Inequality, discrimination and regulatory failure in surgical training during pregnancy

By Sara Dorman

In recent years there has been an increasing number of publications reporting the difficulties experienced by women working in surgical specialities. The World Health Organisation recent gender equality analysis report, ‘Delivered by women, led by men’ highlights that although women account for 70% of the health and social care workforce worldwide, female healthcare workers face barriers at work not experienced by their male colleagues. This can impact well-being, prevent further progress on gender equality and negatively impact healthcare systems and the delivery of quality care¹.

In the UK, female surgical trainees commonly report dissatisfaction with lack of support and available guidance during pregnancy and maternity leave. Trauma and orthopaedics presents a unique risk profile to pregnant trainees with many potential hazards to both mother and child, including ionising radiation and exposure to teratogenic chemicals in bone cement and some scrub solutions. Some professional bodies have made steps towards improving guidance, however the information is difficult to access, fragmented and not specific to T&O. Moreover, there is a lack of awareness and signposting amongst trainees and trainers of the resources that are currently available.

Anecdotally, guidance and risk assessment currently available for pregnant trainees is perceived as a ‘tick box’ exercise rather than providing useful, practical or safe advice.

A recent UK wide study published in the TJTO&C uncovered evidence of inequality, discrimination and regulatory failure in pregnancy Trauma and Orthopaedic trainees. The majority of highlighted issues stemmed from overarching themes of inflexible training infrastructure, lack of communication and clear guidance on what is reasonably expected from the employer, trainer and trainee during pregnancy.

There is currently wide variation in management of pregnant T&O trainees with many women reporting negative experiences during pregnancy and when returning to work after a period of maternity leave. Occupational risk assessment is a statutory responsibility of every employer, which is not currently adequate. The majority of women reported either no risk assessment, or an assessment completed by an inappropriate staff member.

Anxiety was reported from both trainees and trainers regarding risks of operating whilst pregnant and how to support a returning trainee after maternity leave. A lack of clear practical guidance combined with an inability of trainers who have never experienced pregnancy or maternity leave to understand the impact of this on one’s training often lead to well-intentioned but ineffectual support.

There are issues to be addressed with regards to practical aspects of job planning, workplace bias, effective loss of training time towards CCT, lack of engagement with KIT days and lack of awareness of guidance from key trainers. In response to these findings the JCST have released updated guidance, ‘Pregnancy - A guide for surgical trainees and trainers’, to provide current and consistent ‘user friendly’ recommendations. Pregnant T&O trainees are no longer a rare occurrence and it is important to consider the changing trends in the workforce population. In the UK, 55% of current medical students and 59% of doctors in training are female. Whilst surgical specialties have traditionally been a male dominated field, the number of female trainees continues to rise and currently one in three surgical trainees are female².

It is therefore likely that managing pregnant surgical trainees will become increasingly commonplace in the future. Should surgical specialties wish to continue attract highly-skilled, competitive female trainees, these issues need to be addressed.

References

1. World Health Organisation (2019). Delivered by Women, Led by Men: A Gender and Equity Analysis of the Global Health and Social Workforce. Human Resources for Health Observer [Internet cited 2020
Feb 10]. Available at: https://www.who.int/hrh/resources/health-observer24/en/.

2. General Medical Council (2017). Our data on medical students and doctors in training in the UK [Internet cited 2020 Feb 10]. Available at: https://www.gmcuk.org/static/documents/content/SoMEP_2017_chapter_2.pdf.