Li Ruojia Debbie, Janczewski Lauren M, Eng Joshua S, Foote Darci C, Wu Christine, Johnson Julie K, Easter Sarah Rae, Kim Eugene, Buyske Jo, Turner Patricia L, Nasca Thomas J, Bilimoria Karl Y, Hu Yue-Yung, Rangel Erika L
Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University School of Medicine, Indianapolis.
Northwestern Quality Improvement, Research, and Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA Surg. 2024 Oct 1;159(10):1127-1137. doi: 10.1001/jamasurg.2024.2399.
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.
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).
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.
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).
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.
在任何领域，实现计划生育目标的能力都是性别平等的重要组成部分。手术专科对怀孕存在职业风险。普通外科作为最大的手术专科，提供了一个机会来了解计划生育、工作场所对为人父母的支持、产科结局，以及这些因素对劳动力福祉、性别平等和人员流失的影响。
研究美国普通外科住院医师群体中的怀孕及为人父母的经历，包括遭受的虐待和产科结局。
设计、背景和参与者：这项队列研究涉及对所有经毕业后医学教育认证委员会认证的项目中的普通外科住院医师进行的全国性横断面调查，调查时间为2021年美国外科委员会住院医师培训考试之后。询问报告自己怀孕的女性受访者以及在临床培训期间其伴侣怀孕的男性受访者有关基于怀孕和为人父母的虐待、产科结局以及当前的福祉情况（职业倦怠、考虑离职、自杀倾向）。
主要结局包括比较女性住院医师与男性住院医师伴侣之间的产科并发症和产后抑郁症。次要结局包括对计划生育、怀孕或为人父母的支持的看法；辅助生殖技术的使用；基于怀孕/为人父母的虐待；新生儿并发症；以及比较女性和男性住院医师之间的福祉情况。
来自美国325个普通外科项目的5692名住院医师参与了调查（回复率为81.2%）。其中，957名住院医师（16.8%）报告在临床培训期间怀孕（男性692/3097 [22.3%]，女性265/2595 [10.2%]；P <.001）。与男性住院医师相比，女性住院医师因培训而更频繁地推迟生育（女性1201/2568 [46.8%]，男性1006/3072 [32.7%]；P <.001），并且经历基于怀孕/为人父母的虐待（女性132 [58.1%]，男性179 [30.5%]；P <.001）。与男性住院医师的伴侣相比，女性住院医师更有可能经历产科并发症（比值比[OR]，1.42；95%置信区间，1.04 - 1.96）和产后抑郁症（OR，1.63；95%置信区间，1.11 - 2.40）。基于怀孕/为人父母的虐待与职业倦怠增加（OR，2.03；95%置信区间，1.48 - 2.78）和考虑离职（OR，2.50；95%置信区间，1.61 - 3.88）相关。产后抑郁症，无论是在女性住院医师还是男性住院医师伴侣中，都与住院医师职业倦怠（OR，1.93；95%置信区间，1.27 - 2.92）、考虑离职（OR，2.32；95%置信区间，1.36 - 3.96）和自杀倾向（OR，5.58；95%置信区间，2.59 - 11.99）相关。
本研究发现，基于怀孕/为人父母的虐待、产科并发症和产后抑郁症与女性性别相关，可能导致性别差异的人员流失。需要系统性变革以保护母婴健康并促进手术领域的性别平等。
