The Obstetric Experience of Vascular Surgery Trainees
Ruojia Debbie Li, MD MS1, Eric B. Pillado, MD1, Joshua S. Eng, PhD1, Matthew C. Chia, MD MS1, Malachi G. Sheahan, III, MD2, Karl Y. Bilimoria, MD MS1, Erika L. Rangel, MD3, Yue-yung Hu, MD MPH1, Dawn M. Coleman, MD4.
1Northwestern University, Chicago, IL, USA, 2Louisiana State University, New Orleans, LA, USA, 3Brigham and Women's Hospitla, Boston, MA, USA, 4University of Michigan, Ann Arbor, MI, USA.
OBJECTIVES: Vascular surgery training poses unique risks to pregnancy, including long hours, physically demanding work, and radiation exposure. Our objectives were to (1) determine the rate of obstetric complications among vascular trainees and (2) evaluate factors associated with complications and trainee-parent wellness. METHODS: A survey was administered after the 2021 Vascular Surgery In-Training Examination. Residents and fellows who (or whose partners) experienced pregnancies during their clinical years of training were asked about their perceptions of the learning environment (work hours and mistreatment, including discrimination, bullying, harassment), obstetric complications (miscarriage, pre-eclampsia, placental abruption, intrauterine growth restriction, cesarean section, postpartum depression), and burnout. Multivariable logistic regression models identified factors associated with gestational complications and burnout. RESULTS: Among 510 trainees from 125 vascular surgery training programs (response rate 83.6%), women significantly more frequently reported delaying having children due to training (52.8% vs. 30.2%, p<0.001) and to be advised against having children during residency (7.3% vs. 0.7%, p<0.001). Men were more likely than women to have a child during their clinical years (overall 28.0%; female 12.7% vs. male 35.4%, p<0.001). Both female trainees and the partners of male trainees had high rates of obstetric complications (female 47.4% vs. partners of male trainees 45.6%, p=0.89). The only factor associated with gestational complications was PGY level (PGY IV-VII OR 3.09, 95% CI 1.01-9.47 vs. PGY I-III). Among parents, women more frequently reported mistreatment (94.4% vs. 27.4%, p<0.001), duty hour violations (47.4% vs. 11.9%, p<0.001), and burnout (72.2% vs. 37.0%, p<0.001) compared to men. After adjusting for mistreatment (OR 3.79, 95% CI 1.42-10.13), and duty hour violation (OR 17.30, 95% CI 2.74-109.18), mothers were no more likely than fathers to report burnout.CONCLUSIONS:
Vascular trainees experience high rates of obstetric complications. Higher level trainees were more likely to experience obstetric complications, potentially due to older age, longer OR cases due to complexity, and increased frequency of overnight calls. Women experienced more stigma related to pregnancy and childbearing which may account for their higher rates of burnout. Increased support for childbearing trainees, particular pregnant senior trainees, may help maintain a diverse workforce wellness, and maternal-fetal health.
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