Association Between Parental Leave and Ophthalmology Resident Physician Performance

Learning Experiences Abroad for Residents in National Training (LEARN): Results From a Scottish Training Programme Director Survey

Introduction Resident doctors (RDs) in UK training programmes are contractually entitled to take study leave (SL) to pursue activity related to progression of training. In 2024, NHS Education for Scotland (NES) announced a temporary change to SL policy, indicating international attendance at educational events would no longer be supported. NES is also responsible for administration of the RD study budget (SB) in Scotland - one of the lowest in the UK. There is little data regarding Training Program Director (TPD) views on RD use of SL to pursue professional development (particularly internationally) and appropriateness of SB. Here, we present TPD views on international SL and SB with an aim to contribute to wider policy discussions. Methods A cross-sectional survey consisting of closed and open responses was developed by the authors to evaluate a range of TPD opinions related to international SL and current SB. The survey was published in Microsoft Office Forms. Initial pilot testing was carried out by the authors before survey review by a Scotland TPD for content validity. The authors conducted a final re-test before distribution via TPD email addresses available via public domain. All TPDs in Scotland were eligible to respond, which was confirmed via survey response. No incentive or prize was offered. Responses were anonymised before review. Response percentage and chi-square analysis were undertaken using Microsoft Excel. Qualitative analysis of free text comments was conducted with assistance from Google Gemini AI Software, with prompts to assist "thematic analysis" before review by the authors to identify trends in response. Results In total, responses were obtained from 16% of invited TPDs (N=26) across a variety of medical specialties. International SL had been approved by 65% (N=17) of TPDs in the last 12 months. International SL was actively encouraged by 77% (N=20). TPDs were significantly more likely to encourage international SL if they had approved international leave requests within the last 12 months. SB was not considered appropriate to cover mandatory training costs by 85% (N=22) of respondents. Personal costs to trainees were estimated to be at least £1000 per annum in 88.5% (N=23) of training programmes. Annual SB was felt to be adequate for trainees by 12% of respondents (N=3). TPDs indicated overall support for international SL with regard to international collaboration, networking, research opportunity and access to learning opportunity not available in the UK. Responses highlighted concern that removing international SL could reduce the quality of medical training in Scotland and affect recruitment and retention of medical trainees. Conclusion There is relative consensus from Scottish TPDs on the importance of international learning during medical training, highlighting benefits for professional development, collaboration and education. The majority of TPDs view SB provided to trainees by NES as inadequate. Opportunity for suitable use of international SL could benefit RDs in Scottish training programmes with appropriate TPD oversight. Insights gathered from these responses could help inform policies to enhance international engagement in medical training programs within Scotland and the UK. Further exploration of differences in TPD opinion between specialties could highlight potential benefits of a level of autonomy in decisions made around resident doctor study budget funding and learning opportunities.

Formal Parental Leave Policies and Trainee Well-Being in US Graduate Medical Education: A Systematic Review

Background Variability in parental leave policies across graduate medical education (GME) programs in the United States complicates efforts to support resident wellness and identify best practices for resident well-being. Objective This review aims to assess how formal parental leave policies affect trainees' well-being, professional satisfaction, and performance during training. Methods A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) 2020 guidelines was conducted and registered on PROSPERO in May 2023. Databases searched included MEDLINE, Embase, and Cochrane Central. Studies that evaluated parental leave policies of US-based GME programs and their direct impact on residents and/or fellows were included. Studies were screened for inclusion by 2 independent reviewers, and any conflicts were resolved by a third author. Results Of 1068 articles screened, 43 articles met inclusion criteria. These studies highlighted that leave durations of less than 6 weeks were associated with higher rates of burnout and postpartum depression among trainees. There was no evidence that taking parental leave increased program attrition rate; however, 3 studies reported more than one-third of trainees extended training as a result of taking leave. Trainees who had more than 8 weeks of parental leave reported more successful breastfeeding 6 months out from delivery than those with less than 8 weeks of leave. Conclusions Extended parental leave, notably beyond 6 weeks, improved trainee well-being and professional satisfaction. Based on trainees' perspectives, ideal parental leave policies offer a minimum of 6 to 8 weeks of leave, with a formal and clearly written policy available.

Barriers to increasing paid parental leave in U.S. neurology residencies: a survey of program directors

BACKGROUND

The American Board of Psychiatry and Neurology (ABPN) and the Accreditation Council for Graduate Medical Education (ACGME) require that residency programs allow at least 6 weeks of parental leave. The American Medical Association (AMA) recommends 12 weeks of paid parental leave. Despite these recommendations, there is little information about parental leave policies across U.S. neurology residencies. The objective of our study was to assess parental leave policies in U.S. adult neurology residencies and barriers to increasing the duration of leave.

METHODS

We distributed an anonymous online survey to U.S. adult neurology program directors (PDs) to assess demographics, components and length of parental leave, perceived impact on residents' clinical training and academic development, and barriers to increasing the length of leave.

RESULTS

We contacted 163 PDs and received 54 responses (response rate of 33%). 87% reported policies for both childbearing and non-childbearing residents. The average maximal length of leave allowed without extension of training was 8.5 weeks (range 0-13) for childbearing and 6.2 weeks (range 0-13) for non-childbearing residents. Most PDs felt that parental leave had a positive impact on resident wellness and neutral impact on clinical competency, academic opportunities, and career development. The most common barriers to providing a 12-week paid policy were concerns about equity in the program (82%), staffing of clinical services (80%), and impact on clinical training (78%).

CONCLUSIONS

Although most programs in our study have parental leave policies, there is significant variability. Policies to improve parental leave should focus on addressing common barriers, such as additional solutions to staffing clinical services.

Parent Penalty: Parental Leave Experiences of Trainees and Early-Career Faculty in Oncology Subspecialties

PURPOSE

Prime childbearing years occur during medical training and early career, leaving physicians with tough choices between family planning and career growth. Restrictive workplace parental leave (PL) policies may negatively affect physician well-being. We evaluate existing PL and lactation policies, as well as return-to-work experiences, among oncology trainees and early-career faculty.

METHODS

An anonymous 43-question cross-sectional survey was distributed via e-mail and social media channels between May and June 2021 to oncology trainees and physicians within 5 years of terminal training in the United States. The survey was administered through SurveyMonkey. Descriptive statistics were used to analyze data. Two hundred seventy-five participants were recruited via social media and outreach to program directors and coordinators in adult hematology/oncology and radiation oncology program directors.

RESULTS

The average duration of PL was <6 weeks for most participants. Among those who used PL, 50% felt pressured to work while on PL, 60% felt guilty asking coworkers for help, and 79% were overwhelmed with demands of work and home, whereas only 27% had resources available at workplace to assist with transition back to work. Among those who breastfed at return to work, 31% did not have access to a lactation room, 56% did not have adequate pumping breaks, and 66% did not have pumping breaks mandated in contract.

CONCLUSION

Our findings underline the immense magnitude of problems surrounding inadequate PL and support for lactating mothers among trainees and early-career physicians in oncology subspecialities. Policies and practices around PL and lactation should be restructured to meet the needs of the evolving oncology workforce.