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Journal ArticleDOI

Duty hours and pregnancy outcome among residents in obstetrics and gynecology.

01 Nov 2003-Obstetrics & Gynecology (Obstet Gynecol)-Vol. 102, Iss: 5, pp 948-951
TL;DR: It is demonstrated that, although women house officers continued to work more than 80 hours per week during pregnancy, most had a good pregnancy outcome, and there was a higher frequency of preterm labor, preeclampsia, and fetal growth restriction in female residents than in spouses or partners of male residents.
About: This article is published in Obstetrics & Gynecology.The article was published on 2003-11-01. It has received 70 citations till now. The article focuses on the topics: Obstetrics and gynaecology & Pregnancy.
Citations
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Journal ArticleDOI
TL;DR: The challenges of having children during surgical residency may have significant workforce implications and a deeper understanding is critical to prevent attrition and to continue recruiting talented students.
Abstract: Importance Although family priorities influence specialty selection and resident attrition, few studies describe resident perspectives on pregnancy during surgical training. Objective To directly assess the resident experience of childbearing during training. Design, Setting, and Participants A self-administered 74-question survey was electronically distributed in January 2017 to members of the Association of Women Surgeons, to members of the Association of Program Directors in Surgery listserv, and through targeted social media platforms. Surgeons who had 1 or more pregnancies during an Accreditation Council for Graduate Medical Education–accredited US general surgery residency program and completed training in 2007 or later were included. Important themes were identified using focus groups of surgeons who had undergone pregnancy during training in the past 7 years. Additional topics were identified through MEDLINE searches performed from January 2000 to July 2016 combining the keywordspregnancy,resident,attrition, andparentingin any specialty. Main Outcomes and Measures Descriptive data on perceptions of work schedule during pregnancy, maternity leave policies, lactation and childcare support, and career satisfaction after childbirth. Results This study included 347 female surgeons (mean [SD] age, 30.5 [2.7] years) with 452 pregnancies. A total of 297 women (85.6%) worked an unmodified schedule until birth, and 220 (63.6%) were concerned that their work schedule adversely affected their health or the health of their unborn child. Residency program maternity leave policies were reported by 121 participants (34.9%). A total of 251 women (78.4%) received maternity leave of 6 weeks or less, and 250 (72.0%) perceived the duration of leave to be inadequate. The American Board of Surgery leave policy was cited as a major barrier to the desired length of leave by 268 of 326 respondents (82.2%). Breastfeeding was important to 329 (95.6%), but 200 (58.1%) stopped earlier than they wished because of poor access to lactation facilities and challenges leaving the operating room to express milk. Sixty-four women (18.4%) had institutional support for childcare, and 231 (66.8%) reported a desire for greater mentorship on integrating a surgical career with motherhood and pregnancy. A total of 135 (39.0%) strongly considered leaving surgical residency, and 102 (29.5%) would discourage female medical students from a surgical career, specifically because of the difficulties of balancing pregnancy and motherhood with training. Conclusions and Relevance The challenges of having children during surgical residency may have significant workforce implications. A deeper understanding is critical to prevent attrition and to continue recruiting talented students. This survey characterizes these issues to help design interventions to support childbearing residents.

237 citations

Journal ArticleDOI
TL;DR: Female orthopaedic surgeons had an increased risk of pregnancy complications, particularly preterm delivery, compared with the general U.S. population and an increasedrisk of preterm labor and delivery in surgeons working more than sixty hours per week during pregnancy.
Abstract: Background: The number of women entering orthopaedic surgery is steadily increasing. Information regarding pregnancy and childbearing is important to understand as it increasingly affects residency programs, clinical practices, and the female surgeons and their offspring. Methods: One thousand and twenty-one female surgeons completed an anonymous, voluntary, 199-item online survey distributed via individual female surgeon interest groups and word of mouth in nine specialties: general surgery, gynecology, neurosurgery, ophthalmology, orthopaedics, otolaryngology, plastic surgery, podiatry, and urology. Two hundred and twenty-three survey responses from orthopaedic surgeons were compared with those of the other surgical specialists as well as American Pregnancy Association national data to assess differences, if any, in pregnancy characteristics, demographics, and satisfaction. Results: The overall reported complication rate for all pregnancies among orthopaedic surgeons was significantly higher than the rate in the general American population (31.2% [eighty-two of 263] compared with 14.5%). There was an increased risk of preterm delivery among orthopaedic surgeons compared with a cohort of the general U.S. population matched according to age, race, health, and socioeconomic status (risk ratio, 2.5; 95% confidence interval [CI], 1.3 to 4.6). There was an increased risk of preterm labor and preterm delivery among women who reported working more than sixty hours per week (odds ratio, 4.95; 95% CI, 1.4 to 36.6). Female orthopaedic surgeons took shorter maternity leave during training than during clinical practice (median, four compared with seven weeks). The mean duration of breastfeeding was significantly shorter during training than during clinical practice (4.7 compared with 8.3 months, p = 0.03). Conclusions: Female orthopaedic surgeons had an increased risk of pregnancy complications, particularly preterm delivery, compared with the general U.S. population. We found an increased risk of increased risk of preterm labor and delivery in surgeons working more than sixty hours per week during pregnancy.

123 citations

Journal ArticleDOI
TL;DR: The number of women general surgeons becoming pregnant during training has increased in recent years; however, substantial negative bias persists, and even women residents hold negative views of pregnancy among their colleagues during training.
Abstract: Background Women compose half of all medical students but are underrepresented in the field of general surgery. Concerns about childbirth and pregnancy during training and practice are factors that may dissuade women from electing a career in surgery. Objective To assess experiences related to childbirth and pregnancy among women general surgeons. Design Survey questionnaire. Setting Self-administered survey sent individually to women surgeons in training and practice. Participants Women members of the Association for Women Surgeons or the American College of Surgeons who graduated from medical school and practice general surgery or a general surgery subspecialty. Main Outcome Measures Descriptive data on the timing of pregnancy and perception of stigma attending childbirth and pregnancy as experienced by women surgeons, according to date of medical school graduation (0-9 years since graduation, 10-19 years, 20-29 years, and ≥ 30 years). The survey response rate was 49.6%. Trends over time were evaluated using comparisons of proportions and the Cochrane-Armitage trend tests across age cohorts. Results The perception of stigma associated with pregnancy during training remained large but decreased from 76% in the most remote cohort to 67% in the most recent graduation cohort (P Conclusions The number of women general surgeons becoming pregnant during training has increased in recent years; however, substantial negative bias persists. Although the overall magnitude of perceived negative attitudes is greater among male peers than female peers and among faculty than peers, even women residents hold negative views of pregnancy among their colleagues during training. More than half of all women surgeons delay childbearing until they are in independent practice, post-training. Surgical residents and faculty of both sexes exerted negative influences with regard to consideration of childbearing. There was also a trend toward increased childbearing in more recent graduates.

118 citations


Cites result from "Duty hours and pregnancy outcome am..."

  • ...In a study of women urologists, the average maternal age at time of successful first, second, and third childbirth was 33, 35, and 37 years, compared with the Centers for Disease Control and Prevention US population averages of 25, 28, and 29 years.(15) General surgery and urology training programs influence women to delay their first childbirth more than in other specialties....

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Journal ArticleDOI
TL;DR: The data suggest that policies at the level of the Accreditation Council for Graduate Medical Education or Resident Review Committee (RRC), as well as education and the normalization of pregnancy during training, may be effective interventions.
Abstract: Importance To our knowledge, there has been little research conducted on the attitudes of residents toward their pregnant peers and parental leave. Objective To examine the perceptions of current surgery residents regarding parental leave. Design, Setting, and Participants A 36-item survey was distributed to current US general surgery residents and residents in surgical subspecialties through the Association of Program Directors in Surgery listserv and social media platforms. Questions were associated with general information/demographics, parental leave, having children, and respondents’ knowledge regarding the current parental leave policy as set by the American Board of Surgery. The study was conducted from August to September 2018 and the data were analyzed in October 2018. Main Outcomes and Measures Main outcomes included the attitudes of residents toward pregnancy and parental leave, parental leave policy, and the association of parental leave with residency programs. Results A total of 2188 completed responses were obtained; of these, 1049 (50.2%) were women, 1572 (75.8%) were white, 164 (7.9%) were Hispanic/Latinx, 75 (3.6%) were African American, 2 (0.1%) were American Indian or Alaskan Native, 263 (12.7%) were Asian, and 5 (0.2%) were Native Hawaiian or Pacific Islander. From the number of residents who had/were expecting children (581 [28.6%]), 474 (81.6%) had or were going to have a child during the clinical years of residency. Many residents (247 [42.5%]) took fewer than 2 weeks of parental leave. Many residents did not feel supported in taking parental leave (177 [30.4%] did not feel supported by other residents and 190 [32.71%] did not feel supported by the faculty). Only 83 respondents (3.8%%) correctly identified the current American Board of Surgery parental leave policy. Residents who took parental leave identified a lack of a universal leave policy, strain on the residency program, a loss of education/training time, a lack of flexibility of programs, and a perceived or actual lack of support from faculty/peers as the top 5 biggest obstacles to taking leave during the clinical years of residency. Conclusions and Relevance Most of the modifiable factors that inhibit residents from having children during residency are associated with policies (eg, a lack of universal leave policy and lack of flexibility) and personnel (eg, a strain on the residency program and lack of support from peers/faculty). These data suggest that policies at the level of the Accreditation Council for Graduate Medical Education or Resident Review Committee (RRC), as well as education and the normalization of pregnancy during training, may be effective interventions.

73 citations

Journal ArticleDOI
TL;DR: The authors explored the extent to which fear of academic jeopardy, stigma, and being the subject of discussion by colleagues may affect residents' care-seeking and found that time and scheduling difficulties influence the ability to obtain care.
Abstract: PurposeThe authors sought to understand the health issues and care-seeking practices reported by residents and explored the extent to which fear of academic jeopardy, stigma, and being the subject of discussion by colleagues may affect residents' care-seeking.MethodResidents at the Universit

66 citations

References
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Journal ArticleDOI
TL;DR: The authors argue that reform is needed because the long work hours of clinicians adversely affect the quality of health care and current policies regulating residents' hours of work and options for new regulations governing residency shifts.
Abstract: Clinicians, especially physicians in training, often work long hours and get inadequate sleep. The implications of fatigue among clinicians for the quality of medical care have not been adequately studied, but sleep deprivation is likely to cause medical errors. This article reviews the effect of fatigue on performance, as well as current policies regulating residents' hours of work and options for new regulations governing residency shifts. The authors argue that reform is needed because the long work hours of clinicians adversely affect the quality of health care.

643 citations

Journal ArticleDOI
04 Sep 2002-JAMA
TL;DR: A systematic review of the effectiveness of critical appraisal skills training for clinicians and the impact of an evidence-based medicine curriculum based on adult learning theory on students' reading habits and knowledge is presented.
Abstract: new approach to teaching the practice of medicine. JAMA. 1992;268:24202425. 5. Parkes J, Hyde C, Deeks J, Milne R. Teaching critical appraisal skills in health care settings [database on CD-ROM]. Oxford, England: Cochrane Library, Update Software; 2002;issue 2. 6. Taylor R, Reeves B, Ewings P, et al. A systematic review of the effectiveness of critical appraisal skills training for clinicians. Med Educ. 2000;34:120-125. 7. Norman GR, Shannon SI. Effectiveness of instruction in critical appraisal (evidencebased medicine) skills: a critical appraisal. CMAJ. 1998;158:177-181. 8. Linzer M, Brown JT, Frazier LM, DeLong ER, Siegel WC. Impact of a medical journal club on house-staff reading habits, knowledge, and critical appraisal skills: a randomized controlled trial. JAMA. 1988;260:2537-2541. 9. Stern DT, Linzer M, O’Sullivan PS, Weld L. Evaluating medical residents’ literatureappraisal skills. Acad Med. 1995;70:152-154. 10. Bennett KJ, Sackett DL, Haynes RB, Neufeld VR, Tugwell P, Roberts R. A controlled trial of teaching critical appraisal of the clinical literature to medical students. JAMA. 1987;257:2451-2454. 11. Grimes DA. Introducing evidence-based medicine into a department of obstetrics and gynecology. Obstet Gynecol. 1995;86:451-457. 12. Murray E. Challenges in educational research. Med Educ. 2002;36:110-112. 13. Campbell M, Fitzpatrick R, Haines A, et al. Framework for design and evaluation of complex interventions to improve health. BMJ. 2000;321:694-696. 14. Bogdan R, Biklen SK. Qualitative Research for Education: An Introduction to Theory and Methods. Boston, Mass: Allyn & Bacon; 1982. 15. Green ML, Ellis PJ. Impact of an evidence-based medicine curriculum based on adult learning theory. J Gen Intern Med. 1997;12:742-750. 16. Cabell CH, Schardt C, Sanders L, Corey GR, Keitz SA. Resident utilization of information technology. J Gen Intern Med. 2001;16:838-844. 17. Taylor R, Reeves B, Mears R, et al. Development and validation of a questionnaire to evaluate the effectiveness of evidence-based practice teaching. Med Educ. 2001;35:544-547. 18. Flynn C, Helwig A. Evaluating an evidence-based medicine curriculum. Acad Med. 1997;72:454-455. 19. Dobbie AE, Schneider FD, Anderson AD, Littlefield J. What evidence supports teaching evidence-based medicine? Acad Med. 2000;75:1184-1185.

502 citations


"Duty hours and pregnancy outcome am..." refers methods in this paper

  • ...To reduce this stress, the Accreditation Council for Graduate Medical Education instituted substantial changes in scheduled work hours for residents, effective July 1, 2003.(1,2) This policy includes a work week of no longer than 80 hours, one 24-hour day free every 7 days, shifts of no longer than 30 hours, and at least 10 hours off between duty periods....

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Journal ArticleDOI
TL;DR: The system of training resident physicians in the United States is about to undergo substantial changes, and more — but not all — residents will be limited to 80 hours of work per week, averaged over a four-week period.
Abstract: After years of discussion, the system of training resident physicians in the United States is about to undergo substantial changes. As of July 1, 2003, more — but not all — residents will be limited to 80 hours of work per week, averaged over a four-week period.1,2 The new requirements are part of a general effort to improve the safety of patients and the working conditions and education of residents. They are also designed to forestall federal regulation that could take away some of the authority of the Accreditation Council for Graduate Medical Education (ACGME), the organization that accredits . . .

197 citations

Journal ArticleDOI
TL;DR: The author comments on the use of existing data to make common sense changes and on the need for further studies to help clarify the issues and evaluate program changes.
Abstract: PurposeIt is estimated that by 2010 30% of U.S. physicians will be women. Pregnancy during residency can and does happen in all programs, and continues to provide problems for many. The author reviews the issues surrounding pregnancy during residency by evaluating published commentaries and

129 citations


"Duty hours and pregnancy outcome am..." refers background in this paper

  • ...Women residents have several work-related concerns regarding pregnancy.(8) Although their institution is likely...

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Journal ArticleDOI
TL;DR: Those involved in graduate medical education have long struggled with competing priorities that surround the issue of residents' work hours: providing each trainee with an adequate amount of clinical experience; protecting time for teaching conferences and self-study; preserving sufficient continuity of patient care; and avoiding excessive fatigue.
Abstract: Those involved in graduate medical education have long struggled with competing priorities that surround the issue of residents' work hours: providing each trainee with an adequate amount of clinical experience; protecting time for teaching conferences and self-study; preserving sufficient continuity of patient care; and avoiding excessive fatigue. The recent decision by the Accreditation Council for Graduate Medical Education (ACGME) to implement new limits on residents' work hours has abruptly intensified that struggle. When fully implemented in July 2003, these “common duty hour standards”1 will, for the first time, apply a core set of requirements for work hours to all specialties. . . .

123 citations