Speaker

Erika Rangel, MD
Associate Professor of Surgery
Department of Surgery
Harvard Medical School
Medical Director for Clinician Wellbeing
Mass General Brigham

Keywords

Childbearing medical trainees, Burnout, Parental support, Pregnancy support

Slides

Key Points

• Previous studies have shown that surgical residents experience difficulties during medical training and pregnancy and early parenthood. Modified schedules were rare, less than 6 weeks parental leave was common, pumping was difficult, and mentorship regarding balancing family and career was lacking. Many questioned the sustainability of a surgical career affecting an already existing workforce shortage.

• The aim of this study was to improve the work environment and culture for the vulnerable group of childbearing medical trainees while preserving the rigor and quality of the training program.

• Study outcomes were chosen in 3 domains that reflect positive return on investment for the workplace. Domains included well-being (burnout), workforce outcomes, and functioning at work and home. Burnout was used as the primary outcome; burnout costs healthcare organizations $4.6 billion a year and has a human cost to the trainee as well.

• The pragmatic design of the study lessened the burden on participating institutions by including interventions that could be delivered directly to the trainee. The parental support package included a wearable breast pump, a smart bassinet, faculty mentorship, and 24/7 virtual prenatal care via an app.

• Across 7 institutions, 156 pregnant residents and fellows were enrolled and randomized to either usual support or the parental support package group. All participants were given a fitbit to track sleep and all were asked to track medical errors. The research question was deliberately phrased as ‘what happens when this parental support package was offered at an institution.’

• The parental support package was used variably by participants. Institutional environments also varied. These variable factors were analyzed separately. The support package appeared to buffer the rise in burnout for the intervention group. Interpersonal disengagement was significantly improved and improved sleep decreased medical error.

Discussion Themes

Institutions understand that burnout is an issue for childbearing medical trainees, and response to the study was enthusiastic. Originally only 3 institutions were targeted, but 7 were ultimately included in the study.

Medical trainees were also enthusiastic to participate with a 92% retention rate. Word of mouth and social media were instrumental in recruitment.

 

Read more about the The 4^th Trimester Initiative.