Maria S. Altieri, MD, MS Invasive surgery fellow Washington University, St. Louis, MO

Surgical Residency: Multiple Obstacles to Parental Leave Remain Interview with:

Maria S. Altieri, MD, MS Invasive surgery fellow Washington University, St. Louis, MO

Dr. Altieri

Maria S. Altieri, MD, MS
Invasive Surgery
Stony Brook, NY What is the background for this study? What are the main findings?

Response: For majority of residents, training years coincide with prime child bearing years.  Historically, surgical residency has not been conducive for having children, as it is one of the most demanding experiences, requiring long hours, high stress levels, and the acquisition of clinical and technical skills over a short period of time.

However, with recent trends towards a more favorable work-life balance and the 80-hour work week, more male and female residents are having children or considering having children during training.  Thus, the topic of parental leave during residency is becoming more fundamental.  However, there is little research on the attitudes of residents towards their pregnant peers and parental leave.

We wanted to examine the perceptions of surgical trainees towards parental leave and pregnancy during residency.  Through understanding the perceptions of current residents, obstacles could be identified which could lead to potential changes in policies that could help to normalize parenthood and parental leave during surgical training. What are the main findings? What should readers take away from your report?

Response: The survey examined 2,188 responses provided by surgical trainees around the country in 2018.  Only 28.6% of respondents had/were expecting children at the time of the survey and majority of them (82%) had or were currently expecting a child during the clinical years of training.  Despite that, only 4% of the residents knew the current parental leave policy under the American Board of Surgery (ABS).  A significant portion (43%) took less than 2 weeks of parental leave.  In addition, a substantial portion of residents didn’t feel supported by either fellow residents or faculty.  Lack of universal leave policy, strain on the residency program, loss of education/training time, lack of flexibility of programs, and perceived or actual lack of support were identified as the biggest obstacles towards taking leave during the clinical years of residency.  These obstacles are all modifiable factors. What recommendations do you have for future research as a result of this work?

Response: Based on these findings, we are hoping for future policies at the levels of the governing bodies for surgery residency programs, such as the Accreditation Council for Graduate Medical Education (ACGME) or Resident Review Committee (RRC) in order to normalize pregnancy and parenthood during training for both male and female surgery residents.  Currently, parental leave falls under “Medical Leave” under the ABS policy, which applies to an individual with a medical condition.  This means that pregnancy is treated like a medical problem rather than a normal part of adulthood.  In addition, it only applies to the individual who is pregnant, thus fathers in residency cannot technically use this clause for parental leave.  Instead of making exceptions for both parents, there is a significant opportunity for improvement here. Is there anything else you would like to add?

Response: This research stemmed from previous experiences by two of the authors during their residency.  There is never an ideal time for having children during training, especially if the resident doesn’t want to prolong their training by taking research years or the timing is not ideal during research years.  While majority of the experiences have been positive while being pregnant and having children, there were some negative experiences.  We believe it stemmed from lack of education and perception that having a family should be a normal part of an adult life, even during the grueling time of surgical training.  Thus, we wanted to shed some light on a pressing issue in surgical training.  


Altieri MS, Salles A, Bevilacqua LA, et al. Perceptions of Surgery Residents About Parental Leave During Training. JAMA Surg. Published online August 07, 2019. doi:10.1001/jamasurg.2019.2985

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Last Updated on August 7, 2019 by Marie Benz MD FAAD