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Hartman H, Kermanshahi N, Matzkin E, Keyser EA, Gianakos AL. Decreased Fertility Awareness Amongst Surgeons and Surgical Trainees and Potential Role of Formal Fertility Education. JOURNAL OF SURGICAL EDUCATION 2024; 81:947-959. [PMID: 38749812 DOI: 10.1016/j.jsurg.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE Compared to the general population, physicians tend to have children later in life, increasing rates of infertility, obstetrical complications, and the need for assisted reproductive technology (ART). The aim of this study is to systematically review the literature to determine the level of fertility and ART knowledge amongst United States surgeons and surgical trainees, and analyze the impact of the medical career on family planning goals and outcomes. DESIGN A systematic literature search of articles published between 2014 to 2022 in the MEDLINE, EMBASE, and Cochrane databases was performed in January 2023 according to, Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary outcome measures included fertility and ART knowledge, childbearing decision-making factors, and current education. Secondary outcomes included evaluation of institutional support, postpartum, and infertility. PARTICIPANTS Sixteen studies with a total of 6983 partici- pants (908 men and 5162 women) were included in this systematic review. RESULTS Sixteen studies with a total of 6983 participants (908 men and 5162 women) were included in this systematic review. Though most participants were aware of the presence of age-related fertility decline, most were lacking in fertility and ART knowledge, and most likely did not receive formal education in these topics. The vast majority elected to delay childbearing due to career aspirations, with many facing subsequent pregnancy complications, infertility challenges, and a lack of institutional support in the postpartum period. CONCLUSIONS Our study demonstrates that medical students, trainees, and physicians overall are lacking in knowledge and awareness regarding age-related fertility decline and ART, indicating the necessity for a formal educational curriculum. Additionally, female physicians opt to delay childbearing longer than their male counterparts, while also experiencing increased complications and institutional challenges. This study clearly demonstrates a need for parental leave policy expansion, transparency of the policies in place, and financial and time allowance support for elective oocyte cryopreservation in the medical community.
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Affiliation(s)
- Hayden Hartman
- DeBusk College of Osteopathic Medicine; Lincoln Memorial University; Knoxville; TN 37932.
| | - Nazanin Kermanshahi
- Arizona College of Osteopathic Medicine; Midwestsern University; Glendale; AZ 85308
| | - Elizabeth Matzkin
- Department of Orthopaedic Surgery; Brigham and Women's Hospital; Boston; MA 02115
| | - Erin A Keyser
- Gynecologic Surgery & Obstetrics; Brooke Army Medical Center; Houston; TX 78234
| | - Arianna L Gianakos
- Yale Medicine, Orthopedics & Rehabilitation; Yale School of Medicine; New Haven; CT 06519
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Katz S, Insogna I, Tomblinson C, Dave P, Matalon SA. Supporting Physicians through Infertility and Assisted Reproductive Technology. Radiographics 2024; 44:e230187. [PMID: 38206832 DOI: 10.1148/rg.230187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
- Sydney Katz
- From the Department of General Internal Medicine, Division of Hospital Medicine, Weill Cornell Medical College, New York, NY (S.K.); Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, Columbia University Medical Center, New York, NY (I.I.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (C.T.); Department of Internal Medicine, Mount Sinai Health System, New York, NY (P.D.); and Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (S.A.M.)
| | - Iris Insogna
- From the Department of General Internal Medicine, Division of Hospital Medicine, Weill Cornell Medical College, New York, NY (S.K.); Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, Columbia University Medical Center, New York, NY (I.I.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (C.T.); Department of Internal Medicine, Mount Sinai Health System, New York, NY (P.D.); and Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (S.A.M.)
| | - Courtney Tomblinson
- From the Department of General Internal Medicine, Division of Hospital Medicine, Weill Cornell Medical College, New York, NY (S.K.); Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, Columbia University Medical Center, New York, NY (I.I.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (C.T.); Department of Internal Medicine, Mount Sinai Health System, New York, NY (P.D.); and Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (S.A.M.)
| | - Priya Dave
- From the Department of General Internal Medicine, Division of Hospital Medicine, Weill Cornell Medical College, New York, NY (S.K.); Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, Columbia University Medical Center, New York, NY (I.I.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (C.T.); Department of Internal Medicine, Mount Sinai Health System, New York, NY (P.D.); and Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (S.A.M.)
| | - Shanna A Matalon
- From the Department of General Internal Medicine, Division of Hospital Medicine, Weill Cornell Medical College, New York, NY (S.K.); Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, Columbia University Medical Center, New York, NY (I.I.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (C.T.); Department of Internal Medicine, Mount Sinai Health System, New York, NY (P.D.); and Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (S.A.M.)
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Sterbling HM, Kelly CH, Stafford A, Willey S, Dort J. Pregnancy Curriculum: Advocating for a Healthier Pregnancy in General Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2023; 80:1799-1805. [PMID: 37661564 DOI: 10.1016/j.jsurg.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION With an increasing number of women entering surgical careers, pregnancy amongst surgical residents is anecdotally rising. There is no single resource to inform expectant surgical residents of potential occupational risks, or to help them optimize workplace safety during and after pregnancy. The aim of this initiative is to provide surgical residents with an overview of residency occupational risks applicable to maternal-fetal health, propose systemic and situational modifications, and to empower pregnant residents to better plan and advocate for a healthy pregnancy. METHODS Surgery department staff were invited to contribute to the pregnancy curriculum at the authors' institution. Feedback was received from attending physicians and surgical residents (N = 12), as well as all female residents having experienced in-training pregnancy or early child-rearing from 2017 to 2022 (N = 6). After identifying workplace hazard and compiling staff feedback, the authors developed a set of recommendations for the protection of pregnant and early-parenting female trainees. RESULTS Five areas of process improvements were identified for the protection of pregnant residents: culture, ergonomics, exposure, maternal & fetal care, and fourth trimester support. Specific recommendations ranged from widespread institutional support emphasizing psychological safety and zero-retaliation policies, to healthcare-related hazard exposure protections, as well as tangible postpartum and lactation support. Out of this initiative came the pregnancy curriculum. CONCLUSION Widespread and decisive institutional support is paramount to cultural shifts surrounding in-training pregnancy. The guidelines proposed in this project are intended to be enforced by surgical residency leadership with the precise goal of removing the cultural burden from the expectant resident. Only the resident herself can thereafter chose to adopt or decline the protective measures. Through our recommendations, we hope to offer a foundation upon which individual residents and program leaders can build tailored, pregnancy-specific interventions, with the ultimate goal of improving the antenatal outcomes of our trainees and their growing families without compromising surgical training.
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Affiliation(s)
| | - Colleen H Kelly
- Inova Health System, Department of Surgery, Falls Church, Virginia
| | - Arielle Stafford
- Inova Schar Cancer Institute, Department of Breast Surgery, Fairfax, Virginia
| | - Shawna Willey
- Inova Schar Cancer Institute, Department of Breast Surgery, Fairfax, Virginia
| | - Jonathan Dort
- Inova Health System, Department of Surgery, Falls Church, Virginia
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