Ranking family support resources by influence on rank list decisions

Female surgical trainees face substantial emotional and physical demands during and after pregnancy, including increased obstetric complications, postpartum depression, and early attrition. This study assessed the relative importance of ten domains of parental and reproductive support among women and gender-diverse medical students, with the hypothesis that comprehensive parental leave policies would be ranked highest.

An electronic Best-Worst Scaling survey was administered to medical student members of the Association of Women Surgeons from March 27 to June 7, 2025. Eligible participants included medical student members of the Association of Women Surgeons (n = 1050) from multiple medical schools and academic centers. Participants identified the most and least influential factors across ten categories presented in fifteen forced-choice questions. Standardized impact scores (−1.0 to + 1.0) were calculated and used to quantify the relative influence of each category.

A total of 158 students (99% women, 32% fourth-year students, median age 27 years [IQR: 25–29]) completed the survey (response rate 15%). Categories with the highest influence included Postpartum Well-being (impact score = 0.56 ± 0.12), Physical/Emotional Well-being (0.45 ± 0.21), Adoption/Fostering/Surrogacy Support (0.38 ± 0.15), and Grief/Loss Resources (0.19 ± 0.19). The least influential categories were Pregnancy Support (−0.51 ± 0.24) and Parental Leave (−0.64 ± 0.10).

Accommodations related to emotional, physical, and postpartum well-being were identified as the most important supports by respondents. In contrast, pregnancy-specific support and parental leave policies ranked lowest which suggests that, although necessary, these policies do not fully address the broader family-related challenges that arise during training. These findings may also indicate perceived gaps in existing policies or their execution which reinforces the need for accommodations that account for loss, recovery, and other complex circumstances encountered by trainees.