The obstetric experience among vascular surgery trainees

Abstract

Background: Vascular surgery training poses unique risks to pregnancy, including long hours, physically demanding work, and radiation exposure. Our objectives were to (1) understand pregnancy and parenthood experiences among vascular surgery trainees, (2) assess the rate of obstetric complications among vascular trainees, and (3) evaluate factors associated with 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, and harassment), obstetric complications (miscarriage, pre-eclampsia, placental abruption, intrauterine growth restriction, cesarean section, and postpartum depression), and burnout. Multivariable logistic regression models identified factors associated with burnout.

Results: Among 510 trainees from 123 vascular surgery training programs (response rate 85.9%), 128 (25.1%) reported pregnancy during clinical training (12.7% female and 35.4% male; P < .001). Compared with male trainees, female trainees more frequently reported delaying having children owing to training (53.1% vs 30.0%; P < .001) and being advised against having children during residency (7.9% vs 0.4%; P < .001). Both female trainees and the partners of male trainees had high rates of obstetric complications (female 47.1% vs partners of male trainees 34.0%; P = .3). Compared with male trainees who had female partners, female trainees more frequently reported pregnancy/parenthood-related mistreatment (female 60.0% vs male 15.6%; P = .002) and duty-hour violations (female 47.4% vs male 12.0%; P < .001). Female gender was associated with increased risk for burnout (odds ratio, 4.8; 95% confidence interval,1.14-20.15); however, this difference was no longer significant after adjusting for mistreatment and duty-hour violations.

Conclusions: Vascular trainees experience high rates of obstetric complications. Senior-level trainees were more likely to experience obstetric complications, potentially owing to older age, longer and more complex surgical cases, and increased frequency of overnight calls. Women experienced more stigma related to pregnancy and childbearing, which may be associated with higher rates of burnout. Increased support for childbearing during training may help to maintain the wellness of a diverse workforce and better maternal-fetal health.

Keywords: Burnout; Obstetric complications; Pregnancy; Trainee wellness; Vascular surgery training.