Presentation
PS6 - Gaps in Research with Pregnant Bodied Surgeons: Four Recommendations From the Literature
SessionPoster Session 1
DescriptionBackground:
As of 2022, 18.5% of the surgeons in the United States are women, with the number expected to rise over the next five years (datausa.io). Much of the surgical training that individuals who can conceive are required to perform happens in the most fertile years of a pregnant-bodied individual’s life. Unfortunately, this population has also shown a higher risk of facing pregnancy complications and miscarriages than the general population, partly due to the increased stress that they are under in the workplace (Rangel et al., 2021; Phillips et al., 2014). Despite the introduction of tools and protocols to support this population during pregnancy and in lactation, there remain critical research gaps to further understand the entire experience and needs of a surgeon who can conceive before, during, and after pregnancy. The purpose of this poster is to identify four gaps in the literature regarding surgeons who can conceive along with four recommendations for mitigation.
Gap 1: Psychological Safety
In May of 2024, the American Board of Surgery put out a new announcement in collaboration with the Association of Women Surgeons outlining recommendations for supporting pregnant surgeons throughout their pregnancy. Though this is an excellent step in the right direction, some research has found that there is a fear of backlash from colleagues and leaders if individuals utilize these support systems, thus creating a need for research regarding the psychological safety of surgeons who can conceive and pregnant surgeons (Rangel et al., 2022; Young et al., 2021). Psychological safety is the belief that an individual will not be reprimanded for speaking up and advocating for themselves (Edmonson et al., 1999). To illustrate, surgeons who do not feel safe advocating for adjusted shifts to accommodate fertility or prenatal appointments are exhibiting poor psychological safety. Additionally, not all institutions have implemented policies that align with the recommendations outlined for pregnant surgeons (Rangel et al., 2022). To best support this population at an institutional level, it is critical that further research be conducted to understand if and when people are utilizing the support available to them and the factors that influence the degree that they experience psychological safety.
Gap 2: Fertility Journey and Pregnancy Complications and Loss
There is a robust amount of literature stating the decrease in fertility and increase in pregnancy complications and loss among surgeons who can conceive (Delva et al., 2023). However, there is a gap in the literature surrounding ways to support this population throughout their fertility journeys, pregnancy complications, and/or pregnancy loss. The type of support required when these events occur can also vary greatly depending on the nature of the events themselves. For example, if a surgeon decides to utilize assisted reproductive technologies or has pregnancy complications, they could require additional doctor’s appointments, medications, and/or procedures that may require a surgeon to have a more flexible schedule or time off. Conversely, a miscarriage near the end of pregnancy or stillbirth could require time off for bereavement. The intricacies of support required at each stage are underrepresented in the literature. Future research should include insights into the psychological toll taken and the identification of opportunities for organizational or institutional support.
Gap 3: Postpartum Assistance
Many institutions have attempted to implement protocols to offer support to pregnant surgeons. However, the resources available to these same individuals deteriorate rapidly in the postpartum stage. Some researchers have called for hospitals to provide lactation rooms and refrigerators to store milk and allow surgeons to leave the OR to pump (Sterbling et al., 2023; Knell et al., 2023). However, not all institutions are providing support in alignment with recommendations by the American Board of Surgery or research (Rangel et al., 2022). Research is also needed to better understand a surgeon's experience with postpartum complications, such as childbirth-associated complications, breastfeeding-associated complications, and postpartum depression.
Gap 4: Cultural Nuance
There continues to be a lack of research surrounding surgeons of a variety of backgrounds and the influence of culture, both positive and negative, on their experience of pregnancy. The intersectionality of an individual's identity is necessary to fully understand what type of toll is taken. For example, living in a multi-generational household may mean that some surgeons have more support for childcare; however, this could also mean that there are more individuals reliant upon the surgeon for their daily needs. Including this level of detail about the provider pregnancy experience is necessary to meaningfully explore this multifaceted experience.
Recommendations:
Unquestionably, the literature demonstrates that there is a paucity of research related to fertile and pregnant surgeons and their needs. To bridge these gaps, we have provided four recommendations and their rationale for future research.
Recommendation 1: Emphasize Diverse Populations and Perspectives
First, the inclusion of a diverse population is critical to ensure that the cultural nuances are gathered both within and outside of the workplace. Using inclusive language within these research efforts is also necessary to ensure that all individuals with the ability to conceive can have their voices heard based on their individualized experiences. To gather these voices, utilizing online surveys with compensation can be useful in ensuring that people can complete it without fear of a breach of confidentiality or anonymity while also not having to infringe upon their clinical care duties as it can be completed in a safe space on their own time.
Recommendation 2: Leverage Personal and Professional Community Voices
Second, all individuals with the ability to conceive should be identified as potential sources of information, along with critical members of their personal and professional communities. Examples of professional community members could include peer surgeons and administrators; whereas, personal members would then incorporate partners, family, and other caregivers. Further, probing lactation and fertility specialists, physical and occupational therapists, and obstetricians can be valuable ways to gather expert perspectives. Receiving insights from these groups could further illustrate gaps between policy and the lived experience of surgeons.
Recommendation 3: Investigate All Hospital Types
Third, research at a variety of hospital types (e.g., academic, rural, community) is critical to understanding the full scope of how pregnancy is impacting surgeons across the healthcare system. For instance, providing a pregnant surgeon time off to attend doctor’s visits may be more difficult at a rural hospital as opposed to an academic medical center due to the varying numbers of people available for coverage. Insights into these challenges are necessary to understand what policy adjustments are needed to best support surgeons across the board.
Recommendation 4: Provide Peer Education
Fourth, providing practitioners, their communities, and leaders with further education and training about the intersection of surgery and fertility, pregnancy, and postpartum issues may stimulate action to implement or adapt existing policies to support them. This type of training has already been recommended for residents and toolkits have been developed to support this effort (Sterbling et al., 2023). Likewise, individual practitioners have made efforts to promote knowledge regarding these issues through articles and other pathways (Hamilton, 2018). Versions of these resources could be made accessible to leaders, practitioners, and their communities. This has the potential to both effect positive change as well as generate further willingness to invest resources and participate in research endeavors exploring these issues.
As of 2022, 18.5% of the surgeons in the United States are women, with the number expected to rise over the next five years (datausa.io). Much of the surgical training that individuals who can conceive are required to perform happens in the most fertile years of a pregnant-bodied individual’s life. Unfortunately, this population has also shown a higher risk of facing pregnancy complications and miscarriages than the general population, partly due to the increased stress that they are under in the workplace (Rangel et al., 2021; Phillips et al., 2014). Despite the introduction of tools and protocols to support this population during pregnancy and in lactation, there remain critical research gaps to further understand the entire experience and needs of a surgeon who can conceive before, during, and after pregnancy. The purpose of this poster is to identify four gaps in the literature regarding surgeons who can conceive along with four recommendations for mitigation.
Gap 1: Psychological Safety
In May of 2024, the American Board of Surgery put out a new announcement in collaboration with the Association of Women Surgeons outlining recommendations for supporting pregnant surgeons throughout their pregnancy. Though this is an excellent step in the right direction, some research has found that there is a fear of backlash from colleagues and leaders if individuals utilize these support systems, thus creating a need for research regarding the psychological safety of surgeons who can conceive and pregnant surgeons (Rangel et al., 2022; Young et al., 2021). Psychological safety is the belief that an individual will not be reprimanded for speaking up and advocating for themselves (Edmonson et al., 1999). To illustrate, surgeons who do not feel safe advocating for adjusted shifts to accommodate fertility or prenatal appointments are exhibiting poor psychological safety. Additionally, not all institutions have implemented policies that align with the recommendations outlined for pregnant surgeons (Rangel et al., 2022). To best support this population at an institutional level, it is critical that further research be conducted to understand if and when people are utilizing the support available to them and the factors that influence the degree that they experience psychological safety.
Gap 2: Fertility Journey and Pregnancy Complications and Loss
There is a robust amount of literature stating the decrease in fertility and increase in pregnancy complications and loss among surgeons who can conceive (Delva et al., 2023). However, there is a gap in the literature surrounding ways to support this population throughout their fertility journeys, pregnancy complications, and/or pregnancy loss. The type of support required when these events occur can also vary greatly depending on the nature of the events themselves. For example, if a surgeon decides to utilize assisted reproductive technologies or has pregnancy complications, they could require additional doctor’s appointments, medications, and/or procedures that may require a surgeon to have a more flexible schedule or time off. Conversely, a miscarriage near the end of pregnancy or stillbirth could require time off for bereavement. The intricacies of support required at each stage are underrepresented in the literature. Future research should include insights into the psychological toll taken and the identification of opportunities for organizational or institutional support.
Gap 3: Postpartum Assistance
Many institutions have attempted to implement protocols to offer support to pregnant surgeons. However, the resources available to these same individuals deteriorate rapidly in the postpartum stage. Some researchers have called for hospitals to provide lactation rooms and refrigerators to store milk and allow surgeons to leave the OR to pump (Sterbling et al., 2023; Knell et al., 2023). However, not all institutions are providing support in alignment with recommendations by the American Board of Surgery or research (Rangel et al., 2022). Research is also needed to better understand a surgeon's experience with postpartum complications, such as childbirth-associated complications, breastfeeding-associated complications, and postpartum depression.
Gap 4: Cultural Nuance
There continues to be a lack of research surrounding surgeons of a variety of backgrounds and the influence of culture, both positive and negative, on their experience of pregnancy. The intersectionality of an individual's identity is necessary to fully understand what type of toll is taken. For example, living in a multi-generational household may mean that some surgeons have more support for childcare; however, this could also mean that there are more individuals reliant upon the surgeon for their daily needs. Including this level of detail about the provider pregnancy experience is necessary to meaningfully explore this multifaceted experience.
Recommendations:
Unquestionably, the literature demonstrates that there is a paucity of research related to fertile and pregnant surgeons and their needs. To bridge these gaps, we have provided four recommendations and their rationale for future research.
Recommendation 1: Emphasize Diverse Populations and Perspectives
First, the inclusion of a diverse population is critical to ensure that the cultural nuances are gathered both within and outside of the workplace. Using inclusive language within these research efforts is also necessary to ensure that all individuals with the ability to conceive can have their voices heard based on their individualized experiences. To gather these voices, utilizing online surveys with compensation can be useful in ensuring that people can complete it without fear of a breach of confidentiality or anonymity while also not having to infringe upon their clinical care duties as it can be completed in a safe space on their own time.
Recommendation 2: Leverage Personal and Professional Community Voices
Second, all individuals with the ability to conceive should be identified as potential sources of information, along with critical members of their personal and professional communities. Examples of professional community members could include peer surgeons and administrators; whereas, personal members would then incorporate partners, family, and other caregivers. Further, probing lactation and fertility specialists, physical and occupational therapists, and obstetricians can be valuable ways to gather expert perspectives. Receiving insights from these groups could further illustrate gaps between policy and the lived experience of surgeons.
Recommendation 3: Investigate All Hospital Types
Third, research at a variety of hospital types (e.g., academic, rural, community) is critical to understanding the full scope of how pregnancy is impacting surgeons across the healthcare system. For instance, providing a pregnant surgeon time off to attend doctor’s visits may be more difficult at a rural hospital as opposed to an academic medical center due to the varying numbers of people available for coverage. Insights into these challenges are necessary to understand what policy adjustments are needed to best support surgeons across the board.
Recommendation 4: Provide Peer Education
Fourth, providing practitioners, their communities, and leaders with further education and training about the intersection of surgery and fertility, pregnancy, and postpartum issues may stimulate action to implement or adapt existing policies to support them. This type of training has already been recommended for residents and toolkits have been developed to support this effort (Sterbling et al., 2023). Likewise, individual practitioners have made efforts to promote knowledge regarding these issues through articles and other pathways (Hamilton, 2018). Versions of these resources could be made accessible to leaders, practitioners, and their communities. This has the potential to both effect positive change as well as generate further willingness to invest resources and participate in research endeavors exploring these issues.
Authors
Event Type
Poster Presentation
TimeMonday, March 314:45pm - 6:15pm EDT
LocationFrontenac Foyer
Digital Health (DH)
Simulation and Education (SE)
Hospital Environments (HE)
Medical and Drug Delivery Devices (MDD)
Patient Safety and Research Initiatives (PS)