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Professional Well-being

Association of Women Surgeons’ Comprehensive Initiative for Healthy Surgical Families During Residency and Fellowship Training

To identify the key insights or developments described in this article

1 Credit CME

JAMA Surgery

Published Online: January 4, 2023

Special Communication

Article Information and Disclosures

Helen M. Johnson, MD¹;

Madeline B. Torres, MD²;

Mecker G. Möller, MD³;

Lisa Cannada, MD⁴;

Lauren B. Nosanov, MD⁵;

Andrea N. Riner, MD, MPH⁶;

Leah C. Tatebe, MD⁷;

Chantal Reyna, MD⁸;

Maria S. Altieri, MD, MS⁹

Author Affiliations

¹Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
²Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
³DeWitt Daughtry Department of Surgery, University of Miami, Miller School of Medicine, Miami, Florida
⁴University of North Carolina Department of Orthopaedics, Raleigh
⁵Department of Surgery, Weill Cornell Medicine, New York, New York
⁶Department of Surgery, University of Florida College of Medicine, Gainesville
⁷Department of Surgery, Northwestern University, Chicago, Illinois
⁸Department of Surgery, Crozer Health, Upland, Pennsylvania
⁹Department of Surgery, University of Pennsylvania, Philadelphia

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Abstract

Importance The lack of family-friendly policies continues to contribute to the underrepresentation and attrition of surgical trainees. Women in surgery face unique challenges in balancing surgical education with personal and family needs.

Observations The Association of Women Surgeons is committed to supporting surgical families and developing equitable family-friendly guidelines. Herein we detail recommendations for adequate paid parental leave, access to childcare, breastfeeding support, and insurance coverage of fertility preservation and assisted reproductive technology.

Conclusions and Relevance The specific recommendations outlined in this document form the basis of a comprehensive initiative for supporting surgical families.

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Article Information

Accepted for Publication: October 9, 2022.

Published Online: January 4, 2023. doi:10.1001/jamasurg.2022.6334

Corresponding Author: Maria S. Altieri, MD, MS, Division of GI Surgery, Penn Medicine/Pennsylvania Hospital, Philadelphia, PA 19107 (maria.altieri@pennmedicine.upenn.edu).

Author Contributions: Dr Altieri had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Johnson, Torres, Möller, Cannada, Nosanov, Tatebe, Reyna, Altieri.

Acquisition, analysis, or interpretation of data: Riner.

Drafting of the manuscript: Johnson, Torres, Möller, Cannada, Nosanov, Riner, Tatebe, Altieri.

Critical revision of the manuscript for important intellectual content: All authors.

Administrative, technical, or material support: Johnson, Torres, Cannada, Tatebe, Reyna.

Supervision: Tatebe, Reyna.

Conflict of Interest Disclosures: None reported.

Additional Information: The work was initiated by the Publications Committee of the Association of Women Surgeons and this statement was approved by the committee and the AWS Executive Committee.

References

Bamdad MC , Hughes DT , Englesbe M . Safe and supported pregnancy: a call to action for surgery chairs and program directors. Ann Surg. 2022;275(1):e1-e2. doi:10.1097/SLA.0000000000005181 PubMed Google Scholar Crossref

Phillips EA , Nimeh T , Braga J , Lerner LB . Does a surgical career affect a woman’s childbearing and fertility? a report on pregnancy and fertility trends among female surgeons. J Am Coll Surg. 2014;219(5):944-950. doi:10.1016/j.jamcollsurg.2014.07.936 PubMed Google Scholar Crossref

Rangel EL , Castillo-Angeles M , Easter SR , et al. Incidence of infertility and pregnancy complications in US female surgeons. JAMA Surg. 2021;156(10):905-915. doi:10.1001/jamasurg.2021.3301 PubMed Google Scholar Crossref

Frederiksen LE , Ernst A , Brix N , et al. Risk of adverse pregnancy outcomes at advanced maternal age. Obstet Gynecol. 2018;131(3):457-463. doi:10.1097/AOG.0000000000002504 PubMed Google Scholar Crossref

Anderson M , Goldman RH . Occupational reproductive hazards for female surgeons in the operating room: a review. JAMA Surg. 2020;155(3):243-249. doi:10.1001/jamasurg.2019.5420 PubMed Google Scholar Crossref

Rangel EL , Smink DS , Castillo-Angeles M , et al. Pregnancy and motherhood during surgical training. JAMA Surg. 2018;153(7):644-652. doi:10.1001/jamasurg.2018.0153 PubMed Google Scholar Crossref

National Conference of State Legislatures. State laws related to insurance coverage for infertility treatment. March 12, 2021. Accessed June 5, 2022, https://www.ncsl.org/research/health/insurance-coverage-for-infertility-laws.aspx

Atkinson RB , Castillo-Angeles M , Kim ES , et al. The long road to parenthood: assisted reproduction, surrogacy, and adoption among US surgeons. Ann Surg. 2022;275(1):106-114. doi:10.1097/SLA.0000000000005253 PubMed Google Scholar Crossref

Altieri MS , Pryor A , Torres MB , et al; Association for Women Surgeons Publications Committee and the Association for Women Surgeons He For She Committee. Support of pregnancy and parental leave for trainees and practicing surgeons. Am J Surg. 2022;S0002-9610(22)00502-5. doi:10.1016/j.amjsurg.2022.08.005 PubMed Google Scholar Crossref

Johnson HM , Walsh DS . Crafting an evidence-based, Accreditation Council of Graduate Medical Education–compliant lactation policy for residents and fellows. Breastfeed Med. 2020;15(1):49-55. doi:10.1089/bfm.2019.0201 PubMed Google Scholar Crossref

Shanafelt TD , Boone S , Tan L , et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-1385. doi:10.1001/archinternmed.2012.3199 PubMed Google Scholar Crossref

Altieri MS , Salles A , Bevilacqua LA , et al. Perceptions of surgery residents about parental leave during training. JAMA Surg. 2019;154(10):952-958. doi:10.1001/jamasurg.2019.2985 PubMed Google Scholar Crossref

Varda BK , Glover M IV . Specialty board leave policies for resident physicians requesting parental leave. JAMA. 2018;320(22):2374-2377. doi:10.1001/jama.2018.15889 PubMed Google Scholar Crossref

The American Board of Surgery. Leave policy—general surgery. June 2022. Accessed June 9, 2022. https://www.absurgery.org/default.jsp?policygsleave

American Board of Medical Specialties. American Board of Medical Specialties policy on parental, caregiver and medical leave during training. July 1, 2021. Accessed June 9, 2022, https://www.abms.org/policies/parental-leave/

American Board of Surgery. ABS announces more flexible family leave policy for general and vascular surgery trainees. October 21, 2021. Accessed June 9, 2022, https://www.absurgery.org/default.jsp?news_familyleave1021

Slama EM , Johnson HM , Yu YR , Sumra H , Altieri MS . Paid parental leave for surgeons in the United States. Am J Surg. 2021. PubMed Google Scholar

Stuebe A . The risks of not breastfeeding for mothers and infants. Rev Obstet Gynecol. 2009;2(4):222-231.PubMed Google Scholar

World Health Organization. Breastfeeding: recommendations. Accessed June 9, 2022. https://www.who.int/health-topics/breastfeeding#tab=tab_2

Johnson HM , Torres MB , Tatebe LC , Altieri MS ; Publications Committee of the Association of Women Surgeons. Every ounce counts: a call for comprehensive support for breastfeeding surgeons by the Association of Women Surgeons. Am J Surg. 2022;223(6):1226-1227. doi:10.1016/j.amjsurg.2021.12.037 PubMed Google Scholar Crossref

Marinelli KA , Moren K , Taylor JS ; Academy of Breastfeeding Medicine. Breastfeeding support for mothers in workplace employment or educational settings: summary statement. Breastfeed Med. 2013;8(1):137-142. doi:10.1089/bfm.2013.9999 PubMed Google Scholar Crossref

Accreditation Council for Graduate Medical Education. ACGME common program requirements (residency). February 3, 2020. Accessed June 9, 2022. https://www.acgme.org/globalassets/PFAssets/ProgramRequirements/CPRResidency2020.pdf

American Society of Anesthesiologists. Statement on lactation among anesthesia clinicians. October 13, 2021. Accessed June 9, 2022. https://www.asahq.org/standards-and-guidelines/statement-on-lactation-among-anesthesia-clinicians

Herath SC , Herath E . A surgeon, a doctor and a baby—combining parenthood with a medical career. Innov Surg Sci. 2019;4(1):31-34. doi:10.1515/iss-2018-0027 PubMed Google Scholar Crossref

Snyder RA , Bills JL , Phillips SE , Tarpley MJ , Tarpley JL . Specific interventions to increase women’s interest in surgery. J Am Coll Surg. 2008;207(6):942-947, 947.e1-947.e8. doi:10.1016/j.jamcollsurg.2008.08.017 PubMed Google Scholar Crossref

Magudia K , Ng TSC , Bick AG , et al. Parenting while in training: a comprehensive needs assessment of residents and fellows. J Grad Med Educ. 2020;12(2):162-167. doi:10.4300/JGME-D-19-00563.1 PubMed Google Scholar Crossref

Wallace CC , Edmunds RW , Bourne D , Wong L . Parenting in plastic surgery residency. Plast Reconstr Surg. 2022;149(6):1465-1469. doi:10.1097/PRS.0000000000009134 PubMed Google Scholar Crossref

Rangel EL , Castillo-Angeles M , Changala M , Haider AH , Doherty GM , Smink DS . Perspectives of pregnancy and motherhood among general surgery residents: A qualitative analysis. Am J Surg. 2018;216(4):754-759. doi:10.1016/j.amjsurg.2018.07.036 PubMed Google Scholar Crossref

Snyder RA , Tarpley MJ , Phillips SE , Terhune KP . The case for on-site child care in residency training and afterward. J Grad Med Educ. 2013;5(3):365-367. doi:10.4300/JGME-D-12-00294.1 PubMed Google Scholar Crossref

Key LL Jr . Child care supplementation: aid for residents and advantages for residency programs. J Pediatr. 2008;153(4):449-450. doi:10.1016/j.jpeds.2008.05.028 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.