For cardiology Fellows in Training (FITs), learning about the governing bodies that regulate training in cardiovascular disease can taste like just another serving of alphabet soup. Understanding the roles of the Accreditation Council for Graduate Medical Education (ACGME), American Board of Internal Medicine and ACC's "COCATS" curriculum recommendations are generally minimal considerations in our day-to-day lives as trainees. However, a few upcoming changes to the ACGME's Common Program Requirements should impact the lives of physician-mother FITs in a noticeably positive way.

ACGME, the organization responsible for accrediting training programs, has established Common Program Requirements (CPR), which are a set of basic standards regarding the structure, duration, leadership, curriculum, and environment of residency and fellowship training. Over the last five years, the ACGME CPR have increasingly emphasized trainee well-being through the creation of new competencies regarding scheduling, safety and self-care. In the newest CPR iteration approved in June 2018, programs will be required to provide "clean and private facilities for lactation that have refrigeration capabilities, with proximity appropriate for safe patient care." For the first time, the CPR address a critical aspect of well-being for physician-mothers who breastfeed after returning from maternity leave.

As medical students, we learned about the importance of breastfeeding to the growth and development of infants. Currently, organizations like the American Academy of Pediatrics and World Health Organization recommend that infants be exclusively breastfed for the first six months of life and longer if possible. In addition, cardiologists focused on the emerging field of cardio-obstetrics have demonstrated better markers of cardiovascular health in women after they breastfed their children for at least six months. However, fulfilling this recommendation often depends on adequate support from the workplace.

Data from across many American industries have shown that breastfeeding mothers feel stigmatized and penalized for pumping at work. Last month, a breast pump support company released results of their national survey of 774 expectant working mothers in which 62 percent of participants believed that there is a stigma associated with pumping at work, 49 percent were concerned that pumping at work could negatively impact their career trajectories, 47 percent considered a career change because of the need to pump at work, and less than 50 percent of surveyed workplaces had designated lactation areas. Female cardiologists are facing similar barriers. In a 2015 survey of 501 female physician members of the ACC, women consistently described completing shorter breastfeeding durations than originally intended, and less than half of the respondents breastfed beyond six months. Sixty-eight percent of women experienced difficulty breastfeeding at work, citing lack of pumping space, adequate breaks and insufficient pumping time as significant hurdles.

In this context, ACGME CPR's provision for designated and appropriately equipped lactation facilities is a clarion call for cardiology fellowship programs to actively support physician-mothers and to address these issues before being subject to program citation by the ACGME starting in July 2019. Recently, trainees and faculty at my institution collaborated to create a guideline that outlines our cardiovascular division's commitment to changing the culture surrounding breastfeeding in the workplace. In this document, we addressed the challenges of finding the space and time to breastfeed during a busy clinical day, detailed expectations regarding the responsibilities of a physician-mother on consultative and procedural rotations, and reinforced the philosophy that these accommodations should be standard for all trainees. In just a few short months, we have already witnessed the benefits on our trainees' well-being, leaving no doubt that the ACGME CPR will accomplish the same.

This article was authored by Nosheen Reza, MD, cardiology Fellow in Training (FIT) at the University of Pennsylvania in Philadelphia, PA.