Parental leave policy information during residency interviews

Policy and perceptions of pregnancy during training among residents of various subspecialties

PURPOSE OF THE STUDY

Increased risk for adverse birth outcomes, long work hours, limited control over one's own schedule, and concern for making up time may color resident perceptions of their pregnancy during residency. We aimed to survey residents across four different specialties about their personal experiences with pregnancy during training.

STUDY DESIGN

Using a novel, validated, anonymous web-based survey instrument, we assessed experiences around pregnancy during residency training nation-wide. The survey was sent to 123 academic medical training programs in the fields of internal medicine (IM), pediatrics, obstetrics/gynecology (OB/GYN), and general surgery.

RESULTS

A total of 278 residents reported to have delivered, or their partner delivered, during residency. Of those, 38.1% (n = 103) were trainees in OB/GYN, 21.9% (n = 59) were in IM, 21.1% (n = 57) were in pediatrics, and 18.9% (n = 51) were surgery. Most responders (67.6%, n = 188) were 30-34 years old. We did not note birth outcome difference across specialties. OB/GYN trainees attended fewer prenatal visits [X2(6, 228) = 47.84, p < 0.001] compared with trainees in other specialties. Pediatric trainees reported to feel more supported when coordinating parental leave [X2(6, 268) = 17.17, p < 0.01], took longer leaves [X2(18, 228) = 39.68, p < 0.01], and felt perceived as more "capable" upon return [X2(6, 267) = 15.02, p < 0.05]. A total of 79.6% of respondents would encourage pregnancy during residency.

CONCLUSION

We identified differences across specialties in policy and perceptions of pregnancy during training that impact residency quality of life. It is important to address disparities across specialties and ensure resident wellness.   What is already known on this topic: Pregnancy during residency training is common. Previous literature suggests physicians experience higher rates of adverse pregnancy outcomes compared with the general population. Parental leave policies for residents are limited and/or unpublished. Further, little is known about how residents feel about informing their program and co-residents of their pregnancy and how they navigate antepartum and postpartum appointments and leave. What this study adds: We conducted an anonymous, nation-wide survey of residents training in 4 major medical specialties. We examine resident perceptions of informing their program leadership and co-residents of their pregnancy or their partner's pregnancy. We also measure birth outcomes, if there was a clear parental leave policy in place, and the length of parental leave taken by residents. How this study might affect research, practice, or policy: Our findings suggest that parental leave policies need attention and clarity across medical specialties. Further, the perceived or real culture surrounding the normative occurrence of pregnancy during residency could also be improved. Despite these concerns, residents encourage others to use the time during residency to grow their families. Our findings will encourage residency programs to make improvements towards a supportive, transparent, and equitable parental leave policy and parenting culture. Research question bullet points: 1) How do residents feel when informing their program leadership and their resident peers that they are pregnant during residency training? 2) How do residents across specialties differ in their approach to parental leave? 3) Are pregnant residents given clear parental leave policies across specialties?

Very Few ACGME-accredited Orthopaedic Surgery Residency Programs Have Web-accessible Leave Policies Dedicated to Parental Leave for Residents, Despite ACGME Requirements

BACKGROUND

The Accreditation Council for Graduate Medical Education (ACGME) requires that all graduate medical education (GME) programs provide at least 6 paid weeks off for medical, parental, and caregiver leave to residents. However, it is unclear whether all orthopaedic residency programs have adapted to making specific parental leave policies web-accessible since the ACGME's mandate in 2022. This gap in policy knowledge leaves both prospective and current residents in the dark when it comes to choosing residency programs, and knowing what leave benefits they are entitled to when having children during training via birth, surrogacy, adoption, or legal guardianship.

QUESTIONS/PURPOSES

(1) What percentage of ACGME-accredited orthopaedic surgery residency programs provide accessible parental leave policies on their program's website, their GME website, and through direct contact with their program's administration? (2) What percentage of programs offer specific parental leave policies, generic leave policies, or defer to the Family and Medical Leave Act (FMLA)?

METHODS

As indicated in the American Medical Association's 2022 Freida Specialty Guide, 207 ACGME-accredited orthopaedic residency programs were listed. After further evaluation using previous literature's exclusion criteria, 37 programs were excluded based on osteopathic graduate rates. In all, 170 ACGME-accredited allopathic orthopaedic surgery residency programs were identified and included in this study. Three independent reviewers assessed each program website for the presence of an accessible parental leave policy. Each reviewer accessed the program's public webpage initially, and if no parental leave policy was available, they searched the institution's GME webpage. If no policy was found online, the program administrator was contacted directly via email and phone. Available leave policies were further classified into five categories by reviewers: parental leave, generic leave, deferred to FMLA, combination of parental and FMLA, and combination of parental and generic leave.

RESULTS

Our results demonstrated that 6% (10 of 170) of orthopaedic residency programs had policy information available on their program's main orthopaedic web page. Fifty nine-percent (101 of 170) of orthopaedic residency programs had a clearly stated policy on their institution's GME website. The remaining 35% (59 of 170) had no information on their public website and required direct communication with program administration to obtain policy information. After directly contacting program administration, 12% (21 of 170) of programs responded to researchers request with a PDF explicitly outlining their policy. Twenty-two percent (38 of 170) of programs did not have an accessible policy available. Of the programs that had available policies, a total of 53% (70 of 132) of programs were categorized as offering explicit parental leave policies, 9% (12 of 132) were categorized as offering general leave policies, and 27% (36 of 132) deferred to FMLA. Seven percent (9 of 132) offered combined parental leave policies with FMLA, and 4% (5 of 132) offered combined general leave policies with FMLA.

CONCLUSION

Although most ACGME-accredited allopathic orthopaedic surgery residency programs met the ACGME requirement of written parental leave policies in 2023, a small minority of programs have clear, accessible parental leave policies provided on their webpage.

CLINICAL RELEVANCE

Parental leave policies should be easily accessible to prospective and current trainees and should clearly state compensation and length of leave. Ensuring orthopaedic surgery residency programs provide accessible and transparent parental leave policies is important for maintaining diversity in prospective applicants and supporting the work-life balance of current residents.

Enhancing Our Workforce: Recruitment and Retention in Anesthesiology

Increasingly, both healthcare leaders and studies of healthcare outcomes recommend a medical workforce that is representative of the patient population as a method to reduce health disparities and medical costs. Anesthesiology remains a specialty with lower proportions of women and underrepresented in medicine (URiM) physicians as compared to the overall physician workforce, with 26.1% of anesthesiologists identifying as women and 31.3% of anesthesiologists as URiM. Two areas of focus are commonly identified when discussing inadequate representation in the workforce: recruitment into the specialty and retention in the profession. As medical educators, we provide a critical role in the recruitment and retention of women and URiM anesthesiologists, through implementation of processes, programs, and cultural change. Here, we will discuss the current problems of recruitment and retention of women and URiM anesthesiologists and suggest action plans for now and the future to enhance our specialty's diversity.

Parental leave policies in general surgery residencies

BACKGROUND

Prospective residents use program websites to glean information regarding parental leave policies. This study investigates the online availability and content of parental leave policies for general surgery residency programs.

METHODS

Parental leave policy information was collected from general surgery residency program and Graduate Medical Education (GME) websites. Descriptive statistics and multivariable logistic regression were used for analysis.

RESULTS

Of the 344 general surgery residency programs, parental leave policies were found on 6% of program and 52% of GME websites. Family Medical Leave Act policies were reported the most, followed by maternity, then paternity, and then adoption/other clauses. Academic programs, program location in the Southeastern US and larger program size were all significant predictors of online policy availability.

CONCLUSIONS

General surgery parental leave policies vary and are not readily available online. These findings identify a significant opportunity for surgery residency programs to improve the disclosure of parental leave policy information.

The Parental Leave Paradox in Obstetrics and Gynecology

Medical school, residency, and fellowship occur during peak reproductive years for most trainees. This poses certain challenges for medical trainees as they approach family-building decisions. While the demands of residency have been well-elucidated, attempts at mitigating these demands alongside parenthood have long been neglected across various specialties. These challenges are perhaps most pronounced in Obstetrics and Gynecology residency programs, which are made-up of an 85% female-identifying workforce and whose training focuses on prenatal and postpartum health. Recent literature suggests an improvement in attitudes and policies towards parental leave during medical graduate education, however, there remains a lack of uniformity across specialties and programs. Through a recently developed Parental Leave Task Force made up of Obstetrics and Gynecology Trainees, we sought to conduct a review of the literature examining parental leave policies and their implications across various specialties as a call for uniform parental leave policies for all residents.

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.

Parenthood and Medical Training: Challenges and Experiences of Physician Moms in the US

Phenomenon: Balancing the demands of medical training and parenthood is challenging. We explored perceptions of programmatic support, parental leave, breastfeeding, and self-reported biggest challenges among a large cohort of physician mothers in a variety of medical specialties and across the stage of training when they had their first child. Our goal was to inform strategies to help improve the physician parent experience. Approach: This cross-sectional, observational survey study was performed using a convenience sample from an online physician-mom support group from January to February 2018. Descriptive statistics and bivariate analyses were used to report results and examine relationships between career stage at first child and outcome variables. Responses to the open-ended question, "What is your biggest challenge as a physician mom?" were qualitatively analyzed. Findings: The survey received 896 complete responses. The most common specialties were obstetrics and gynecology (25.3%), pediatrics (19.9%), internal medicine or medicine/pediatrics (17.1%), and family medicine (10.2%). The majority of participants (63.9%) had their first child during medical training, including medical school (14.3%), residency (35.8%) or fellowship (13.6%). Medical students were less likely to perceive programmatic support than residents or fellows (44.1% vs. 63.1% vs. 62.3%, respectively), and only 19.9% of participants who became parents during medical training reported having a clear and adequate parental leave policy. Nearly 70% of participants breastfed for six months or more, with no statistical differences across career stage. Most participants (57.6%) delayed child-bearing for one or more reasons, with 32.3% delaying to complete training. The most common codes applied to responses for 'biggest challenges as a physician mom' were insufficient time, lack of work-life balance, missing out, and over-expectation. Insights: Physician mothers, particularly those who had their first child during training, continue to struggle with support from training programs, finding work-life balance, and feelings of inadequacy. Interventions such as clear and adequate leave policies, program-sponsored or onsite childcare and improved programmatic support of breastfeeding and pumping may help to ameliorate the challenges described by our participants.

Pregnancy and parental leave policies at Australian and New Zealand medical schools

BACKGROUND

Research into how medical schools support students who are pregnant or with current parental responsibilities has been mostly limited to the US context.

OBJECTIVES

To review pregnancy and parental leave policies for students at Australian/New Zealand medical schools.

DESIGN

A cross-sectional survey.

METHODS

Data were collected between June and September 2021. Websites of Australian/New Zealand medical schools (n = 23) were searched for freely available information on pregnancy and parental leave policies. Each school was contacted to provide supplementary information on the processes to support students who apply for pregnancy and/or parental leave. Outcome harvesting techniques were used to analyse the key attributes and processes used by medical schools.

RESULTS

None of the 23 accredited Australian/New Zealand medical schools had specific pregnancy and/or parental leave policies. Fourteen of the 23 Australian/New Zealand medical schools responded to the request for more information. All confirmed, beyond their University's general student leave policies, they had no additional pregnancy and parental leave policy. Analysis of each school's processes identified the following themes: lack of school specific pregnancy and/or parental leave policies; lack of public statements of support for medical students who are pregnant and/or with current parental responsibilities; and lack of attention to the specific needs of medical students who are pregnant and/or with current parental responsibilities, including those with pregnant partners or are a birth support person.

CONCLUSION

There was a lack of documentation and formalized processes related to the support of this group of students. By creating easily accessible information on pregnancy and parental leave which is nuanced to the challenges of medical school and clinical placements, medical schools and medical education accreditation bodies in Australia/New Zealand can address the needs of medical students who are pregnant and/or with current parental responsibilities and normalize pregnancy and parental status within entry-to-practice medical courses.