Parental Support: The 5-in-6 Pathway - Flexibility in Surgical Residency Training

Behind The Knife: The Surgery Podcast

Education, Science, Health & Fitness, Medicine

4.8 • 1.4K Ratings

🗓️ 29 January 2026

⏱️ 41 minutes

🔗️ Recording | iTunes | RSS

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Summary

You’re in the middle of surgical residency, and you realize you need more than a few weeks away from clinical responsibilities. Maybe you need more time to be a parent, recover from an illness, care for family, learn a new skill, or simply create space to reflect and reset. What if you could complete five years of training over six calendar years by spreading that time out in a way that fits your life?
Join Dr. Kara Button with Dr. Joe Buyske, and Dr. Bridget Olson as they break down the 5-in-6 pathway including how it works, who it’s for, and the real-world logistics that matter.

Hosts:
Kara Button, DO — General Surgery Resident, Maine Medical Center; Behind the Knife Surgical Education Fellow
Jo Buyske, MD — President & CEO, American Board of Surgery
Dr. Bridget Olsen, MD — General Surgery Resident, Maine Medical Center

References:
Bamdad MC, Hughes DT, Englesbe M. Safe and supported pregnancy: A call to action for surgery chairs and program directors: A call to action for surgery chairs and program directors. Ann Surg. 2022;275(1):e1-e2. doi:10.1097/SLA.0000000000005181 https://pubmed.ncbi.nlm.nih.gov/34433187/

Castillo-Angeles M, Atkinson RB, Easter SR, et al. Pregnancy during surgical training: Are residency programs truly supporting their trainees? J Surg Educ. 2022;79(6):e92-e102. doi:10.1016/j.jsurg.2022.06.011 https://pubmed.ncbi.nlm.nih.gov/35842402/

Castillo-Angeles M, Smink DS, Rangel EL. Perspectives of general surgery program directors on paternity leave during surgical training. JAMA Surg. 2022;157(2):105-111. doi:10.1001/jamasurg.2021.6223 https://pubmed.ncbi.nlm.nih.gov/34851404/

Kanters AE, Shubeck SP. The importance of parental leave and lactation support for surgeons. Clin Colon Rectal Surg. 2023;36(5):333-337. doi:10.1055/s-0043-1764288 https://pubmed.ncbi.nlm.nih.gov/37564351/

Kling SM, Slashinski MJ, Green RL, Taylor GA, Dunham P, Kuo LE. Parental leave experiences for the non-childbearing general surgery resident parent: A qualitative analysis. Surgery. 2024;176(5):1320-1326. doi:10.1016/j.surg.2024.04.035 https://pubmed.ncbi.nlm.nih.gov/38910045/

Mann H, Glazer T. Current state of safe pregnancy policies for the US surgical trainee. OTO Open. 2024;8(3):e172. doi:10.1002/oto2.172 https://pubmed.ncbi.nlm.nih.gov/39036338/

Rangel EL, Smink DS, Castillo-Angeles M, et al. Pregnancy and motherhood during surgical training. JAMA Surg. 2018;153(7):644-652. doi:10.1001/jamasurg.2018.0153 https://pubmed.ncbi.nlm.nih.gov/29562068/

Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of infertility and pregnancy complications in US female surgeons. JAMA Surg. 2021;156(10):905-915. doi:10.1001/jamasurg.2021.3301 https://pubmed.ncbi.nlm.nih.gov/34319353/

https://www.nytimes.com/2019/12/20/science/doctors-surgery-motherhood-medical-school.html

https://behindtheknife.org/podcast/family-leave-during-surgical-training-a-discussion-with-abs-president-dr-jo-buyske

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Transcript

Click on a timestamp to play from that location

0:00.0	Behind the Night, The Surgery Podcast, relevant and engaging content designed to help you dominate the day. Hi everyone, my name is Kara Button. I'm a general surgery resident at Maine Medical Center and a behind-the-knife surgical education fellow.
0:28.6	Today we're focusing on flexibility and surgical training, specifically a program known as the 5 and 6.
0:35.6	This option allows residents with approval from their program
0:38.8	and the ABS to complete five years of residency training over six calendar years. Unlike traditional
0:45.1	research time, the extra year is spread out over five years, creating more flexibility for residents
0:51.0	who may need time for family, personal, or professional reasons.
0:55.6	I'm honored to be joined today by two incredible guests.
0:58.8	Dr. Joe Byski is the president and CEO of the American Board of Surgery,
1:03.2	and has held a leadership role with the ABS since 2009.
1:07.0	During her time there, the five and six became a formal policy.
1:19.6	And I'm also joined by Dr. Bridget Olson, who is one of my co-residents, a PGI4 at Maine Medical Center, and a current participant in the five and six. Dr. Byski and Dr. Olson, thank you so much for joining us today.
1:23.6	My pleasure.
1:24.6	Thank you. We are excited to be here. We are especially excited to have Dr. Byski back with us.
1:31.1	She joined Behind the Knife in 2021 to discuss the family leave during surgical training after some
1:37.3	recent changes in the ABS parental leave policy. And today we're re-engaging in that dialogue as we
1:43.3	further explore the five and six
1:44.7	pathway. Dr. Byski, to get us started, can you give us a quick overview of the baseline
1:50.9	training requirements for general surgery, really in terms of how much time can a resident be
1:56.2	away from clinical training without having to extend their time in residency?
2:01.3	Sure.
2:02.1	So the short version, the core version, is that there are 52 weeks in a year, and for a year
2:10.1	to count, you have to work for 48 of those weeks.
	...

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