Maternity Leave in Residency: A Multicenter Study of Determinants and Wellness Outcomes

Lurking in the shadows: time as an actor in the narratives of pregnancy within graduate medical education

Previous studies suggest that time factors heavily into trainees' decision-making around issues of pregnancy within graduate medical education (GME). Trainees are often dissatisfied with parental leave policies and tension exists as they navigate training interruptions. However, our understanding is limited because prior studies have conceptualized only two main actors involved in this negotiation, program directors (PDs) and trainees. This study aimed to understand the role of a third ever present character that has been overlooked - Time. We recruited 13 pairs of residents/fellows who had been pregnant during GME training and their PDs. We conducted semi-structured interviews on trainee and PD experiences, which were then analyzed utilizing narrative analysis to interrogate how individuals assigned meaning to time. Time loomed in the background of all trainees' and PDs' experiences as they negotiated pregnancy. Depending on context, time was positioned either as an ally, assisting trainees with achieving their personal and professional goals, or as a foil, sabotaging their experience. As an ally, time was positioned as a malleable commodity that was flexed to meet the individual trainee's needs. As a foil, time was an immovable barrier exerting rigid constraints. How time was experienced by the trainee was strongly influenced by the attitudes and actions of the PD. This study positions time as a main actor in trainees' narratives of pregnancy. The role time plays largely reflects the value assigned to conformity with traditional timelines and whether a program has revised their perspectives to position time as a side character.

Examining the impact of a change in maternity leave policy in Canada on maternal mental health care visits to the physician

PURPOSE

Maternity leave is a critical employee benefit that allows mothers to recover from the stress of pregnancy and childbirth and bond with their new baby. We aimed to examine the association between the extension of a maternity leave policy and maternal use of mental health services and prescription drugs in a universal public healthcare system.

METHODS

This study uses administrative medical records from 18,000 randomly selected women who gave birth three months before and after an extension of the maternity leave policy. More specifically, mothers who gave birth after January 1st 2001, were entitled to 50 weeks of paid maternity leave, while mothers who gave birth before that date were entitled to only 26 weeks of paid maternity leave. Medical records were analyzed over a seven-year period (i.e., from October 1998 to March 2006). We examined the number and costs of mothers' medical visits for mental health care in the five years following delivery, as well as maternal use of prescribed medication for mental health problems.

RESULTS

We found that mothers with extended maternity leave had - 0.12 (95%CI=-0.21; -0.02) fewer medical visits than mothers without a more generous maternity leave and that the cost of mental health services was Can$5 less expensive per women. These differences were found specifically during the extended maternity leave period.

CONCLUSIONS

The extra time away from work may help mothers to balance new family dynamics which may result in less demand on the healthcare system.

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.

Impact of Policy Changes and Program Support on Family Planning Goals among Plastic Surgery Trainees

Background

In 2020, the American Board of Plastic Surgeons announced an update in the leave policy for plastic surgery trainees, extending personal leave to 12 weeks without delay in graduation. Simultaneously, the Accreditation Council for Graduate Medical Education announced their update in lactation policy. This study sought to understand the influence of the policy change on plastic surgery trainees' goals for family planning and lactation.

Methods

An online 32-question survey was developed to evaluate plastic surgery trainees' perceptions of family planning and perceived program support in the United States. The survey was approved by the American Council of Academic Plastic Surgeons Research Committee and sent out to a total of 216 plastic surgery programs.

Results

One hundred thirty plastic surgery trainees completed the survey. Most respondents were women, between the ages of 30 and 34 years, and married. Forty-five (34.6%) respondents or their partners had experienced pregnancy or live birth during their training. More than 70% did not feel that they had adequate time for leave. Female trainees faced more barriers than men, including having a partner in training, concern for their pregnancy, and burdening their co-residents during leave. The majority stated that their decision to apply to plastic surgery residency was influenced by program support for family planning compared with policy changes.

Conclusions

This survey highlighted that the new policies benefit trainees who consider starting a family during training. Despite this, there are still challenges that need to be addressed to help foster a fair environment for trainees to work and have a family.

Pregnancy and infertility in orthopedics: A review of the current state

BACKGROUND

Orthopedic surgery continues to have one of the lowest rates of female trainees among all medical specialties in the United States. Barriers to pursuing a surgical residency include the challenges of family planning and work-life balance during training.

METHODS

A systematic literature search of articles published between June 2012 and December 2022 in the MEDLINE, EMBASE, and Cochrane databases was performed in January 2023 according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Studies were included if they evaluated pregnancy and peripartum experience and/or outcomes amongst orthopedic surgeons or trainees.

RESULTS

Eighteen studies were included. Up to 67.3% of female orthopedic surgeons and trainees and 38.7% of their male counterparts delayed childbearing during residency. The most reported reasons for this delay included career choice as an orthopedic surgeon, residency training, and reputational concerns among faculty or co-residents. Infertility ranged from 17.0% to 30.4% in female orthopedic surgeons and up to 31.2% suffered obstetric complications. Assisted Reproductive Technology (ART) resulted in 12.4%-56.3% of successful pregnancies. Maternity and paternity leaves ranged from 1 to 11 weeks for trainees with more negative attitudes associated with maternal leave.

CONCLUSIONS

Female orthopedic trainees and attending delay childbearing, experience higher rates of obstetric complications, and more stigma associated with pregnancy compared to their male colleagues. Program and institutional policies regarding maternity and paternity leave are variable across programs, and therefore, attention should be directed toward standardizing policies.

Support of parenting in undergraduate medical training in New Zealand

PURPOSE

This research assessed support for parents studying undergraduate medicine at a New Zealand medical school and identified requirements for additional support.

METHOD

Support documentation was sourced from Student Affairs and university and medical school websites. The Medical Deans of Australia and New Zealand Medical Students Outcome and Longitudinal tracking Project was retrospectively examined for data specific to medical student parents. Student parents and medical school staff were also surveyed for their knowledge and perceptions around organisation and effectiveness of available support, and suggestions for additional support.

RESULTS

Parents and expectant parents formed a consistent, likely growing sub-group studying medicine from 2008 to 2020, yet no formal student parent support policy existed until 2019. Prior to this, 67% of student parents and 47% of staff lacked knowledge of available support. Since 2020, calls for greater visibility of parenting policies and flexibility in the curriculum have been operationalised by the medical school.

CONCLUSION

Formalising policies and procedures, maximising access to parenting support resources and introducing flexibility in medical curricula can help students balancing families and medical training. This is relevant for sustainability of medicine as a career option for medical students wanting children, especially considering over half of all medical students are female.

Can I Leave? Perspectives on Parental Leave and Parenthood in Medical Training Among Program Directors and Trainees in Oncologic Specialties

Purpose: Peak fertility commonly occurs during medical training, and delaying parenthood can complicate pregnancies. Trainee parental leave policies are varied and lack transparency. Research on the impacts of parenthood on trainee education is limited. Methods: A Qualtrics-based survey was distributed via e-mail/social media to program directors (PDs) within oncologic specialties with a request to forward a parallel survey to trainees. Questions assessed awareness of parental leave policies, supportiveness of parenthood, and impacts on trainee education. Statistical analyses included descriptive frequencies and bivariable comparisons by key groups. Results: A total of 195 PDs and 286 trainees responded. Twelve percent and 29% of PDs were unsure of maternity/paternity leave options, respectively. PDs felt they were more supportive of trainee parenthood than trainees perceived they were. Thirty-nine percent of nonparent trainees (NPTs) would have children already if not in medicine, and >80% of women trainees were concerned about declining fertility. Perceived impacts of parenthood on trainee overall education and academic productivity were more negative for women trainees when rated by PDs and NPTs; however, men/women parents self-reported equal impacts. Leave burden was perceived as higher for women trainees. Conclusions: A significant portion of PDs lack awareness of parental leave policies, highlighting needs for increased transparency. Trainees' perception of PD support for parenthood is less than PD self-reported support. Alongside significant rates of delayed parenthood and fertility concerns, this poses a problem for trainees seeking to start a family, particularly women who are perceived more negatively. Further work is needed to create a supportive culture for trainee parenthood.

Parental, caregiving, and family leave during clinical neuropsychology postdoctoral training: Recommendations and guidelines from the Women in Neuropsychology (WIN) committee and Education Advisory Committee (EAC) of the Society for Clinical Neuropsychology (SCN; APA division 40)

Objective: Parental and other caregiving leave is important to postdoctoral fellows, yet there is no field-wide recommendation for leave policies among clinical neuropsychology postdoctoral training programs, which is of particular relevance given the two-year requirement for eligibility for board certification. The aims of this manuscript are to (a) discuss general guidelines and recommendations for leave policies, both informed by prior empirical evidence as well as relevant existing policy guidelines from various academic and healthcare organizations, and (b) use vignettes to provide possible solutions for potential leave scenarios. Method: A critical review of literature on family leave from public policy and political science, industrial-organizational psychology, academic medicine, and psychology was conducted and findings were synthesized. Results and Conclusions: Fellowship training programs are encouraged to adopt a competency-based model that permits flexibility in leave during training without necessarily requiring an extended end date. Programs should adopt clear policies and make this information readily available to trainees and think flexibly about training options that best meet the training needs and goals of each individual. We also encourage neuropsychologists at all levels to engage in advocacy for broader systemic supports of trainees seeking equitable family leave.

Breastfeeding in US working mothers: A systematic review

BACKGROUND

Previous studies demonstrate that exclusive breastfeeding has positive long-term health effects on the mother and infant, but research has shown that nearly 50% of mothers do not breastfeed for the recommended amount of time.

OBJECTIVE

This article systematizes previous quantitative research on the impact of work on breastfeeding practices to identify the factors that correlate to the cessation of breastfeeding in working mothers.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statements, we performed a systematic review that screened PubMed, CINAHL, PsycINFO, and Academic Search Complete databases for articles relating to maternal employment and breastfeeding.

RESULTS

Of the 13,106 articles assessed for eligibility, 21 studies met all requirements and were included in this systematic review. The 21 articles were divided into study type and methods, participant demographics, study outcomes, and additional factors that included stressors and stress levels, factors that increased or decreased rates of breastfeeding, and feeding methods. Articles outside of the United States were excluded due to differences in maternity leave policies of other countries impacting the data.

CONCLUSION

Cessation of breastfeeding and breastfeeding outcomes were seen to have a strong association with maternal employment, specifically with the policies and employer support in the workplace. Other factors such as race, level of education, and stress were also shown to relate to breastfeeding outcomes and are important to consider in future public health interventions and workplace policies.

Physicians as shock absorbers: The system of structural factors driving burnout and dissatisfaction in medicine

American physicians disproportionately suffer from burnout. Despite calls for systemic solutions, however, few studies have actually examined how 'the system' works-i.e. how structural factors intersect in real-time as a system to shape wellbeing. I borrow a systems theoretical approach, which explicitly recognizes the dynamic relationships and interdependencies between different actors and factors in healthcare, to examine how structural factors work together to shape physicians' wellbeing. Drawing on an eight-month ethnography in a pediatrics clinic, I show how respondents experienced pressures from multiple structural levels: societal (including broader social inequality and changing doctor-patient relationships); organizational (centralized decision-making, economic pressures, and unresponsive leadership); and professional (specialty cultures and unhealthy norms). I find that individual physicians effectively served as shock absorbers, routinely absorbing countless, interconnected structural demands ("shocks") and converting them into competent medical care, at significant cost to their mental health. In so doing, I intervene in sociological debates about the broader fate of the medical profession and conclude that if medicine remains resilient against threats to its dominance, it may well be at the expense of individual physicians' mental wellbeing.

Association between maternity leave policies and postpartum depression: a systematic review

PURPOSE

Working mothers are at greater risk for postpartum depression. Maternity leave characteristics, including length, wage replacement and employment protection, could have relevant implications for mothers' mental health. We propose to explore whether there is an association between maternity leave characteristics and postpartum depression.

METHODS

We conducted a systematic review searching for randomized controlled trials, quasi-experimental, cohort or cross-sectional studies on five databases using search terms including maternity and parental leave and depression, as well as references in relevant articles. We identified 500 articles and included 23 of those. We used the EPHPP Quality Assessment Tool for Quantitative Studies to assess the quality of the studies.

RESULTS

Paid and longer maternity leaves tend to be associated with a reduction of postpartum depression symptoms in high-income countries. No studies explored the association between employment protection and postpartum depression. The quality of studies ranged from strong to weak, mostly influenced by study design.

CONCLUSION

More restrictive maternity leave policies tend to be associated with higher rates of postpartum depression, although more research needs to be conducted in the Global South.

Parental leave, childcare policies, and workplace bias for hepatology professionals: A national survey

BACKGROUND

The presence of workplace bias around child-rearing and inadequate parental leave may negatively impact childbearing decisions and sex equity in hepatology. This study aimed to understand the influence of parental leave and child-rearing on career advancement in hepatology.

METHODS

A cross-sectional survey of physician members of the American Association for the Study of Liver Diseases (AASLD) was distributed through email listserv in January 2021. The 33-item survey included demographic questions, questions about bias, altering training, career plans, family planning, parental leave, and work accommodations.

RESULTS

Among 199 US physician respondents, 65.3% were women, and 83.4% (n = 166) were attendings. Sex and racial differences were reported in several domains, including paid leave, perceptions of bias, and child-rearing. Most women (79.3%) took fewer than the recommended 12 paid weeks of parental leave for their first child (average paid leave 7.5 wk for women and 1.7 for men). A majority (75.2%) of women reported workplace discrimination, including 83.3% of Black and 62.5% of Hispanic women. Twenty percent of women were asked about their/their partners' pregnancy intentions or child-rearing plans during interviews for training. Women were more likely to alter career plans due to child-rearing (30.0% vs. 15.9%, p = 0.030). Women were also more likely to delay having children than men (69.5% vs.35.9%).

CONCLUSIONS

Women reported sex and maternity bias in the workplace and during training interviews, which was more frequently experienced by Black and Hispanic women. As two-thirds of women had children during training, it is a particularly influential time to reevaluate programmatic support to address long-term gender disparities in career advancement.

Recovery of Skill Decay After COVID-19 Redeployments and Implications for Competency Attainment

INTRODUCTION

The COVID-19 pandemic immediately interrupted procedural training. The lasting impact of reduced caseloads and service redeployments on procedural-resident training has been underexplored. This longitudinal study investigated the long-term perspectives of skill decay after short breaks in training and implications for ensuring resident competency attainment.

METHODS

Web-based cross-sectional surveys distributed immediately after (June 2020) compared to 1 y after (July 2021) COVID-19 redeployments at two tertiary academic medical centers of an integrated health system in New York. Participants included general surgery, surgical subspecialty, and anesthesiology residents and faculty.

RESULTS

Fifty-five residents and 33 faculty completed the survey. Ninety-point nine percent of residents and 36.4% of faculty were redeployed to COVID-ICUs. Sixty-three-point seven percent of residents and 75.0% of faculty reported a reduction in resident technical skills in the short-term, with significantly less (45.5% of residents and 21.2% of faculty) reporting persistent reduction in technical skill after 1 y (P = 0.001, P < 0.001). Seventy-five percent of residents and 100% of faculty were confident residents would be able to practice independently at the conclusion of their training. Sixty-five-point five percent of residents and 63.6% of faculty felt that residents experienced a durable improvement in critical care skills. Residents also reported a positive long-term impact on professional core competencies at 1 y.

CONCLUSIONS

Longitudinal surveillance of residents after COVID-19 redeployments suggests washout of temporary skill decay and return of resident confidence upon resumption of traditional training. This may provide insight into the impact of other short-term training interruptions on resident skill and promote greater resident support upon training resumption to ensure competency attainment.

Length of Maternity Leave Impact on Mental and Physical Health of Mothers and Infants, a Systematic Review and Meta-analysis

BACKGROUND

Recent legislative decisions in the United States have encouraged discussion about national parental leave programs. Currently, over 47% of the United States workforce is female. However, the United States is the only nation of the 37 member countries in the Organization for Economic Co-Operation and Development (OECD) to have no national requirement for maternity leave. The first few months of a child's life are vital to their physical and mental development. Likewise, a gradual return to pre-partum functioning is important for a newly postpartum woman. While it has been shown that maternity leave positively impacts various measures of maternal and infant mental and physical health, we lack consensus on the optimal length of paid or unpaid maternity leave. Accordingly, we conducted a systematic review and meta-analysis to evaluate the optimal length of paid or unpaid maternity leave to encourage maternal and infant mental and physical health in the United States.

METHODS

A systematic review and meta-analysis were conducted to synthesize and critically evaluate the current research investigating the association between maternity leave and maternal and infant mental and physical health using the Preferred Reporting in Systematic Reviews and Meta-Analyses guidelines. Databases EMBASE, PsycInfo, and PubMed were searched using specific inclusion and exclusion criteria. Methodological Index for Non-Randomized Studies scale assessed the methodological quality of the included eligible studies. The magnitude of heterogeneity between-study was tested using The Cochrane χ² test and the Moran's I² statistic. Possible publication bias was assessed through the funnel plot and the Egger regression test. A p-value of < 0.10 will be considered as an indication for the existence of potential publication bias. All statistical analyses were carried out with Stata software version 15.

RESULTS

A total of 21 studies were analyzed. It was found that longer maternity leave may decrease rates of maternal mental and physical health complaints. It was also found that longer maternity leave leads to more positive mother-child interactions, decreased infant mortality, and longer periods of breastfeeding.

CONCLUSION

Maternity leave of 12 weeks or more confers the greatest benefit for mothers and their infants.

Challenges Training Women in Neurology

The challenges that current women neurologists in training face remain similar to a certain extent to those experienced by their women neurologists' mentors. The key challenge that often coincides with residency or fellowship is childbearing. This has the potential to prolong training time and delaying graduation. Women neurologists in training face additional challenges of juggling between family responsibilities--as caregivers--and professional roles.

The Experiences of Motherhood in Female Surgeons: A Scoping Review

OBJECTIVE

The objective of this study is to systematically synthesize the existing literature on the experiences of motherhood in female surgeons both during surgical training and as staff physicians, to identify knowledge gaps, and to provide recommendations for institutional changes to better support pregnant female surgeons.

BACKGROUND

There are disproportionately fewer medical students pursuing surgical specialties, as surgery is often seen as incompatible with childbearing and pregnancy. However, no review has summarized the published literature on the collective experiences of female surgeons in navigating motherhood.

METHODS

Four databases were searched and 1106 abstracts were identified. Forty-two studies were included and a thematic analysis was performed.

RESULTS

Four themes were identified: path toward motherhood (n=18), realities of motherhood (n=25), medical culture and its impact on career and family life (n=24), and institutional reproductive wellness policies (n=21). Female surgeons are more likely to delay motherhood until after training and have high rates of assisted reproductive technology use. Pregnancy during surgical training is associated with negative perception from peers, pregnancy complications, and scheduling challenges. Maternity leave policies and breastfeeding and childcare facilities are variable and often inadequate. Many female surgeons would agree that greater institutional support would help support women in both their roles as mothers and as surgeons.

CONCLUSIONS

Both female residents and staff surgeons experience significant and unique barriers before, during, and after motherhood that impact their personal and professional lives. Understanding the unique challenges that mothers face when pursuing surgical specialties is critical to achieving gender equity.

Supporting Breastfeeding Physicians Across the Educational and Professional Continuum: A Call to Action

The benefits of breastmilk and lactation are well established for both infants and women. National organizations recommend exclusively breastfeeding for the first 6 months of life and continued breastfeeding for the first 1-2 years of life. For physicians, childbearing years often coincide with key periods of training and their early career. Physician mothers have high rates of initiating breastfeeding but low success in maintaining breastfeeding. Breastfeeding discontinuation among physicians is a well-described, multifactorial issue that has persisted for decades. Reasons for discontinuation include inadequate access to pumping rooms, insufficient workplace and coworker support, and constrained schedules. Pumping is viewed as a burden to teammates and superiors, and physicians are often required to make up time spent pumping. Vague or absent policies to support breastfeeding by accreditation organizations and institutions create workplace conflict and impose additional stress on breastfeeding physicians, who devote significant time, energy, and mental reserves navigating clinical responsibilities, workplace relationships, and licensing requirements to pump. The authors propose several recommendations to improve the environment, support, and resources for breastfeeding physicians with a focus on what individuals, institutions, and professional organizations can do. Creating lactation policies that allow breastfeeding physicians equitable participation in the workplace is a matter of reproductive justice. Improving the collective awareness and support for breastfeeding trainees and physicians is a critical step in recruiting, retaining, and supporting women in medicine.

The effect of parental leave on parents' mental health: a systematic review

Mental health disorders during the post-partum period are a common morbidity, but parental leave might help alleviate symptoms by preventing or reducing stress. We aim to summarise available evidence on the effect of different types of parental leave on mental health outcomes among parents. For this systematic review, we searched Ovid MEDLINE, Web of Science, PsycINFO, CINAHL, and Scopus from database inception to Aug 29, 2022, for peer-reviewed, quantitative studies written in English. We included studies if the exposure was postnatal parental leave; a relevant comparison group was present (eg, paid vs unpaid leave); and if indicators related to general mental health, including depression, anxiety, stress, and suicide, for either parent were evaluated or recorded at any time after childbirth. The Review is registered with PROSPERO (registration number CRD42021227499). Of the 3441 records screened, 45 studies were narratively synthesised. Studies were done in high-income countries, and they examined generosity by any parental leave (n=5), benefit amount (n=13), and leave duration (n=31). 38 studies were of medium or high quality. Improved mental health was generally observed among women (referred to as mothers in this Review) with more generous parental leave policies (ie, leave duration and paid vs unpaid leave). For example, increased duration of leave was generally associated with reduced risk of poor maternal mental health, including depressive symptoms, psychological distress and burnout, and lower mental health-care uptake. However, the association between fathers' leave and paternal mental health outcomes was less conclusive as was the indirect effect of parental leave use on partners' mental health.

Parental leave during pediatric fellowship training: A national survey

BACKGROUND

Until recently, no uniform requirements for parental leave (PL) existed in graduate medical education. We implemented a national survey, with the objective of ascertaining fellows' perceptions of PL policies and their impact. This is the first study to focus exclusively on pediatric subspecialty fellows.

METHODS

An online survey instrument was created targeting pediatric fellows.

RESULTS

The survey was accessed by 1003 (25%) of the estimated 4078 pediatric subspecialty fellows and 853 (21%) submitted surveys. Respondent demographic data paralleled the data reported by the American Board of Pediatrics. Half of respondents did not know whether their program had a written PL policy. Over 40% reported ≥ 5 weeks of paid PL. Most indicated that fellows use vacation, sick leave, and unpaid time for PL. Almost half of respondents (45%) indicated that their program's PL policy increases the stress of having a child. Fellows chose establishing/extending paid leave and intentionally fostering a more supportive program culture as the most crucial candidate improvements. The importance of equitable PL polices between parent fellows and co-fellows was an important theme of our qualitative data. Fellows feel there is a moral misalignment between the field of pediatrics' dedication to maternal and child health and current PL policies governing pediatric trainees.

CONCLUSIONS

PL policies vary widely among pediatric fellowship programs and are often not known by fellows. Fellows are not satisfied with PL policies, which often exacerbate stress for new parents and burden their co-fellows. Targeted modification of several aspects of PL policies may improve their acceptance.

Association Between Parental Leave and Ophthalmology Resident Physician Performance

Importance

Although parental leave is essential in enhancing resident wellness and fostering inclusive workplace environments, residents may often feel discouraged from using parental leave owing to perceived stigma and concerns about possible negative effects on their training.

Objective

To examine parental leave usage across multiple institutions and compare residency performance metrics between residents who took parental leave vs their peers who did not take leave.

Design, Setting, and Participants

This was a retrospective cross-sectional analysis conducted from April 1, 2020, to July 28, 2022, of educational records. Multicenter data were obtained from 10 Accreditation Council for Graduate Medical Education (ACGME)-accredited ophthalmology programs across the US. Included ophthalmology residents graduated between 2015 and 2019. Data were analyzed from August 15, 2021, to July 25, 2022.

Exposures

Performance metrics of residents who used parental leave during residency were compared with those of residents who did not take parental leave.

Main Outcomes and Measures

Measures of performance included the Ophthalmic Knowledge Assessment Program (OKAP) scores, ACGME milestones scores, board examination pass rates, research activity, and surgical volumes.

Results

Of the 283 ophthalmology residents (149 male [52.7%]) included in the study, 44 (15.5%) took a median (IQR) parental leave of 4.5 (2-6) weeks. There were no differences in average OKAP percentiles, research activity, average ACGME milestones scores, or surgical volume between residents who took parental leave and those who did not. Residents who pursued fellowship were less likely to have taken parental leave (odds ratio [OR], 0.43; 95% CI, 0.27-0.68; P < .001), and residents who practiced in private settings after residency were more likely to have taken parental leave (OR, 3.56; 95% CI, 1.79-7.08; P < .001). When stratified by sex, no differences were identified in performance between female residents who took parental leave compared with residents who did not take leave, except a mild surgical number difference in 1 subspecialty category of keratorefractive procedures (difference in median values, -2; 95% CI, -3.7 to -0.3; P = .03).

Conclusions and Relevance

In this multicenter cross-sectional study, no differences in performance metrics were identified between residents taking parental leave compared with their peers. These findings may provide reassurance to trainees and program directors regarding the unlikelihood, on average, that taking adequate parental leave will affect performance metrics adversely.

Examining the Relationship Between Return to Work After Giving Birth and Maternal Mental Health: A Systematic Review

INTRODUCTION

The negative impacts of mental health disorders on the well-being of women and their infants are clear. However, less is known about the relationship between returning to work after giving birth and mental health. Previous reviews examined the relationship between maternity leave and mental health, but we defined return to work as the process of returning to part-time or full-time work after giving birth and caring for infant. This systematic review aims to: (1) describe operational definitions for return to work and (2) describe the evidence on the relationship between return to work and maternal mental health.

METHODS

We searched PubMed, PsycINFO, CINAHL, and Web of Science for peer-reviewed studies. Articles were selected if they were published within the past 20 years, examined at least one mental health condition (e.g., depression, anxiety), and included a study sample of U.S. working mothers.

RESULTS

We identified 20 articles published between 2001 and 2020. We found conflicting evidence from longitudinal and cross-sectional data demonstrating that return to work was associated with improvements and negative consequences to mental health. Work-related predictors of mental health included: access to paid maternity leave, work-family conflict, total workload, job flexibility, and coworker support.

DISCUSSION

This review provides evidence that return to work and mental health are related, though the study samples have limited generalizability to all U.S. working mothers. More research is needed to understand the direction of this relationship throughout the perinatal period and how return to work affects other mental health conditions (e.g., anxiety, stress).

A Perspective on Wellness in Anesthesiology Residency Programs: A Multi-Strategy Approach

Addressing resident wellness is an important topic given the high risk for burnout and depression in resident physicians compared with the general U.S. population. This article provides an overview of various approaches to help conceptualize and intervene on resident wellness, based on the 9-strategies framework to improve wellness laid out by Shanafelt and colleagues. This article outlines the most relevant literature in each strategy followed by the authors' experience within their anesthesiology residency program.

Knowledge of Fertility and Perspectives About Family Planning Among Female Physicians

Importance

Pervasive gender disparities exist in medicine regarding promotion, achievement of academic rank, and appointment to leadership positions. Fertility and childbearing concerns may contribute to these disparities.

Objective

To assess fertility knowledge and concerns and evaluate barriers to family building and impact on academic attrition reported by female physicians.

Design, Setting, and Participants

This qualitative study used mixed methods; first, structured 1:1 interviews exploring fertility knowledge and family-building concerns were conducted among 16 female physicians between November 2019 and May 2020. Transcripts were coded in Dedoose and used to develop a survey instrument with subsequent pilot testing conducted among 24 female physicians between April 2020 and September 2020. Data analysis was performed from January 2021 to March 2021.

Main Outcomes and Measures

Fertility knowledge, perceptions of peer and institutional support surrounding childbearing, factors contributing to delayed childbearing, and impact of family planning on career decisions.

Results

Among 16 women who completed qualitative interviews, 4 (25%) were Asian, 1 (6%) was Black, 1 (6%) was multiracial, and 10 (63%) were White; mean (SD) age was 34.9 (4.0) years. Evaluation of fertility knowledge revealed 3 notable themes: (1) inadequate formal fertility education, (2) informal learning through infertility experiences of patients, peers, or personal struggles, and (3) desire to improve medical education through early introduction and transparent discussions about infertility. Exploration of childbearing concerns similarly revealed several salient themes: (1) high incidence of delayed childbearing, (2) perceived lack of peer and administrative support, and (3) impact of family building on career trajectory. These themes were borne out in pilot testing of the survey instrument: of 24 female physicians (7 Asian women [27%], 1 Black woman [4%], 1 Hispanic or Latinx woman [4%], 1 multiracial woman [4%], 15 White women [58%]; mean [SD] age, 36.1 [6.7] years), 17 (71%) had delayed childbearing and 16 (67%) had altered their career for family-building reasons.

Conclusions and Relevance

Qualitative interviews identified fertility and family building concerns among female physicians and were used to develop a tailored survey for women in medicine. These findings suggest that female physicians may delay childbearing and make substantial accommodations in their careers to support family building. A large-scale national survey is needed to better characterize the unique fertility, childbearing, and parenting needs of women in academic medicine to better understand how these concerns may contribute to academic attrition.

The Use of Parenting Electives in Pediatric Residency

BACKGROUND

Financial considerations and the desire to not prolong training often influence residents' parental leave length. Some residencies offer parenting electives. These primarily self-directed electives can extend parental time at home, support transition back to work, and allow residents to remain in training and be paid during these transitions.

OBJECTIVE

Describe the prevalence and structure of parenting electives within pediatric residency programs from 3 geographic regions of the Association of Pediatric Program Directors (APPD).

METHODS

All 66 pediatric residency program directors in the Western, Mid-America, and Northeastern regions of APPD were invited to participate in a phone interview regarding existence of and structure of their programs' parenting elective.

RESULTS

Thirty-six programs responded (55%). Of those, 24 (67% of responding programs) offer a specific parenting elective and an additional 5 (14%) offer a generic elective that can be tailored to new parents. Curricular elements shared by almost all programs offering specific parenting electives include self-reflective exercises, exploration of a community resource, and parenting articles/book review. Most programs incorporate clinic but not call into these electives.

CONCLUSION

Parenting electives are increasingly available in pediatric residency programs to support new resident parents. Sharing common curricular elements may help other programs implement and/or enhance this elective offering.

Ensuring a Smooth Transition for Trainees Returning from Parental Leave - A Guide for Program Directors

Transitioning from parental leave during radiology residency training can be a time of stress and uncertainty. However, there are ways that program directors can help make the transition smoother and less overwhelming. Trainees report numerous stressors upon returning from leave involving childcare, lactation concerns and logistics, and discrimination. Program directors can help alleveate these stressors by counseling trainees returning from parental leave and providing reseources and a supportive enviroment. This article provides a structured frame work with tool for programs directors to ensure the transition from parental leave back to training is a smooth one.

Development and Impact of a Progressive Parental Leave Policy in a Neurology Residency

Appropriate parental leave policies remain an unmet need in graduate medical education. Although legal and institutional guidelines allow for policies that support parental leave, there are many challenges and perceived barriers to consider in developing and implementing a successful policy. In 2018, we revised the parental leave policy for our neurology residency. Here we describe the development of our policy, measure its effects, and offer guidelines for other programs to develop a similar approach. We propose solutions to commonly encountered problems, focusing on training and education, staffing of clinical services, evolving legal requirements, resident well-being and equity, and financial support.

Work stress in nurses returning to tertiary a general hospitals in China after the delivery of their second child: a cross-sectional study

OBJECTIVE

To investigate the current situation of work stress in nurses returning to work in Chinese tertiary A general hospitals after giving birth to their second child and to analyze influencing factors.

METHODS

From January to April 2021, 448 nurses returning to work after the birth of their second child, working in 23 general hospitals in China, were investigated and completed the postpartum work stress scale and self-rating depression scale.

RESULTS

The total work stress score of returning nurses after giving birth to their second child was 90.40 ± 18.29, and the dimension with the highest score was the role commitment of the mother. Multiple linear regression analysis showed that family monthly income, turnover intention, time since returning to work, age of the first child, and depressive symptoms were the influencing factors on work stress.

CONCLUSION

It is important to reduce the work stress of the nurses returning to work after the birth of their second child. Nursing managers should pay attention to this group of postpartum nurses and formulate targeted measures to alleviate their work stress.

Are Psychiatry Programs Providing Adequate Parental Leave to Their Residents?

OBJECTIVE

During residency training, parental leave is frequently briefer than may be optimal for the well-being of the family. The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to have a parental leave policy without providing specific guidelines on its makeup, resulting in varying policies and confusion among residents planning parental leave. This study identifies differences in parental leave policies in psychiatry residencies and discusses if these policies are adequate.

METHODS

A 45-question, anonymous survey was emailed to general psychiatry and fellowship program directors in the USA.

RESULTS

Out of 520 program directors contacted, 186 completed the survey (35.7% response rate). Among the respondents, 94.1% had policies for maternity leave, 79.8% had policies for paternity leave, and 67.2% had policies for non-childbearing parental leave (e.g., adoption). Variations were reported in implementation, coverage, and accommodations. Most respondents (57.1%) believed that residents would benefit from more parental leave. Some (11.5%) believed that parenthood negatively affected residents' overall performance, especially regarding patient care and clinical skills; 36.5% endorsed that parenthood negatively affected overall residents' well-being; and 7.5% felt negatively when an applicant was pregnant or was planning to become pregnant during residency. Lastly, 32.9% were not confident regarding ACGME, American Board of Psychiatry and Neurology, federal, and hospital policies.

CONCLUSIONS

Parental leave policies are not universal in US psychiatry residency and fellowship programs. Some program directors feel that parenthood adversely affects residents' clinical performance as well as well-being. If true, reformation of parental leave policies may be a remedy.

We Have No Choice but to Transform: The Future of Medical Education After the COVID-19 Pandemic

Medical education exists to prepare the physician workforce that our nation needs, but the COVID-19 pandemic threatened to disrupt that mission. Likewise, the national increase in awareness of social justice gaps in our country pointed out significant gaps in health care, medicine, and our medical education ecosystem. Crises in all industries often present leaders with no choice but to transform-or to fail. In this perspective, the authors suggest that medical education is at such an inflection point and propose a transformational vision of the medical education ecosystem, followed by a 10-year, 10-point plan that focuses on building the workforce that will achieve that vision. Broad themes include adopting a national vision; enhancing medicine's role in social justice through broadened curricula and a focus on communities; establishing equity in learning and processes related to learning, including wellness in learners, as a baseline; and realizing the promise of competency-based, time-variable training. Ultimately, 2020 can be viewed as a strategic inflection point in medical education if those who lead and regulate it analyze and apply lessons learned from the pandemic and its associated syndemics.

Parental Leave for Residents and Pediatric Training Programs

Residency and fellowship are unique occupational time periods for many early career physicians, generally consisting of long duty hours. Many early career physicians have or are in the process of building their families during this time period. The literature suggests many medical and psychosocial benefits of protected parental leave for both parents and children, which necessitates parental leaves of absence. The Institutional Requirements of the Accreditation Council for Graduate Medical Education require training programs to provide written policies regarding leaves of absence, including parental leave, and these policies must comply with current legislation such as the Family Medical Leave Act. The length of leave has considerable variability among residency programs. This policy statement aims to navigate and outline the challenges of parental leave policies in training programs and to put forth recommendations to protect trainees and their families. The definition of families should also be expanded to include all types of families.

Parental leave in medical school: supporting students as parents

CONTEXT

The overlap between medical school, residency, and childbearing potential increases the likelihood a woman will pursue parenthood within her, or her partner's, medical training. Parental leave benefits mothers, fathers, and infants. Adequate parental leave promotes physical recovery, mental health, infant bonding, improved breastfeeding, appropriate childhood immunization, and familial engagement. Despite the risks and benefits, the United States does not have national paid maternity, paternity, or parental leave requirements. Complicating matters for medical trainees, parental leave policies are not well-defined within the undergraduate (UME) and graduate medical education (GME) realms. Significant policy advancements are on the horizon for GME; however, medical schools are left without evidence to support policy formation.

OBJECTIVES

This study aims to identify the presence and nature of maternal/paternal leave policies and procedures within UME. Given the authors' close association with osteopathic medical education, only osteopathic medical schools were considered to lay the framework for future study in UME.

METHODS

Investigators searched university websites for student handbooks outlining rules and policies surrounding parental leave. The following terms were utilized to investigate these documents: "parental," "maternity," "paternity," "pregnant," "pregnancy," and "leave of absence" (LOA). Administrative personnel were contacted, and subjective data were documented. A parental leave policy was defined as explicitly dedicated to expectant parents or those parents planning on adoption. Medical leave or other short- and long-term LOA policies were not considered a parental leave policy.

RESULTS

A total of 42 osteopathic medical schools were identified. Investigators established email communication with 17 schools (40.5%). Neither a student handbook nor email contact could be made with one institution. Two (4.9%) osteopathic medical schools overtly described parental leave in their policies. The majority of schools recommended students seeking parental leave follow short- or long-term LOA policies.

CONCLUSIONS

Without protected leave time, students must decide whether to begin a family or delay medical education. As GME begins prioritizing policy change, the authors call on UME to follow suit. Parenthood and medicine must be intertwined.

Pregnancy in physicians: A scoping review

BACKGROUND

The personal health and professional impact of physician pregnancy requires further study. We performed a comprehensive scoping review of physician pregnancy to synthesize and assess the evidence to aid decision-making for relevant stakeholders.

METHODS

A search of 7 databases resulted in 3733 citations. 407 manuscripts were included and scored for evidence level. Data were extracted into themes using template analysis.

RESULTS

Physician pregnancy impacted colleagues through perceived increased workload and resulted in persistent stigmatization and discrimination despite work productivity and academic metrics being independent of pregnancy events. Maternity leave policies were inconsistent and largely unsatisfactory. Women physicians incurred occupational hazard risk and had high rates of childbearing delay, abortion, and fertility treatment; obstetric and fetal complication rates compared to controls are conflicting.

CONCLUSIONS

Comprehensive literature review found that physician pregnancy impacts colleagues, elicits negative perceptions of productivity, and is inadequately addressed by current parental leave policies. Data are poor and insufficient to definitively determine the impact of physician pregnancy on maternal and fetal health. Prospective risk-matched observational studies of physician pregnancy should be pursued.

The Motherhood Penalty in Obstetrics and Gynecology Training

Since 2017, the number of women enrolled in medical schools in the United States has increased steadily. For the average female graduate, residency training will coincide with peak childbearing years. Despite increasingly well-defined parental leave policies in other industries, there is no standardized approach across graduate medical education programs. Physician mothers, particularly those in surgical specialties, have also been shown to be at increased risk for major pregnancy complications and postpartum depression. In addition, despite excellent initiation rates, the majority of breastfeeding trainees struggle with low milk supply, and as few as 7% of physician mothers continue to breastfeed for 1 year. Although the medical field routinely advocates for the benefits of parental leave and breastfeeding for our patients, significant and comprehensive change is needed to ensure that graduate medical education trainees can follow physician-recommended postpartum guidelines without meaningful implications for their careers. In February 2020, the American Board of Obstetrics and Gynecology changed its leave policy, allowing residents to take up to 12 weeks of paid or unpaid leave in a single year for vacation, parenting, or medical issues without extending their training. This change represents an important first step, and, as comprehensive women's health care professionals, our specialty should be leaders in normalizing family building for physicians-in-training. A culture change toward an environment of support for pregnant and parenting trainees and access to affordable, extended-hour childcare are also critical to enabling physicians at all levels to be successful in their careers.

Parenthood, Parental Benefits, and Career Goals Among Pediatric Residents: 2008 and 2019

OBJECTIVES

Examine reported availability of parental benefits for pediatric residents and impact of parenthood on reported importance of characteristics of post-training positions and career goals in 2008 and 2019.

METHODS

We analyzed data from American Academy of Pediatrics surveys of graduating residents in 2008 and 2019 querying (1) parenthood, (2) benefits during residency, (3) importance of parental benefits and job characteristics in post-training position, and (4) subspecialty career goal. Logistic regression was used to estimate independent effects of gender, partner status, and parenthood via derived predicted values (PVs).

RESULTS

Of 1021 respondents, three-fourths were women. Respondents in 2019 were less likely than in 2008 to have children (24.5% vs 33.8%, P < .01). In 2019, respondents were less likely to report availability of maternity (PV = 78.5% vs 89.5%, P < .001) or parental leave (PV = 42.5% vs 59.2%, P < .001) and more likely to report availability of lactation space (PV = 77.8% vs 56.1%, P < .001.). Most residents reported control over work hours, family considerations, and number of overnight calls per month as essential or very important characteristics in post-training positions. Controlling for resident characteristics, parenthood was associated with importance of family considerations and overnight calls in post-training position. Parenthood did not associate with subspecialty career goals, but gender did.

CONCLUSIONS

Residents are less likely to report availability of parental benefits during residency training in 2019. Most residents, both those with children and those without, consider parent friendly characteristics important in post-training positions. Parenthood does not correlate with subspecialty career goals independent from gender.

Gender of Department Chair and Paid Parental Leave Benefits in Academic Radiology Residency Programs

RATIONALE AND OBJECTIVES

Residency training often overlaps with prime childbearing years, yet variability in availability and duration of parental leave in residency can complicate the decision to become parents. Gender disparities in attitudes towards parenthood in residency is well recognized, with females generally reporting more concerns surrounding prolonged training, hindrance of future career plans, and negative perception from peers. However, gender of the department chair has not yet been examined as a factor influencing parental leave policies for residents in Radiology.

MATERIALS AND METHODS

The gender of the department chair and parental leave policies for residents in 209 ACGME accredited diagnostic radiology programs across the United States were procured from their websites. These programs were stratified into 6 geographical regions to identify regional differences. Chi-squared analyses were used to compare availability of paid parental benefits with the gender of department chairs.

RESULTS

Seventy-seven percent of diagnostic radiology program department chairs were male. 34 of 49 programs (69%) with female department chairs advertised paid parental benefits, compared to 61 of 160 programs (38%) chaired by males (P < 0.001). When stratified by region, this gender difference remained statistically significant in the mid-Atlantic and New England.

CONCLUSION

Female gender of the department chair was associated with the increased availability of paid parental leave benefits for residents, yet females hold fewer academic leadership positions than males. Future discussions regarding parental leave policies for residents will have to consider the unique challenges in residency such as length of training and burden on coresidents.

Fellowship program directors and trainees across the United States find parental leave policies to be inconsistent, inaccessible, and inadequate

INTRODUCTION

Determine the consistency, accessibility, and adequacy of parental leave policies for adult and pediatric medicine fellowship programs.

METHODS

We administered a 40-question survey to fellowship program directors (PDs) and trainees in adult and pediatric cardiology, hematology/oncology, gastroenterology, and pulmonology/critical care fellowship programs in the United States. We used Chi-square tests to compare proportions for categorical variables and t-tests to compare means for continuous variables.

RESULTS

A total of 190 PDs from 500 programs (38.0%) and 236 trainees from 142 programs (28.4%) responded. Most respondents did not believe that parental leave policies were accessible publicly (322/426; 75.6%), on password-protected intranet (343/426; 80.5%), or upon request (240/426; 56.3%). The PDs and trainees broadly felt that parental leave for fellows should be 5-10 weeks (156/426; 36.6%) or 11-15 weeks (165/426; 38.7%). A majority of PDs felt that there was no increased burden upon other fellows (122/190; 64.2%) or change in overall well-being (110/190; 57.9%). When asked about the biggest barrier to parental leave support, most PDs noted time constrains of fellowship (101/190; 53.1%) and the limited number of fellows (43/190; 22.6%). Trainees similarly selected the time constraints of training (88/236; 37.3%), but nearly one-fifth chose the culture in medicine (44/236; 18.6%). There were no statistically significant differences in answers based on the respondents' sex, specialty, or subspecialty.

DISCUSSION

Parental leave policies are broadly in place, but did not feel these were readily accessible, standardized, or of optimum length. PDs and trainees noted several barriers that undermine support for better parental leave policies, including time constraints of fellowship, the limited number of fellows for coverage, and workplace culture. Standardization of parental leave policies is advisable to allow trainees to pursue fellowship training and care for their newborns without undermining their educational experiences.

Persistence of Gender Bias Over Four Decades of Surgical Training

OBJECTIVE

Female surgeons face gender-specific obstacles during residency training, yet longitudinal data on gender bias experienced by female surgery residents are lacking. We aimed to investigate the evolution of gender bias, identify obstacles experienced by female general surgery residents, and discuss approaches to supporting female surgeons during residency training.

METHODS

Between August 2019 and January 2021, we conducted a retrospective cohort study using structured telephone interviews of female graduates of the UCLA General Surgery Residency training program. Responses of early graduates (1981-2009) were compared with those of recent graduates (2010-2020). Quantitative data were compared with Fisher's exact tests and Chi-squared tests. Interview responses were reviewed to catalog gender bias, obstacles experienced by female surgeons, and advice offered to training programs to address women's concerns.

RESULTS

Of 61 female surgery residency graduates, 37 (61%) participated. Compared to early graduates (N = 20), recent graduates (N = 17) were significantly more likely to pursue fellowship training (100% vs. 65%, p < 0.01) and have children before or during residency (65% vs. 25%, p = 0.02). A substantial proportion in each cohort experienced some form of gender bias (71% vs. 85%, p = 0.43). Compared to early graduates, recent graduates were significantly less likely to report experiencing explicit gender bias (12% vs. 50%, p = 0.02) but equally likely to report implicit gender bias (71% vs. 55%, p = 0.50). Female graduates across the decades advocated for specific measures to champion work-life balance in residency (51%), strengthen female mentorship (49%), increase childcare support (41%), and promote women into leadership positions (32%).

CONCLUSIONS

While having children during residency has become more common and accepted over the decades, female surgery residents continue to experience implicit gender bias in the workplace. Female surgeons advocate for targeted interventions to establish systems for parental leave, address gender bias, and strengthen female mentorship.

Parenthood and Parental Leave Decisions in Pediatric Residency

OBJECTIVES

The demands of residency training may impact trainees' decision to have children. We examined characteristics of pediatric residents' decisions regarding childbearing, determinants of resident parental leave, and associations with well-being.

METHODS

A survey of 845 pediatric residents at 13 programs was conducted between October 2019 and May 2020. Survey items included demographics, desire for future children, and logistics of parental leave. Outcomes included parental leave length, burnout and depression screening results, satisfaction with duration of breastfeeding, and satisfaction with parental leave and parenthood decisions.

RESULTS

Seventy-six percent (639 of 845) of residents responded to the survey. Fifty-two percent (330) of respondents reported delaying having children during residency, and 29% (97) of those were dissatisfied with their decision to do so. Busy work schedule (89.7%), finances (50.9%), and a desire not to extend residency (41.2%) were the most common reasons for delay. Of respondents, 16% were parents and 4% were pregnant or had pregnant partners. Sixty-one parental leaves were reported, and 67% of parents reported dissatisfaction with leave length. The most frequently self-reported determinant of leave duration was the desire not to extend residency training (74%). Program mean leave length was negatively associated with burnout, measured as a dichotomous outcome (odds ratio = 0.81 [95% confidence interval 0.68-0.98]; P = .02).

CONCLUSIONS

Many pediatric trainees delay parenthood during residency and are not satisfied with their decision to do so. Pediatric resident parental leave remains short and variable in duration, despite the positive association between longer leaves and overall well-being.

Pregnancy and Parenting in Medical School: Highlighting the Need for Data and Support

More than 7% of medical students graduate from medical school with at least 1 nonspouse dependent, the majority of whom are likely children. However, there are no national studies on medical students who are parents, and very little is known about what medical schools are doing to support them. A growing literature on the experiences of residents and attending physicians who are parents has neglected to include those of medical students who are parents. It is possible that focusing on research and policy change for residents and attending physicians who are parents without considering medical students may bring about improvements that come too late for many. Further data are needed both on the available policies for students who are parents and on the experiences and needs of these students. Leading national organizations in medical education can help guide medical schools by leveraging their national networks to highlight existing best practices and to foster discussions about how best to support medical students who are parents.

Pediatric Trainees as Parents: Perspectives on Parenthood From Pediatric Resident Parents

OBJECTIVES

Prior work across medical and surgical specialties shows that parenthood during residency training is associated with challenges including limited parental leave, lack of accommodations for breastfeeding, and concerns about career impact. Less is known about the experience of parenthood during pediatric residency training. The objective of this study was to identify themes related to the experience of parenthood during pediatric residency.

METHODS

In this qualitative study using thematic analysis, we performed semistructured interviews with participants who were currently in pediatric residency or had graduated in the previous 3 years and were parents during residency. Participants were recruited by e-mail. Data were collected and analyzed iteratively until thematic saturation was achieved. Two independent reviewers coded each transcript. Codes were grouped into categories and then into dominant themes.

RESULTS

Thirty-one residents were interviewed from 13 pediatric residency programs. Four major themes regarding the experience of parenthood during pediatric residency were defined by the data: 1) the struggles of parenthood and residency exacerbate each other; 2) institutional modifiers strongly influence the experiences of resident parents; 3) resident parents develop skills and perspectives that enhance their pediatric training; and 4) although levels of support for pediatric resident parents vary, the culture of pediatrics positively influences the experience of parenthood in residency.

CONCLUSIONS

There are numerous challenges navigating parenthood and residency, but institutional policies and culture can modify the experience. Importantly, the educational value of parenthood to pediatric training was immense. Our findings may be used to design interventions to support parenting during residency.

A Systematic Review of Wellness in Plastic Surgery Training

BACKGROUND

Physician and resident wellness has been increasingly emphasized as a means of improving patient outcomes and preventing physician burnout. Few studies have been performed with a focus on wellness in plastic surgery training.

OBJECTIVES

The aim of this study was to systematically review what literature exists on the topic of wellness in plastic surgery training and critically appraise it.

METHODS

A PubMed search was performed to identify journal articles related to wellness in plastic surgery residency. Seventeen studies (6 cohort and 11 cross-sectional) met inclusion criteria and were appraised with the Newcastle-Ottawa Quality Assessment Scale (NOQAS) to determine the quality of the studies based on selection, comparability, and outcome metrics.

RESULTS

Critical assessment showed that the studies were highly variable in focus. Overall, the quality of the data was low, with an average NOQAS score of 4.1. Only 2 studies focused on plastic surgery residents, examining work hours and social wellness, respectively; they were awarded NOQAS scores of 3 and 4 out of 10.

CONCLUSIONS

The results of this systematic review suggest that little research has been devoted to wellness in surgery training, especially in regard to plastic surgery residents, and what research that has been performed is of relatively low quality. The available research suggests a relatively high prevalence of burnout among plastic surgery residents. Evidence suggests some organization-level interventions to improve trainee wellness. Because outcomes-based data on the effects of such interventions are particularly lacking, further investigation is warranted.

Paving the Path to Wellness: A Systematic Review of Wellness Programs for Neurosurgery Trainees

BACKGROUND

Neurosurgical trainees have a heavy workload and poor quality of life, resulting in high rates of burnout and attrition. Consequently, wellness programs have been used by various training institutions to combat this situation.

OBJECTIVE

We aimed to identify and describe wellness programs available for neurosurgical trainees in their training institutions, the outcome measures used to assess them, and their efficacy.

METHODS

A systematic review of the literature was made following PRISMA guidelines.

RESULTS

Six studies were included in the review, describing wellness programs from 9 institutions. All programs except 1 used exercise as the core component. The other components included physical and mental well-being lectures, team-building activities, and cultural excursions. Most institutions used piloted satisfaction and perception questionnaires to assess efficacy. Trainee perceptions of wellness programs were generally positive, but the responses on validated questionnaires and surveys were mixed. Barriers to the program included lack of institutional support, time constraints, fatigue, and feelings of guilt in prioritizing wellness over patient care.

CONCLUSIONS

There is a paucity of literature regarding trainee wellness in neurosurgery. A few training programs have instituted wellness initiatives for trainees, and the feedback was generally positive. However, objective measures of efficacy such as validated questionnaires and scales yielded mixed results.

Flexible Scheduling Policy for Pregnant and New Parent Residents: A Descriptive Pilot Study

OBJECTIVES

Many physicians complete residency training during optimal childbearing years. The literature shows that working nights or on call can lead to pregnancy complications including miscarriage, preterm labor, and preeclampsia. In addition, infant-parent bonding in the postpartum period is crucial for breastfeeding, health, and well-being. No national standards exist for flexible scheduling options for pregnant or new parent residents. Our project objectives are 1) to describe a policy for scheduling pregnant and new parent residents in an emergency medicine (EM) residency and 2) to report pilot outcomes to assess feasibility of implementation, resident satisfaction, and pregnancy outcomes.

METHODS

An EM residency task force developed a proposal of scheduling options for pregnant and new parent residents based on best practice recommendations and resident input. The policy included prenatal scheduling options for pregnant residents and postpartum scheduling options for all new resident parents. Resident support for the policy was evaluated via an anonymous survey. It was piloted for 2 months in an EM residency program.

RESULTS

Policy development resulted in 1) an opt-out prenatal pregnancy work hour option policy with no nights or call during the first and third trimesters, 2) a 6-week new parent flexible scheduling policy, and 3) clarified sick call options. A majority of residents approved the new policy. During the 2-month pilot period, four residents (of 73 total) utilized the policy. The chief residents reported no added burden in scheduling. Of the residents who utilized the policy, all reported high satisfaction. There were no reported pregnancy or postpartum complications.

CONCLUSIONS

We successfully adopted a new scheduling policy for pregnant residents and new parents in one of the largest EM residency training programs in the country. This policy can serve as a national model for other graduate medical education programs.

Parental Leave Policies in Canadian Residency Education

BACKGROUND

In recent decades, the gender makeup of Canadian medical residents has approached parity. As residency training years coincide closely with childbearing years and paid parental leave is associated with numerous benefits for both parents and children, it is important for there to be clarity about parental leave benefits.

OBJECTIVES

We aimed to conduct a comprehensive review of maternity and parental leave policies in all residency education programs in Canada, to highlight gaps that might be improved or areas in which Canadian programs excel.

METHODS

We searched websites of the 8 provincial housestaff organizations (PHOs) for information regarding pregnancy workload accommodations, maternity leave, and parental leave policies in each province in effect as of January 2020. We summarized the policies and analyzed their readability using the Flesch Reading Ease.

RESULTS

All Canadian PHOs provide specific accommodations around maternity and parental leave for medical residents. All organizations offer at least 35 weeks of total leave, while only 3 PHOs offer extended leave of about 63 weeks, in line with federal regulations. All but 2 PHOs offer supplemental income to their residents, although not for the full duration of offered leave. All PHOs offer workplace accommodations for pregnant residents in their second and/or third trimester.

CONCLUSIONS

Although all provinces had some form of leave, significant variability was found in the accommodations, duration of leave, and financial benefits provided to medical residents on maternity and parental leave across Canada. There is a lack of clarity in policy documents, which may be a barrier to optimal uptake.

Baby Steps in the Right Direction: Toward a Parental Leave Policy for Gastroenterology Fellows

The American Board of Medical Specialties announced in July 2020 the adoption of a parental leave policy for residents and fellows allows for a minimum of 6 weeks of leave. This policy includes caveats: vacation and/or sick leave can be applied toward these 6 weeks, this leave can only be utilized once during training (whether for parental, caregiver, or medical leave), and this policy only applies to training programs of 2 or more years' duration. Although the new existence of a parental leave policy is a step in the right direction, trainees are in need of a more robust and evidence-based policy. There are particular challenges to be addressed in the male-dominated and procedural field of gastroenterology, in which women are underrepresented and female gastroenterology trainees are more likely to have career decisions limited around the availability of parental leave. This article reviews the evidence supporting the creation of a parental leave policy for gastroenterology fellows, with potential benefits to individual trainees as well as the field, in order to promote equity, recruitment, retention, and advancement of women in gastroenterology.