P3A094: Implementing a Standardized Procedure for Supporting Lactating Residents in a Pediatric Residency Program

Background: In 2021, our pediatric residency participated in the American Academy of Pediatrics (AAP) Breastfeeding & Lactation Support for Medical Trainees Implementation Project. Initial steps of the project included a baseline survey evaluating our Policy, Lactation Facilities, Protected Time, Culture of Support, and Responsibilities. We developed a comprehensive action plan based on our results. We scored lowest in the Culture of Support section, therefore, we chose to address our culture as our first area for improvement.

Project Description: Our objective was to create and disseminate a standard operating procedure (SOP) that normalizes breastfeeding/pumping in the workplace for medical residents. The SOP would clarify expectations and promotes a more active culture of support. Our local AAP project team convened monthly. We created a SOP clarifying expectations of lactating residents, attendings, co-residents, and support staff from pregnancy and return to work through the duration of lactation in inpatient and clinic settings. Our SOP was approved by residency leadership. A one page summary document was created and embedded in a larger explanatory PowerPoint. In September 2022, A 15 question pre-survey was administered to pediatric residents followed by the SOP PowerPoint presentation. A resident post-survey was administered in January 2023. Faculty survey and the SOP presentation were given at the October 2022 Pediatric department meeting. Resident experience will be monitored with a standard rotation experience survey and feedback will be given to departments.

Discussion: 29 of 34 residents completed the pre-survey. 23 of 29 completed the post-survey. From the resident’s strongly agree/agree perspective, program leadership being supportive of breastfeeding residents increased from 27.6% to 82.6%. Attendings being supportive of resident pumping increased from 10.3% to 65.2%. Residents can easily step away to pump increased from 10.3% to 56.5%. Residents being aware of breastfeeding education and how to support residents increased from 13.8% to 65.2%. Prior to education and implementation of the SOP, 100% of attendings agreed that they were not aware of lactating residents starting their service.

Conclusion: Most residents and attendings were unsure regarding current expectations of the lactating resident, co-residents and attendings. By sharing clear, accessible expectations for both the pumping resident, attendings and co-residents; our culture of support improved. Post survey revealed significant improvement in perception of program leadership support, attending support, resident ability to step away to pump, and knowledge of education and benefits of breastfeeding. Ultimately, residents will be more successful at maintaining and providing breast milk to their infants and pumping in the workplace will be normalized.