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Sociodemographic factors affecting paediatric surgical training in Malaysia: Gender matters

      Highlights

      • We provide a rare snapshot of paediatric surgical training in a developing middle-income country in South-East Asia.
      • While there is near parity in gender representation in the speciality, female paediatric surgical trainees remain more likely than male trainees to face work-life conflicts.
      • The most common issues raised were concerns regarding hands-on opportunities and the importance of support in balancing work and personal needs.

      Abstract

      Background

      A shortage of specialist paediatric surgeons in Malaysia led to establishment of a national postgraduate training programme in 2004. We aimed to identify sociodemographic factors impacting training experience, and to define pressure points during training to inform targeted trainee support strategies.

      Methods

      We conducted an anonymized online survey in June 2021 on all programme graduates. Participants were asked for sociodemographic data, both current and during training. Likert scale responses were required for questions regarding adequacy of support received for family, health and personal issues during training. A free text response question soliciting suggestions for programme improvement was included. Data are reported as median (range). Chi-square/Fisher's exact tests for categorical variables and Mann-Whitney U tests for continuous variables were used, with p<0.05 significance.

      Results

      Of 53 eligible participants, 52 (98%) responded, 24 (46%) were female. Marital status was similar between genders at entry, but female trainees were more likely to be unmarried on exit (p = 0.001), and less likely to have children while training (p = 0.017). Of the 6 female and 18 male trainees who had children while training, women were more likely to take parental leave (p = 0.01). The majority felt advice given regarding parental leave and managing training while having children were poor. In thematic analysis of free text answers, lack of hands-on experience was the most common concern.

      Conclusion

      Factors related to marriage and parenthood significantly associate with gender amongst trainees in Malaysia despite both genders being well represented. Concerns regarding adequacy of hands-on training highlight the need for educational innovations such as simulation models.

      Level of study

      Level III.

      Keywords

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      References

      1. Mahmud M.N. A long journey of hope - the development of paediatric surgery in Malaysia. Berita CSM, College of Surgeons, Academy of Medicine of Malaysia. Oct 2012.

        • Hu Y.Y.
        • Ellis R.J.
        • Hewitt D.B.
        • et al.
        Discrimination, abuse, harassment, and burnout in surgical residency training.
        N Engl J Med. 2019; 381: 1741-1752https://doi.org/10.1056/NEJMsa1903759
        • Butler E.K.
        • Tran T.M.
        • Nagarajan N.
        • et al.
        SOSAS 4 country research group. Epidemiology of pediatric surgical needs in low-income countries.
        PLoS ONE. 2017; 12e0170968https://doi.org/10.1371/journal.pone.0170968
        • Arshat H.
        • Tey N.P.
        An overview of the population dynamics in Malaysia.
        Malays J Reprod Health. 1988; 6: 23-46
      2. https://population.un.org/wpp/dataquery/

        • Phillips E.A.
        • Nimeh T.
        • Braga J.
        • et al.
        Does a surgical career affect a woman's childbearing and fertility? A report on pregnancy and fertility trends among female surgeons.
        J Am Coll Surg. 2014; 219: 944-950https://doi.org/10.1016/j.jamcollsurg.2014.07.936
        • Rangel E.L.
        • Castillo-Angeles M.
        • Easter S.R.
        • et al.
        Incidence of infertility and pregnancy complications in US female surgeons.
        JAMA Surg. 2021; 156: 905-915https://doi.org/10.1001/jamasurg.2021.3301
        • Atkinson R.B.
        • Castillo-Angeles M.
        • Kim E.S.
        • et al.
        The long road to parenthood: assisted reproduction, surrogacy, and adoption among US surgeons.
        Ann Surg. 2022; 275: 106-114https://doi.org/10.1097/SLA.0000000000005253
        • Todd A.R.
        • Cawthorn T.R.
        • Temple-Oberle C.
        Pregnancy and parenthood remain challenging during surgical residency: a systematic review.
        Acad Med. 2020; 95: 1607-1615https://doi.org/10.1097/ACM.0000000000003351
        • Altieri M.S.
        • Salles A.
        • Bevilacqua L.A.
        • et al.
        Perceptions of surgery residents about parental leave during training.
        JAMA Surg. 2019; 154: 952-958https://doi.org/10.1001/jamasurg.2019.2985
        • Rogers A.C.
        • Wren S.M.
        • McNamara D.A.
        Gender and specialty influences on personal and professional life among trainees.
        Ann Surg. 2019; 269: 383-387https://doi.org/10.1097/SLA.0000000000002580
        • Obrenovic B.
        • Jianguo D.
        • Khudaykulov A.
        • et al.
        Work-family conflict impact on psychological safety and psychological well-being: a job performance model.
        Front Psychol. 2020; 11: 475https://doi.org/10.3389/fpsyg.2020.00475
        • Castillo-Angeles M.
        • Stucke R.S.
        • Rosenkranz K.M.
        • et al.
        Paternity leave during surgical training: perspectives of male residents.
        J Surg Educ. 2022; (S1931-7204(22)00101-5)https://doi.org/10.1016/j.jsurg.2022.04.012
        • Evans J.
        • Kemp M.T.
        • Rivard S.J.
        • et al.
        Not just bystanders: a qualitative study on the vicarious effects of surgical training on the wellness of support persons for trainees.
        Ann Surg. 2021; 274: e295-e300https://doi.org/10.1097/SLA.0000000000004890
        • Patel N.
        • Loveland J.
        A perspective on paediatric surgical training: opportunities and challenges.
        S Afr J Surg. 2018; 56 (Mar): 3-6
        • Beasley S.W.
        The challenges facing training in pediatric surgery worldwide.
        Front Pediatr. 2013; 1: 24https://doi.org/10.3389/fped.2013.00024
        • Nataraja R.M.
        • Oo Y.M.
        • Ljuhar D.
        • et al.
        Overview of a novel paediatric surgical simulation-based medical education programme in Myanmar.
        ANZ J Surg. 2020; 90: 1925-1932https://doi.org/10.1111/ans.16200
        • McClelland T.J.
        • Ford K.
        • Dagash H.
        • et al.
        Low-fidelity paediatric surgical simulation: description of models in low-resource settings.
        World J Surg. 2019; 43: 1193-1197https://doi.org/10.1007/s00268-019-04921-3
        • Neville J.J.
        • Chacon C.S.
        • Haghighi-Osgouei R.
        • et al.
        Development and validation of a novel 3D-printed simulation model for open oesophageal atresia and tracheo-oesophageal fistula repair.
        Pediatr Surg Int. 2022; 38: 133-141https://doi.org/10.1007/s00383-021-05007-9
        • Wallis C.J.D.
        • Jerath A.
        • Coburn N.
        • et al.
        Association of surgeon-patient sex concordance with postoperative outcomes.
        JAMA Surg. 2022; 157: 146-156https://doi.org/10.1001/jamasurg.2021.6339