WORCESTER MEDICINE
Infertility
Building Families: Educating our Next Generation of Physicians Christine Van Horn, MD Jennifer Yates, MD Haley Schachter
G
enerations of physicians have walked a
tightrope — balancing dedication to patient care, career aspirations, personal goals and interests, and, in many cases, starting and raising a family. We are fortunate to see many changes over the past decade, with more attention paid to quality of life, burnout, work-life balance, and overall physician and provider wellness. We, as physicians, regardless of our specialty, have undoubtably offered our time, energy and expertise at some point in our careers to support our patients as they become pregnant or adopt, raise children, and thrive as parents. Our colleagues in the Obstetrics and Pediatrics department come to mind as physicians committed and dedicated to this cause. Surgeons and medical specialists take into consideration how the diagnostic tests and treatments we offer impact patients’ fertility and ability to raise a family. For example, our Radiology colleagues are dedicated to limiting the risks of radiation to our patients of childbearing age. But, do we excel at protecting and educating ourselves and our colleagues, our trainees and their families? Historically, this aspect of our lives as physicians has not been an area of research or advocacy. A recent New York Times article highlighted what many physicians already knew from small studies within our own specialties: our chosen career path and, for most of us, our passion, can be at the expense of our own fertility and pregnancies(1). In this article, Jacqueline Mroz describes the challenges female physicians face, including delaying childbearing until after training, infertility and the poor health outcomes that have been described in pregnant physicians. This should be a burning platform, an epidemic of infertility and higher risk pregnancies in an identified cohort of patients. And, thankfully, this is indeed receiving more attention, more study and, we can only hope, with time, improved outcomes. Recognizing the challenges physicians are facing as they anticipate or begin to build families, what can we do to build awareness and support our colleagues? We can start with our trainees, with education and infor-
8
mation and resources that many of us discovered along the way, during our career and family-building journeys. At UMass Chan Medical School, we are taking the first step to support our trainees by learning about the educational gaps. In an IRB-approved survey designed by a urology resident, Dr. Christine Van Horn, we are building a level of understanding of trainees’ experience regarding building families, and what gaps in both knowledge and support exist so we can begin to fill them. Dr. Van Horn reviewed the existing literature regarding these knowledge gaps, and the challenges faced by physicians, which mirror those outlined in Mroz’s article. Published literature explores issues such as the stigma of taking time off for pregnancy, barriers within institutions to pregnancy and motherhood for trainees, and duration of maternity leave afforded childbearing residents (2, 3, 4, 5). In addition to seeking information about the challenges faced when becoming pregnant and maintaining pregnancy, we sought also to understand other knowledge gaps, including fertility preservation options and the risks to the mother and fetus that can be unique to our careers. The study is ongoing, but preliminary review of the data has revealed findings, some of which are expected, and others which were more surprising. Interestingly, 56% of respondents felt some degree of guilt thinking about having children in residency and 51% were planning on delaying childbearing until completion of training. On knowledge base questions, the majority did not know basic information regarding oocyte cryopreservation and expressed uncertainty in knowledge of safety protocols for fluoroscopy use in pregnancy. In addition, 64% showed some concern regarding declining fertility while in training. The majority were also unsure of the answers regarding aspects of infertility in physicians or childbearing in training drawn from the primary literature with the exceptions of questions regarding bias or other negative aspects of pregnancy in training. As we continue to gather data from the survey, we ask ourselves where we go next with this information. We initiated this project with strong support from UMass Chan Medical School, and we will partner with our undergraduate medical students and graduate offices to provide educational resources for trainees. Based on these findings, we would like to focus on education surrounding the dynamics of fertility throughout training and offer additional information regarding fertility preservation options. These are topics which we, as physicians, often do not discuss with our trainees. However, we are poised as mentors, colleagues and educators to open the dialogue. We are excited to practice as residents and faculty during a time when these topics are gaining traction and looking forward to supporting our physicians and aspiring physician colleagues. + references (see digital edition)
Christine Van Horn, MD Urology Resident (PGY-4), University of Massachusetts Chan Medical School Jennifer Yates, MD Associate Professor and Vice-Chair of Academic Affairs, University of Massachusetts Chan Medical School, University of Massachusetts Medical Center Haley Schachter, third-year medical student, UMass Chan Medical School
JANUARY / FEBRUARY 2022
