Medical student views on barriers to family planning during surgical training: a mixed methods study

Due to the impending surgeon shortage and high resident attrition, it is imperative to understand medical students’ perceptions of surgery, especially related to family planning, to evaluate ways to increase interest in the field. Our previous study identified that over half of students surveyed were strongly considering having children in residency. However, top barriers for students pursuing surgery included work-time demands, childcare, and time away from training. This study used a mixed methods approach with an initial survey and then individual structured interviews with medical students. A secondary analysis was performed on survey data previously collected at a single institution in 2023 to inform development of interview questions. Thematic analysis was done with subsequent quantitative analysis of content codes as a measure of importance.. Survey questions included demographics and questions regarding barriers to family planning during surgical training rated on a 5-point Likert scale. Univariable and multivariable analysis was performed. Students interested in surgery were more likely to perceive time away from training, strain on the program, and support from faculty as stronger barriers to having children in residency. Females were significantly more likely to perceive time away from training, work-time demand, breastfeeding barriers, support from faculty, and personal health as strong barriers to having children during training. Eight themes were identified within 21 interviews: accommodations and policies, logistics of training, culture, specialty, career, external views, concerns related to personal resources, and health-related concerns. Ideas differed by student characteristics, including gender, curriculum stage, and specialty interest. Students perceive a multitude of barriers to having children during surgical training. Pre-surgical and female students perceive unique barriers compared with their peers, and many students discussed the idea of choosing an alternative specialty due to these barriers.