Research Original Investigation
Pregnancy-Related Attrition
Invited Commentary
Are There Repercussions Associated With Pregnancy-Related Attrition? Jeffrey M. Gauvin, MD
Surgical training programs have long had the highest attrition rates of any medical specialty; approximately 20% of categorical general surgery residents do not complete their training.1 Understanding the changing demographics and Related article page 893 priorities of our current residents is crucial if we are to address this issue. Women have been underrepresented in our specialty for a long time but fortunately, this is changing; there are currently more women in surgical training than ever before. Additionally, today’s male residents are far more likely to have working spouses and the desire to be more involved parents compared with male residents in preceding generations. Brown and colleagues2 have published the first study, to my knowledge, to examine the link between pregnancy and attrition in a general surgery training program. The authors considered the effects of child rearing on both male and female residents and conclude, despite prevalent stereotypes, that child rearing does not appear to cause women or men to leave their training programs at a higher rate than their nonchildrearing colleagues. Alhough this is an important first step, I fear the data from this single institution may not be easily extrapolated to other residency programs. The University of California, Davis general surgical residency program is unique in several ways; it ARTICLE INFORMATION Author Affiliation: Cottage Health System, Santa Barbara, California. Corresponding Author: Jeffrey M. Gauvin, MD, Cottage Health System, PO Box 689, Santa Barbara, CA 93102-6089 ([email protected]).
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has a very large number of categorical residents, a large pool of preliminary interns, and a steady reserve of midlevel residents in the laboratory. These features provide a deep bullpen from which a program director can call in reserves when someone is on leave. This may be a very different scenario for small or midsized programs that have very limited—if any— reserves. The authors claim that residents who took leave did not put undue stress on their remaining peers. This was an assumption and not formally studied. I suspect that resentment might develop after some time while covering residents on leave; some residents left the program for as long as 16 weeks. The authors might want to survey the residents who had to fill in and assess the effect this may have had on morale, especially on individuals who chose to defer childbearing until after residency. I congratulate the authors for addressing this timely and important topic and agree with their conclusions as they apply to large programs. However, further study is required before we can extrapolate these data to general surgery programs at large. Regardless, increasing numbers of residents will have children and surgical residencies will continue to have high attrition rates. Any information gathered to help us better understand this phenomenon is important. This study is an excellent step in that direction.
Published Online: July 16, 2014. doi:10.1001/jamasurg.2014.1200.
residents leave and where do they go? Ann Surg. 2010;252(3):529-534, discussion 534-536.
Conflict of Interest Disclosures: None reported.
2. Brown EG, Galante JM, Keller BA, Braxton J, Farmer DL. Pregnancy-related attrition in general surgery [published online July 16, 2014]. JAMA Surg. doi:10.1001/jamasurg.2014.1227.
REFERENCES 1. Yeo H, Bucholz E, Ann Sosa J, et al. A national study of attrition in general surgery training: which
JAMA Surgery September 2014 Volume 149, Number 9
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a University of Texas at Austin User on 06/06/2015
jamasurgery.com
Pregnancy-Related Attrition
Invited Commentary
Are There Repercussions Associated With Pregnancy-Related Attrition? Jeffrey M. Gauvin, MD
Surgical training programs have long had the highest attrition rates of any medical specialty; approximately 20% of categorical general surgery residents do not complete their training.1 Understanding the changing demographics and Related article page 893 priorities of our current residents is crucial if we are to address this issue. Women have been underrepresented in our specialty for a long time but fortunately, this is changing; there are currently more women in surgical training than ever before. Additionally, today’s male residents are far more likely to have working spouses and the desire to be more involved parents compared with male residents in preceding generations. Brown and colleagues2 have published the first study, to my knowledge, to examine the link between pregnancy and attrition in a general surgery training program. The authors considered the effects of child rearing on both male and female residents and conclude, despite prevalent stereotypes, that child rearing does not appear to cause women or men to leave their training programs at a higher rate than their nonchildrearing colleagues. Alhough this is an important first step, I fear the data from this single institution may not be easily extrapolated to other residency programs. The University of California, Davis general surgical residency program is unique in several ways; it ARTICLE INFORMATION Author Affiliation: Cottage Health System, Santa Barbara, California. Corresponding Author: Jeffrey M. Gauvin, MD, Cottage Health System, PO Box 689, Santa Barbara, CA 93102-6089 ([email protected]).
898
has a very large number of categorical residents, a large pool of preliminary interns, and a steady reserve of midlevel residents in the laboratory. These features provide a deep bullpen from which a program director can call in reserves when someone is on leave. This may be a very different scenario for small or midsized programs that have very limited—if any— reserves. The authors claim that residents who took leave did not put undue stress on their remaining peers. This was an assumption and not formally studied. I suspect that resentment might develop after some time while covering residents on leave; some residents left the program for as long as 16 weeks. The authors might want to survey the residents who had to fill in and assess the effect this may have had on morale, especially on individuals who chose to defer childbearing until after residency. I congratulate the authors for addressing this timely and important topic and agree with their conclusions as they apply to large programs. However, further study is required before we can extrapolate these data to general surgery programs at large. Regardless, increasing numbers of residents will have children and surgical residencies will continue to have high attrition rates. Any information gathered to help us better understand this phenomenon is important. This study is an excellent step in that direction.
Published Online: July 16, 2014. doi:10.1001/jamasurg.2014.1200.
residents leave and where do they go? Ann Surg. 2010;252(3):529-534, discussion 534-536.
Conflict of Interest Disclosures: None reported.
2. Brown EG, Galante JM, Keller BA, Braxton J, Farmer DL. Pregnancy-related attrition in general surgery [published online July 16, 2014]. JAMA Surg. doi:10.1001/jamasurg.2014.1227.
REFERENCES 1. Yeo H, Bucholz E, Ann Sosa J, et al. A national study of attrition in general surgery training: which
JAMA Surgery September 2014 Volume 149, Number 9
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a University of Texas at Austin User on 06/06/2015
jamasurgery.com
