Educación de Pregrado en Medicina/métodos , Retroalimentación , Estudiantes de Medicina/psicología , Cirugía General/educación
14.
JAMA Surg ; 157(2): 105-111, 2022 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-34851404

RESUMEN

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.


Asunto(s)
Actitud del Personal de Salud , Docentes Médicos/psicología , Cirugía General/educación , Permiso Parental , Femenino , Humanos , Internado y Residencia , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Política Organizacional , Investigación Cualitativa , Estados Unidos
15.
J Surg Educ ; 79(6): e85-e91, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35595628

RESUMEN

OBJECTIVE: Recent literature on parental leave during residency has focused on the importance of supporting new mothers, but the needs and challenges faced by expectant nonchildbearing residents are less well described. Male residents are more likely than their female counterparts to have children during surgical training, and they experience similar stressors including childcare and conflicts between work and home priorities. As nonchildbearing parents of this generation become more involved in childrearing, the need to establish inclusive parental leave policies is essential. The aim of this study was to provide a deeper understanding of the perspectives of male residents about parental leave. DESIGN: A semi-structured interview guide was developed using a literature search and an expert panel. Interviews were audio-recorded and transcribed verbatim and emergent themes were identified using content analysis. SETTING: Four academic institutions. PARTICIPANTS: Four focus groups were held with of a total of 15 male resident-parents. These were selected using convenience sampling. RESULTS: Multiple themes emerged: 1) male residents perceive greater stigma attached to taking leave compared to female colleagues; 2) paternity leave policies are vague and sometimes non-existent; 3) male residents experience a high burden of guilt related to burdening peers with clinical coverage while on leave; 4) male residents face internal conflict between surgical and parental responsibilities; 5) male residents have little mentorship on successful work-life integration and feel compelled to model the behavior of their attendings who often prioritize career before family; and 6) shifts in family values and priorities are common following childbirth and impact how male resident-parents view other new parents in training. CONCLUSIONS: Significant challenges exist for residents who become fathers during their surgical training. Key stressors include poorly defined leave policies, historic paradigms of prioritizing professional duties before personal duties, stigma against taking time off for parental bonding in the absence of medical need, and guilt related to extra work imposed on colleagues by time away. Establishment of formal parental leave policies for both genders, programmatic support to offset the increased workload on colleagues, and greater mentorship on balancing family and career are needed to foster a culture of work-life integration.


Asunto(s)
Internado y Residencia , Permiso Parental , Humanos , Niño , Femenino , Masculino , Carga de Trabajo , Relaciones Familiares
16.
J Surg Educ ; 79(6): e92-e102, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35842402

RESUMEN

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.


Asunto(s)
Aborto Espontáneo , Internado y Residencia , Humanos , Embarazo , Lactante , Femenino , Adulto , Permiso Parental , Admisión y Programación de Personal , Encuestas y Cuestionarios
17.
J Am Coll Surg ; 234(6): 1051-1061, 2022 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-35703796

RESUMEN

BACKGROUND: Postpartum depression has well-established long-term adverse effects on maternal and infant health. Surgeons with rigorous operative schedules are at higher risk of obstetric complications, but they rarely reduce their workload during pregnancy. We evaluated whether lack of workplace support for work reductions during difficult pregnancies or after neonatal complications is associated with surgeon postpartum depression. STUDY DESIGN: An electronic survey was sent to practicing and resident surgeons of both sexes in the US. Female surgeons who had at least one live birth were included. Lack of workplace support was defined as: (1) disagreeing that colleagues/leadership were supportive of obstetric-mandated bedrest or time off to care for an infant in the neonatal intensive care unit; (2) feeling unable to reduce clinical duties during pregnancy despite health concerns or to care for an infant in the neonatal intensive care unit. Multivariate logistic regression was used to determine the association of lack of workplace support with postpartum depression. RESULTS: Six hundred ninety-two surgeons were included. The 441 (63.7%) respondents who perceived a lack of workplace support had a higher risk of postpartum depression than those who did not perceive a lack of workplace support (odds ratio 2.21, 95% CI 1.09 to 4.46), controlling for age, race, career stage, and pregnancy/neonatal complications. Of the surgeons with obstetric-related work restrictions, 22.6% experienced loss of income and 38.5% reported >$50,000 loss. CONCLUSION: Lack of workplace support for surgeons with obstetric or neonatal health concerns is associated with a higher risk of postpartum depression. Institutional policies must address the needs of surgeons facing difficult pregnancies to improve mental health outcomes and promote career longevity.


Asunto(s)
Depresión Posparto , Complicaciones del Embarazo , Cirujanos , Depresión Posparto/epidemiología , Depresión Posparto/etiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Embarazo , Lugar de Trabajo
18.
JAMA Surg ; 156(7): 647-653, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-34009280

RESUMEN

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.


Asunto(s)
Actitud del Personal de Salud , Cirugía General/educación , Internado y Residencia , Cultura Organizacional , Política Organizacional , Permiso Parental , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posparto , Embarazo , Estados Unidos
19.
JAMA Surg ; 156(10): 905-915, 2021 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-34319353

RESUMEN

Importance: While surgeons often delay pregnancy and childbearing because of training and establishing early careers, little is known about risks of infertility and pregnancy complications among female surgeons. Objective: To describe the incidence of infertility and pregnancy complications among female surgeons in the US and to identify workplace factors associated with increased risk compared with a sociodemographically similar nonsurgeon population. Design, Setting, and Participants: This self-administered survey questionnaire was electronically distributed and collected from November 2020 to January 2021 through multiple surgical societies in the US and social media among male and female attending and resident surgeons with children. Nonchildbearing surgeons were asked to answer questions regarding the pregnancies of their nonsurgeon partners as applicable. Exposures: Surgical profession; work, operative, and overnight call schedules. Main Outcomes and Measures: Descriptive data on pregnancy loss were collected for female surgeons. Use of assisted reproductive technology was compared between male and female surgeons. Pregnancy and neonatal complications were compared between female surgeons and female nonsurgeon partners of surgeons. Results: A total of 850 surgeons (692 women and 158 men) were included in this survey study. Female surgeons with female partners were excluded because of lack of clarity about who carried the pregnancy. Because the included nonchildbearing population was therefore made up of male individuals with female partners, this group is referred to throughout the study as male surgeons. The median (IQR) age was 40 (36-45) years. Of 692 female surgeons surveyed, 290 (42.0%) had a pregnancy loss, more than twice the rate of the general population. Compared with male surgeons, female surgeons had fewer children (mean [SD], 1.8 [0.8] vs 2.3 [1.1]; P < .001), were more likely to delay having children because of surgical training (450 of 692 [65.0%] vs 69 of 158 [43.7%]; P < .001), and were more likely to use assisted reproductive technology (172 of 692 [24.9%] vs 27 of 158 [17.1%]; P = .04). Compared with female nonsurgeon partners, female surgeons were more likely to have major pregnancy complications (311 of 692 [48.3%] vs 43 of 158 [27.2%]; P < .001), which was significant after controlling for age, work hours, in vitro fertilization use, and multiple gestation (odds ratio [OR], 1.72; 95% CI, 1.11-2.66). Female surgeons operating 12 or more hours per week during the last trimester of pregnancy were at higher risk of major pregnancy complications compared with those operating less than 12 hours per week (OR, 1.57; 95% CI, 1.08-2.26). Compared with female nonsurgeon partners, female surgeons were more likely to have musculoskeletal disorders (255 of 692 [36.9%] vs 29 of 158 [18.4%]; P < .001), nonelective cesarean delivery (170 of 692 [25.5%] vs 24 of 158 [15.3%]; P = .01), and postpartum depression (77 of 692 [11.1%] vs 9 of 158 [5.7%]; P = .04). Conclusions and Relevance: This national survey study highlighted increased medical risks of infertility and pregnancy complications among female surgeons. With an increasing percentage of women representing the surgical workforce, changing surgical culture to support pregnancy is paramount to reducing the risk of major pregnancy complications, use of fertility interventions, or involuntary childlessness because of delayed attempts at childbearing.


Asunto(s)
Infertilidad Femenina/epidemiología , Médicos Mujeres/estadística & datos numéricos , Complicaciones del Embarazo/epidemiología , Cirujanos/estadística & datos numéricos , Adulto , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Embarazo , Técnicas Reproductivas Asistidas , Factores de Riesgo , Estados Unidos , Lugar de Trabajo
20.
J Trauma ; 69(1): 20-5, 2010 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-20622574

RESUMEN

BACKGROUND: While disparities in abuse-related mortality between minority and white infants have been reported, the influence of socioeconomic status on outcome has not been evaluated. The goal of this study was to determine the impact of socioeconomic status and race on outcomes for abused infants using multiinstitutional data. METHODS: Data on infants (<12 months old) with abusive injuries over a 5-year period were obtained from nine U.S. pediatric trauma centers. Demographics, insurance status, Injury Severity Scores, Glasgow Coma Scale scores, median household income and outcomes were recorded. Logistic regression was used to evaluate the impact of race, income and insurance status on mortality. RESULTS: There were 867 patients identified with a mortality of 8.8%. Patients without private insurance had a 3.8 times greater odds (give 95% confidence interval) of dying. Those in the lower three quartiles of income also had a higher odds of death even after controlling for race, injury severity, and Glasgow Coma Scale. Although African American infants had a higher overall mortality than whites (11.2% vs. 7.8%, p = 0.14), race was not an independent predictor of mortality (p = 0.98). CONCLUSIONS: There are significant differences in mortality among abused infants associated with insurance status and income even after controlling for injury severity. These associations show a need to better understand and address socioeconomic variations in outcome.


Asunto(s)
Maltrato a los Niños/mortalidad , Disparidades en Atención de Salud/estadística & datos numéricos , Factores Socioeconómicos , Maltrato a los Niños/estadística & datos numéricos , Escala de Coma de Glasgow/estadística & datos numéricos , Humanos , Renta/estadística & datos numéricos , Lactante , Puntaje de Gravedad del Traumatismo , Seguro de Salud/estadística & datos numéricos , Modelos Logísticos , Pacientes no Asegurados/estadística & datos numéricos , Oportunidad Relativa , Grupos Raciales/estadística & datos numéricos , Centros Traumatológicos/estadística & datos numéricos , Resultado del Tratamiento , Estados Unidos/epidemiología , Heridas y Lesiones/mortalidad
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