A Qualitative Evaluation of the Experience of Parenthood During Surgical Residency

To describe the longitudinal experience of parenthood in surgical residency.

Childbearing during training is increasingly common. While pregnancy and postpartum accommodations are increasingly available, their impact on residents' experience is unclear. Moreover, their experience beyond leave is under-characterized.

We performed semi-structured interviews about wellness with residents, faculty, and staff at 15 general surgery residency programs; the experience of parenthood during residency was a recurring topic. A codebook was developed inductively. Themes are presented as either Challenges or Program Supports within phases of parenthood: Pregnancy , Fourth Trimester ( ie, postpartum ), and Long-term Parenthood .

Eighty-two interviews, performed at 13 programs, had content relevant to the experience of parenthood in residency. Residents described intense pressure to avoid burdening co-residents during Pregnancy , driving them to maintain a full workload and attempt to schedule gestation/delivery around the program's needs. Those who experienced obstetric complications attributed them to working at full pace. Many described incompletely utilizing available Fourth Trimester accommodations due to perceived resentment. Normalization of pregnancy, supportive peer and faculty behaviors, and program-implemented policies empowered residents to utilize accommodations and self-advocate. During Long-term Parenthood , residents struggled with the "moral injury" of experiencing parenthood and education/patient care as competing priorities. Surgeons described spousal/family support and/or independent wealth as essential to securing childcare. Programmatic supports in Parenthood consisted primarily of role modeling; practical, infrastructural solutions (eg, affordable childcare) were lacking.

Substantial progress has been made in addressing Fourth Trimester issues during surgical residency (eg, parental leave, lactation support). However, major barriers to parenthood persist during the remaining phases, including a dearth of systems-level supports. These barriers likely perpetuate gender and socioeconomic inequities in the surgical workforce.