Abstract
Objective:
Our aim was to better understand attitudes towards parental leave from the perspective of both surgeon faculty and current surgical trainees. We hypothesized that support for trainees to take parental leave would vary by year of residency graduation and by parental status.
Design:
We conducted a web-based survey regarding opinions on trainee parental leave. Quantitative and conventional content qualitative analyses were performed.
Participants:
Surveys were sent to surgeon faculty and current trainees from five large academic surgical residency programs.
Results:
Survey response rates were 11.5% for surgeon faculty (68/589), and 17.7% for trainees (50/281). There were 80/118 (67.8%) respondents who reported they had or were currently expecting children, 40/80 (50%) of whom were the gestational carrier. Most thought that 6–12 weeks of parental leave should be given to child-bearing trainees (62/118, 52.5%); another 32.2% (38/118) thought >12 weeks should be given. Responses were similar amongst surgeon faculty and trainees, parents and non-parents, and respondents who identified as men and women. Qualitative analysis revealed that most respondents felt parental leave did not put unreasonable strain on other trainees and felt support could be shown both informally and with formal written policies facilitating patient care coverage. Current surgeon faculty were less likely to feel moderately/extremely supported by their faculty compared to trainees (39 vs 77%, p=0.004). Less than a third (37/117, 31.6%) of respondents knew the current leave policies.
Conclusions:
Amongst survey respondents, there was broad support for parental leave for surgical trainees of at least 6 weeks amongst trainees and faculty, and those with and without children. Current trainees felt more supported than current surgical faculty, suggesting that parental leave is increasingly more accepted. Support can be shown both informally and through easily accessible written policies and procedures that facilitate patient care coverage.
Keywords: General Surgery Residency, Parental Leave, Family Medical Leave, Women in Surgery
Introduction:
Surgical training often coincides with the time in trainees lives when they wish to begin childbearing/rearing.1 National organizations who govern surgical training including the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Surgery (ABS) have recently made changes to their policies to support trainees during pregnancy and early parenthood.2–6 These include six weeks of paid family medical leave, now mandated by the ACGME, and an ABS policy that allows for an additional four weeks off, up to two times during general surgery residency without the need to extend training or reduce vacation/conference/interview time (Table 1). Surgical training programs must balance the need to train competent surgeons with the need to support healthy pregnancies of their trainees without placing undue burden on others within the training program and provides safe patient care. Due to these competing interests, time off for parental leave remains a controversial topic in surgical training. Our aim was to better understand attitudes towards parental leave from the perspective of both surgeon faculty and current surgical trainees to determine how these opinions varied with surgeon level characteristics including timing of completion of training, parental status, and timing of childbearing/rearing relative to completion of surgical training. We hypothesized that support for trainees to take parental leave would be higher among current trainees and recent graduates than among those who completed training more than ten years ago.
Table 1.
Parental leave policies of the Accreditation Council for Graduate Medical Education (ACGME), American Board of Surgery (ABS), American Board of Plastic Surgery, and American Board of Thoracic Surgery, with date of policy creation
| Accrediting Body | Parental Leave Policy | Clinical Weeks Policy |
|---|---|---|
| ACGME (7/1/22)6 (https://www.acgme.org/newsroom/blog/2022/acgme-answers-resident-leave-policies/) | Minimum 6 weeks of 100% paid parental leave; minimum 1 week of paid leave for use outside of the first 6 weeks | |
| ABS General Surgery (6/1/22)2 (https://www.absurgery.org/resources/abs-policies/policy-leave/) | 4 weeks of documented leave during the first 3 years, and 4 weeks of documented leave during the last 2 years to care for a new child | 140 weeks first three years and 92 weeks last 2 years, minimum of 48 weeks chief rotations, OR averaging 48 weeks /year over the first 3 years and last 2 years, OR extending chief year through the end of August, OR 5 years of training over 6 years |
| ABS Vascular Surgery (6/1/22)3 Integrated (https://www.absurgery.org/resources/abs-policies/policy-leave-vascular/) | 4 weeks of documented leave twice during training to care for a new child | 140 weeks first 3 years and 92 weeks last 2 years, OR averaging 48 weeks /year over the first 3 years and last 2 years, OR extending chief year through the end of August, OR 5 years of training over 6 years |
| American Board of Plastic Surgery (5/2023)5 (https://www.abplasticsurgery.org/programdirectors/reference-forprogram-directors/) | Optional 12 weeks of personal leave (including to care for a new child), no more 4 weeks during the last 3 months of training | 48 clinical weeks per year averaged over the duration of training |
| American Board of Thoracic Surgery (2/25/22)4 (http://www.abts.org/ABTS/CertificationWebPages/Leave_of_Absence_Policy_2022.aspx#:~:text=Pathway%20Three%20candidates%20(I%2D6,parent%20with%20a%20serious%20health) | Eligible for 12 weeks of parental leave, may be taken at any time except used entirely in the last 3 months. If leave occurs in last 12 months, need 12 of last 18 months with senior-level responsibility. |
Materials and Methods:
Study overview and survey development
We conducted a web-based survey of surgical faculty and current surgical trainees enrolled in an ACGME accredited training program in general surgery, integrated plastic surgery, integrated cardiothoracic surgery, and integrated vascular surgery and the faculty surgeons (surgeons who had completed training) of those training programs at five medical schools across the US including the University of Colorado, University of Michigan, University of Southern California, Oregon Health and Sciences University, and the University of Utah from November 2021 to February 2023. Due to the method of distribution utilizing institutional listservs, which were known to contain duplicate recipients and recipients that may have not been eligible for participation, the survey response rate was estimated based on the number of faculty and residents at each institution. The survey was adapted from a previously utilized survey instrument7 and was revised to address the current aims. We conducted a multi-step survey development process that began with a literature review and interviews with members of the study team (NC, SA, JR) as well as the author of the original survey. Testing and subsequent revision of the survey was performed by the study team, including members with formal training in survey development (SA). The survey was designed to measure the following constructs related to parental leave during surgical training: 1) knowledge of current national and local policies regarding parental leave, 2) personal experiences of parental leave before, during, or after surgical training, 3) attitudes towards parental leave during formal surgical training. Cognitive pre-testing was not performed due to the expected cognitive abilities of the surveyed participants. Following survey development, the instrument was piloted by five surgeon faculty to ensure adequate response variation and functionality of the survey tool. This survey was developed as per prior published guidelines and reported following Consensus-Based Checklist for Reporting of Survey Studies guidelines.8,9 The final survey consisted of 37 questions and took less than 10 minutes to complete. This included five open ended questions which asked respondents to expand upon answers to closed-ended questions. The full survey instrument can be found in the Supplement.
Survey population and administration
Survey invitations were sent to all eligible faculty and trainees at each participating site by the collaborating surgeon at that site. An invitation and two subsequent reminders were sent via email at two-week intervals. No incentives were offered. Study data were collected and managed using the REDCap tools hosted at the University of Colorado.10,11 REDCap is a secure, web-based application designed to support data capture for research studies. A statement of confidentiality and anonymity was included in the invitation email. This study was reviewed by the Colorado Multiple Institutional Review Board and deemed exempt. Consent was presumed with completion of the survey.
Data Analysis
Quantitative Data
Four separate analyses were performed to assess differences in attitudes towards parental leave among different groups of surgeons. The first analysis compared responses between current surgical trainees and surgeon faculty. The second analysis compared current parents to non-parents. The third analysis compared responses of those who had children during training and those who had their first child after completion of surgical training. And the final analysis which compared responses based on year of completion of surgical training (prior to 2000, 2000–2009, 2010–2019, 2020 and later). All analyses were performed using R Statistical Software (version 4.2.2, R Foundation for Statistical Computing, Vienna, Austria, http://www.R-project.org/). Statistical significance was set at 0.05. Demographic differences were tested using Fisher’s Exact tests for categorical variables and Kruskal-Wallis tests for continuous variables. Survey responses were analyzed for both unadjusted and sex and age adjusted models with the primary predictor indicated by the columns in each table. Ordinal logistic regression was performed for ordinal factor variables and logistic regression was performed for binary variables.
Qualitative Data
Two investigators (SA, CS) reviewed all open-ended responses. Themes were identified for each of the four questions and conventional content analysis approach was used to categorize responses based on these themes.12 Themes were updated during iterative review of the comments. Discrepancies between reviewers were resolved through discussion.
Results:
Respondent Demographics
Demographics of survey respondents are presented in Table 2. Survey response rates were 11.5% for surgeon faculty (68/589), and 17.7% for trainees (50/281). In summary, a majority of respondents were female (62/118, 52.5%) and most respondents were white (84/118, 71.2%). The median age of trainees was 31 (interquartile range (IQR) 29.5, 33), and for surgeon faculty was 45 (IQR 40, 51.25) p<0.001. There were nine surgical sub-specialties represented among surgeon faculty including general, vascular, cardiothoracic, breast, surgical oncology, minimally invasive/bariatrics, plastic surgery, pediatrics, and trauma/critical care surgery, with fairly even distribution. There were 80/118 (67.8%) respondents who reported they had or were currently expecting children, 40/80 (50%) of whom were the gestational carrier. Demographic differences between surgeon faculty and trainees included that they were older (p<0.001), more often reported having children compared to trainees (86.8% vs 42%, p<0.001), and more often had children prior to or during clinical training (48.5% vs 40%, p<0.001).
Table 2.
Survey respondent demographics.
| Overall (N=118) | Current Trainee (N=50) | Practicing Surgeon (N=68) | P-Value | |
|---|---|---|---|---|
| Gender (n, % responding) | 113 (96%) | 48 (96%) | 65 (96%) | |
| Male | 51 (43.2%) | 20 (40.0%) | 31 (45.6%) | 0.57 |
| Female | 62 (52.5%) | 28 (56.0%) | 34 (50.0%) | |
| Non-Binary | 0 (0%) | 0 (0%) | 0 (0%) | |
| Race/Ethnicity (n, % responding) | 114 (97%) | 50 (100) | 64 (94%) | |
| Black/African American | 3 (2.5%) | 0 (0%) | 3 (4.4%) | 0.185 |
| American Indian or Alaskan Native | 0 (0%) | 0 (0%) | 0 (0%) | |
| White | 84 (71.2%) | 41 (82.0%) | 43 (63.2%) | |
| Asian | 21 (17.8%) | 7 (14.0%) | 14 (20.6%) | |
| Native Hawaiian or Pacific Islander | 0 (0%) | 0 (0%) | 0 (0%) | |
| Other | 6 (5.1%) | 2 (4.0%) | 4 (5.9%) | |
| Hispanic/Latino(a) | 5 (4.2%) | 3 (6.0%) | 2 (2.9%) | 0.476 |
| Non-Hispanic/Latino(a) | 108 (91.5%) | 47 (94.0%) | 61 (89.7%) | |
| Age (n, % responding) | 111 (94%) | 47 (94%) | 64 (94%) | |
| Median (IQR) | 38 [32, 45.5] | 31 [29.5, 33] | 44.5 [40, 51.25] | <0.001 |
| Year of completion of surgical training (n, % responding) | 101 (86%) | 42 (84%) | 59 (87%) | |
| Median (IQR) | 2020 [2012, 2026] | 2026 [2025, 2028] | 2014 [2005, 2019] | <0.001 |
| Currently have children (n, % responding) | 117 (99) | 50 (100) | 67 (99) | |
| Yes/Currently Expecting | 80 (67.8%) | 21 (42.0%) | 59 (86.8%) | <0.001 |
| Stage of career when first child was born (n, % responding) | 80 (100) | 21 (100) | 59 (100) | |
| Had Children Prior to/During Residency/Fellowship | 53 (44.9%) | 20 (40.0%) | 33 (48.5%) | <0.001 |
| Had Children Following Completion of Clinical Training | 27 (22.9%) | 1 (2.0%) | 26 (38.2%) | |
| Gestational carrier of child born during training (n, % responding) | 80 (100) | 21 (100) | 59 (100) | |
| Yes | 40 (33.9%) | 9 (18.0%) | 31 (45.6%) | 0.612 |
Bold p-values indicate statistical significance.
Attitudes towards parental leave during surgical training
Survey responses regarding parental leave during surgical training are presented in Table 3. Respondents were asked how much time should be given for parental leave. Most thought that 6–12 weeks should be given to child-bearing trainees (62/118, 52.5%), with another 32.2% (38/118) thought >12 weeks should be given. By comparison, most thought that non-childbearing parents should be given <6 weeks (72/119, 61%). Most stated they did not feel time off for parental leave put an unreasonable strain on other trainees (73/118, 73%). Responses were similar between surgeon faculty and trainees, between parents and non-parents, and between parents who had children in training to those who had children after training in unadjusted and adjusted models (Table 3). Attitudes towards length of parental leave and strain of parental leave on co-residents did not significantly vary based on time of completion of surgical training (Figure 1).
Table 3.
Associations between role, gender identity, and parental leave options.
| Question/Outcome | Current Trainee (N=50) | Surgeon Faculty* (N=68) | Odds Ratio (95% CI) | Adjusted P-Value | No Children (N=37) | Has Children/Expecting (N=80) | Odds Ratio (95% CI) | Adjusted P-Value |
|---|---|---|---|---|---|---|---|---|
| How much time per pregnancy do you think female or childbearing surgical trainees should get for parental leave? | 1.21 (0.4, 3.67) | 0.700 | 2.13 (0.82, 5.57) | 0.120 | ||||
| < 6 Weeks | 8 (16.0%) | 6 (8.8%) | 10 (27.0%) | 4 (5.0%) | ||||
| 6 – 12 Weeks | 25 (50.0%) | 37 (54.4%) | 17 (45.9%) | 45 (56.3%) | ||||
| > 12 Weeks | 17 (34.0%) | 21 (30.9%) | 10 (27.0%) | 27 (33.8%) | ||||
| Missing | 0 (0%) | 4 (5.9%) | 0 (0%) | 4 (5.0%) | ||||
| How much time per pregnancy do you think male on non-childbearing surgical trainees should get for parental leave? | 2.8 (0.87, 8.98) | 0.082 | 1.57 (0.59, 4.22) | 0.400 | ||||
| < 6 Weeks | 31 (62.0%) | 41 (60.3%) | 25 (67.6%) | 47 (58.8%) | ||||
| 6 – 12 Weeks | 11 (22.0%) | 20 (29.4%) | 7 (18.9%) | 23 (28.8%) | ||||
| > 12 Weeks | 7 (14.0%) | 4 (5.9%) | 5 (13.5%) | 6 (7.5%) | ||||
| Missing | 1 (2.0%) | 3 (4.4%) | 0 (0%) | 4 (5.0%) | ||||
| Do you feel that time off for maternity leave (childbearing parent) puts an unreasonable strain on other residents and fellows in the surgical program? | 2.42 (0.52, 12.5) | 0.300 | 0.79 (0.23, 2.74) | 0.700 | ||||
| Yes | 14 (28.0%) | 12 (17.6%) | 9 (24.3%) | 17 (21.3%) | ||||
| No | 32 (64.0%) | 41 (60.3%) | 24 (64.9%) | 48 (60.0%) | ||||
| Missing | 4 (8.0%) | 15 (22.1%) | 4 (10.8%) | 15 (18.8%) | ||||
| Do you know the current leave policy under the American Board of Surgery (ABS) or other specific subspecialty surgical board guidelines for trainees in ACGME accredited surgical training programs? | 1.19 (0.31, 4.67) | 0.800 | 4.91 (1.42, 18.9) | 0.015 | ||||
| Yes | 15 (30.0%) | 22 (32.4%) | 7 (18.9%) | 30 (37.5%) | ||||
| No | 18 (36.0%) | 28 (41.2%) | 19 (51.4%) | 27 (33.8%) | ||||
| Unsure/Missing | 17 (34.0%) | 18 (26.5%) | 11 (29.7%) | 23 (28.8%) |
Adjusted p-values are adjusting for age and gender identity. Bold p-values indicate statistical significance.
Odds ratios are presented as the odds of an outcome occurring more often for practicing surgeons compared to current trainees
Figure 1.
Opinions on optimal childbearing and non-childbearing parental leave duration by year of training (residency or fellowship) completion. 1A. Most respondents, regardless of year of training completion, recommended at least 6 weeks duration of leave for the childbearing parent. 1B. The duration of leave recommended for the non-childbearing parent was not uniform, with recommendations evenly split between 0–4 weeks, 5–6 weeks, and 6–12 weeks but did not vary based on timing of completion of training. Of note, leave of greater than 12 weeks for the non-childbearing parent was only recommended by surgeons who completed or will complete training after 2010, but this difference did not reach statistical significance.
For those who did not feel parental leave put an unreasonable strain on other trainees, reasons provided that reached thematic saturation included that all trainees needed support for various personal reasons in addition to parental needs, that even if strain was felt this was reasonable because it was the “right thing to do,” and that patient care could be supported with adequate program planning. For those who felt it did put unreasonable strain on other trainees, reasons provided that reached thematic saturation included that the increase in call burden was not covered by APPs/faculty, and that no established plan was in place for parental leave, including concerns related to residents being responsible for arranging their own coverage, and sentiments that APPs and hospitals should share in the responsibility of covering patient care needs. Similar themes appeared for respondents who identified as female and male. Responses to open ended questions with illustrative quotations are presented in Table 4.
Table 4.
Responses to open ended questions regarding parental leave among surgical trainees.
| Question | Please explain why you think this (pregnancy) does or does not place an unreasonable strain on other trainees. | |
|
| ||
| Gender | Female respondents | Male respondents |
|
| ||
| Themes | Not unreasonable strain: | Not unreasonable strain: |
| Everyone needs help • “I think parental leave is as reasonable as many other reasons for resident leave, therefore the strain on the remaining residents is not atypical or unusual” |
Everyone needs help • “There is sufficient redundancy built into our program to cover for such absences.” |
|
| Right thing to do • “It’s a natural part of life that affects many residents and so while it may place a slight additional strain on co-residents, it’s not unreasonable” |
Right thing to do • “This is very necessary for the wellbeing of the childbearing parent” • “Family obligations take priority” |
|
| Program size/planning • “The program/hospital should accommodate for this foreseen event by having staff or mid levels available to help with the gaps” |
Program size/planning • “Enough residents/faculty/staff that although there was a change in work burden, it was minimal when everyone helped” |
|
| Unreasonable strain: | Unreasonable strain: | |
| Burden goes to other reJdents • “It is a strain because most programs have just enough residents to cover the hospitals so any decrease for illness/pregnancy/emergencies is a strain” • “Other residents are expected to find the solution with minimal help from leadership, and unwillingness to pay APPs for the extra time” |
Burden goes to other residents • “Coverage requirements get placed on other residents without increased pay or understanding of our increased responsibilities” • “It should not be on the residents who don’t have children to make up additional work because others chose to have children and they didn’t” |
|
| Program needs a plan • “It’s the responsibility of the program (and health system) to not be so overly dependent on residents that they can’t take leave” |
Program needs a plan • “We don’t have a good jeopardy system like IM does, probably because of the size of our program” |
|
|
| ||
| Question | What would have made you feel more supported in taking parental leave? Are there specific things faculty, residents, or others around you could do? | |
|
| ||
| Themes | Faculty support • “There are attitudes from faculty about residents of this generation “being soft” or “not committed to surgery” when they take a reasonable maternity leave” • “Faculty not making comments suggesting I should take less time; faculty not making comments about leaving work early to have the baby.” |
|
| Dedicated parental leave • “Not having to use my vacation for paternity leave” • “If leadership mandated the amount of time away rather than asking you how much you ‘wanted to use’” | ||
| Established system for patient care coverage • “If there were a system in place where other residents wouldn’t have to work significantly harder while I was on leave” | ||
| Having a written policy • “There was no specific policy at the time” • “Having a policy where expectations are set as opposed to having to set my own boundaries would have made me feel more supported. | ||
|
| ||
| Question | Is there anything else you want to share about your experience having hildren during surgical training? | |
|
| ||
| Themes | Need for daycare • “The difficult access to childcare facilities that caters to resident hours (5–6AM) start time clinically is a significant barrier towards parents in residency, especially for couples where both parents are in residency” |
|
| Need for better culture supporting childbearing/rearing • “Surgery, as a whole and for trainee education, is suffering from a failure of imagination about accommodating having and raising children. We see it as an imposition or problem when we should be celebrating it” • “The dehumanizing, demeaning and even punitive culture that existed around childbirth (particularly for the male partner, “because he’s not the one who is pregnant”) had to change” | ||
Questions asked of respondents with themes that emerged and representative quotations. The first question was stratified by gender identity.
Attitudes regarding support and knowledge regarding parental leave during surgical training
Less than one third (37/117, 31.6%) of respondents knew the current ABS leave policy for ACGME-accredited surgical trainees; after adjusting for age and gender identity, individuals who had children had 4.91 (95% CI: 1.42, 18.9) times higher odds of being aware of current policies than those who did not have children (37.5% vs 18.9%, adjusted p=0.015). Of 67 individuals who answered the question, “To what extent did you feel supported by the faculty at your program to take parental leave,” less than half (31/67, 46%) felt “moderately” or “extremely” supported. This was largely due to fewer positive responses from surgeon faculty (21/54, 38.9%), compared to trainees (10/13, 76.9%) who felt “moderately” or “extremely” supported (p=0.0004) (Figure 2). Of note, surgeon faculty were asked to comment on the support they felt regarding parental leave that occurred during their residency or fellowship training.
Figure 2.
Perceived level of support for parental leave during surgical training amongst current trainees and surgeon faculty. The percentage of current trainees who felt moderately or extremely supported to take parental leave was higher than current surgeon faculty members (77% vs 39%, p=0.0004).
Respondents were asked what would make them feel more supported in taking paternal leave. Responses that reached thematic saturation included verbal faculty support, having dedicated parental leave (as opposed to using vacation time), having an established system for patient care coverage, and having a written policy regarding parental leave (Table 4).
Respondents were asked if there was anything else they wanted to share about being parents during training. Responses that reached thematic saturation included need for daycare and need for better overall culture supporting childbearing/rearing in training (Table 4).
Discussion:
Here we report a multi-institutional survey assessing the attitudes and opinions regarding parental leave during surgical training amongst both current faculty and trainees. We found that two thirds of respondents were parents, that most supported parental leave of 6–12 weeks and that this does not place unreasonable strain on other trainees. Our initial hypothesis was that support for parental leave among surgical trainees would be higher among current trainees and recent graduates. However, we were pleasantly surprised to find support for parental leave among all respondents with no significant differences detected between current trainees and faculty, parents and non-parents, those who had children during training and those who waited until completion of training, and independent of timing of completion of training. Importantly, however, few respondents understood the existing parental leave polices. Further, less than half of surgeon parents felt supported by their faculty to take parental leave. This appeared to be the greatest problem for those who were already faculty, suggesting that cultural shifts are beginning to take effect for current surgeon trainees. Survey respondents expressed that having an established system for patient care coverage and a written policy regarding paternal leave were important supports of childbearing/rearing during surgical training. These results are important in that they demonstrated advocacy for parental leave even amongst respondents who did not directly benefit from it because of the belief that it was “the right thing to do”. Furthermore, respondents believed that parental leave of 6–12 weeks was feasible without putting unreasonable strain on others. Thus, if programs want to train surgeons of childbearing/rearing capacity in a manner that supports parenthood, a status that two-thirds of respondents here claimed, steps need to be taken to create a culture enabling understanding and use of parental leave.
Our findings dovetail the results of a 2018 survey of 2188 general surgery residents regarding parental leave, in which ~30% of respondents did not feel supported in taking parental leave.7 This was further reflected by their finding that only 3.8% could identify the current ABS parental leave policy, and 45% of surgical trainees who became parents took less than two weeks of parental leave. These authors concluded that most of the modifiable factors inhibiting surgical trainees from having children during training were associated with absences of clear policies and personnel to support patient care coverage. A similar study of general surgery, urology, and obstetrics/gynecology faculty reported in 2019 found that 67% of respondents believed that parental leave should be >4 weeks, and 42% of respondents felt that parental leave should be >12 weeks.13 In this study, 31% reported they felt discriminated against due to their parental leave, and only 27% of respondents who identified as male took any parental leave. Again, respondents did not believe parental leave put undue strain on their colleagues, but this may be interpreted somewhat differently given that trainees were not represented in this study. The current series adds to the published literature, providing data from both trainees and faculty surgeons supporting formal parental leave policies, with no differences found between the opinions of these two groups.
In 2022, the ACGME revised the institutional requirements such that institutions must now provide residents and fellows with a minimum of six weeks of medical, parental, or caregiver leave at 100% salary at least once during their residency training (a policy that went into effect July 1, 2022).6 The ABS policy goes further, allowing residents to take an additional four weeks of leave up to two times during training without extending their residency.2 Additional details of these policies are presented in Table 1. These parental leave policies were created to enable parental leave without the need to extend training or reduce vacation/conference/interview time. These policy changes do not however address a variety of other aspects that contribute to creating a culture supportive of parental leave. For example, a recent review of parental leave policies in 344 general surgery residency programs found that these policies were readily available on only 6% of program websites, and roughly half of graduate medical education websites.14 The authors also found that academic programs were more than three times more likely to have a parental leave policy listed anywhere online, suggesting that trainees from community or hybrid programs may have less access to and/or support for parental leave. Another study from 2021 noted that only half of general surgery program directors even offered leave for parents who identified as male, and that leave typically was only one week.15 A study from 2018 reported that 39% of respondents agreed with the statement, “my experience of pregnancy/motherhood during residency made me strongly re-consider whether I wanted to stay in surgery.”.16 Respondents who agreed with this statement were twice as likely to not have a formal parental leave policy and feel a negative stigma associated with their pregnancy. Our data echo these findings, calling for formal (written policies) and informal (verbal support from faculty and a culture of support at a program level) policies supporting parental leave for surgical trainees.
This study has limitations, including that response rate was relatively low, and that respondents likely had greater interest in parental leave compared to non-respondents. In this study, 67.8% of respondents were parents, and 40.7% were parents during training, whereas a previous contemporary survey indicated only 24% of trainees were parents.7 Another limitation of the study was that practical/implementation aspects of parental leave were not addressed here (minimum number of weeks of training, financial support for trainees on leave or who graduate “late,” cost of non-trainee patient coverage to support parental leave). Respondent parental leave support may have been different if questions regarding monetary or time-costs had been included in the survey. For example, a survey of 1541 female identifying faculty from 2017 reported lost wages exceeding $10,000 during parental leave.17 In that study, proceduralists reported more often having to complete missed call shifts and losing productivity bonuses and were twice as likely to agree with the statement that “they wished they had chosen a less demanding specialty or job.” While these were experiences of faculty, not trainees, undoubtably these experiences will have influence on the treatment of trainees. Lastly, this survey data represents a convenience sample of individuals who are involved in larger academic general surgery residency programs primarily in the Western United States. It is unclear how responses may have differed from individuals involved in smaller community programs, and from programs located in other parts of the United States.
Conclusions:
The data presented here add value to the current literature by demonstrating widespread support for parental leave of at least 6 weeks for surgical trainees that is uniform across current trainees and faculty. Support was sought through both informal and formal policies enabling patient care coverage. Current trainees feel more supported than those who already completed training, suggesting that parental leave is increasingly more accepted. These data may be used to inform the design of future parental leave policies and modify existing policies while building a culture of support for trainees who wish to become parents during their clinical training.
Highlights.
There is broad support for surgical trainee parental leave of at least 6 weeks.
Parental leave support existed across demographics including those with and without children.
Surgical faculty reported feeling less supported than current trainees in parental leave.
Few respondents knew current American Board of Surgery parental leave policies.
Acknowledgements:
We wish to thank Dr. Maria Altieri for allowing us to use her original survey instrument and collaborating with us to revise the instrument based on our current aims. This manuscript was supported by NIH/NCATS Colorado CTSA Grant Number UL1TR002535. Its contents are the authors’ sole responsibility and do not necessarily represent official NIH views.
Funding:
This manuscript was supported by NIH/NCATS Colorado CTSA Grant Number UL1TR002535. Its contents are the authors’ sole responsibility and do not necessarily represent official NIH views.
Footnotes
Declarations of interest: none
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References
- 1.Casilla-Lennon M, Hanchuk S, Zheng S, et al. Pregnancy in physicians: A scoping review. Am J Surg. Jan 2022;223(1):36–46. doi: 10.1016/j.amjsurg.2021.07.011 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Surgery ABo. General Surgery Leave Policy. Accessed March 1, 2024, 2024. https://www.absurgery.org/resources/abs-policies/policy-leave/
- 3.Surgery ABo. Vascular Surgery Leave Policy. Accessed JUne 6, 2024, 2024. https://www.absurgery.org/resources/abs-policies/policy-leave-vascular/
- 4.Surgery ABoT. Leave of Abscence Policy. Accessed June 6, 2024, 2024. https://www.abts.org/ABTS/CertificationWebPages/Leave_of_Absence_Policy_2022.aspx#:~:text=Pathway%20Three%20candidates%20(I-6,parent%20with%20a%20serious%20health
- 5.Surgery TABoP. Reference for Program Directors and Residency Coordinators. Accessed June 5, 2024, 2024. https://www.abplasticsurgery.org/program-directors/reference-for-program-directors/
- 6.ACGME. ACGME Answeres: Resident Leave Policies. Accessed May 15, 2023, 2023. acgme.org/newsroom/blog/2022/acgme-answers-resident-leave-policies/
- 7.Altieri MS, Salles A, Bevilacqua LA, et al. Perceptions of Surgery Residents About Parental Leave During Training. JAMA Surg. Oct 1 2019;154(10):952–958. doi: 10.1001/jamasurg.2019.2985 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Gehlbach H, Artino AR Jr., Durning S. AM last page: survey development guidance for medical education researchers. Acad Med. May 2010;85(5):925. doi: 10.1097/ACM.0b013e3181dd3e88 [DOI] [PubMed] [Google Scholar]
- 9.Sharma A, Minh Duc NT, Luu Lam Thang T, et al. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med. Oct 2021;36(10):3179–3187. doi: 10.1007/s11606-021-06737-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. Jul 2019;95:103208. doi: 10.1016/j.jbi.2019.103208 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. Apr 2009;42(2):377–81. doi: 10.1016/j.jbi.2008.08.010 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. Nov 2005;15(9):1277–88. doi: 10.1177/1049732305276687 [DOI] [PubMed] [Google Scholar]
- 13.Gaines T, Harkhani N, Chen H, Malik RD. Current policies and practicing surgeon perspectives on parental leave. Am J Surg. Oct 2019;218(4):772–779. doi: 10.1016/j.amjsurg.2019.07.019 [DOI] [PubMed] [Google Scholar]
- 14.Engelbrecht-Wiggans EA, Sundel MH, Newland JJ, Seyoum N, Brown RF. Parental leave policies in general surgery residencies. Am J Surg. Dec 15 2023;doi: 10.1016/j.amjsurg.2023.12.017 [DOI] [PubMed] [Google Scholar]
- 15.Castillo-Angeles M, Smink DS, Rangel EL. Perspectives of US General Surgery Program Directors on Cultural and Fiscal Barriers to Maternity Leave and Postpartum Support During Surgical Training. JAMA Surg. Jul 1 2021;156(7):647–653. doi: 10.1001/jamasurg.2021.1807 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Rangel EL, Lyu H, Haider AH, Castillo-Angeles M, Doherty GM, Smink DS. Factors Associated With Residency and Career Dissatisfaction in Childbearing Surgical Residents. JAMA Surg. Nov 1 2018;153(11):1004–1011. doi: 10.1001/jamasurg.2018.2571 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Scully RE, Davids JS, Melnitchouk N. Impact of Procedural Specialty on Maternity Leave and Career Satisfaction Among Female Physicians. Ann Surg. Aug 2017;266(2):210–217. doi: 10.1097/sla.0000000000002196 [DOI] [PubMed] [Google Scholar]