Parental Leave Policies in Canadian Residency Education

Pregnancy and Childbearing for Orthopaedic Surgeons: Challenges and Successful Support Initiatives

ABSTRACT

While female representation within surgical specialties is increasing, the field of orthopaedic surgery remains male-dominated. Residency, fellowship, and early career coincide with the childbearing years of female surgeons. Given the overlap between these critical career stages and years of childbearing, there has been a rise in articles characterizing the experiences and perceptions around childbearing and its impact on surgeons and their careers. Multiple studies have reported the alarmingly high rates of pregnancy complications, infertility, pregnancy loss, voluntary delay in childbearing, and postpartum depression in surgeons, including those in the field of orthopaedic surgery. However, perinatal complications are not the only barriers female orthopaedic surgeons may face should they decide to start a family alongside their career. Negative perceptions and lack of support from their colleagues and institutions have also been reported as commonplace. Limited but successful support programs, policies, and resources that are designed to support female surgeons and their partners have been created in North America. Successful support programs can be used to inspire institutional policies across North America to hopefully improve the pregnancy and childbirth experiences of orthopaedic surgeons.

Gender, Marital, and Parental Barriers to Pursuing Gastroenterology Fellowship: A Multicenter Analysis of a National Survey and Actionable Solutions

INTRODUCTION

Female gastroenterologists comprise 19% of the gastroenterology (GI) workforce, despite females making up 30% of GI fellows and over 50% of medical students in the USA. Barriers to pursuing GI fellowship have not been studied at the resident level. We aimed to determine multiple barriers that may prevent internal medicine (IM) residents from pursuing GI fellowship.

METHODS

Our multi-center team distributed an IRB-approved electronic survey to residents in IM residency programs nationwide. Multiple rounds of emails with survey description and link were sent to program directors and coordinators to forward to their residents. Four-point Likert barrier scales were used where "not a barrier" was analyzed as "no" and "somewhat a barrier" to "extreme barrier" was analyzed as "yes." Frequencies and Chi-square tests (p < 0.05) were used to compare barriers by gender.

RESULTS

The mean age was 29.9 years. 287 (52.9%) were female. Compared to males, female residents were more likely to report concerns regarding maternity/paternity leave, child care during or after training, fertility, and delaying pregnancy as significant barriers to applying for GI fellowship (Fig. 1). Lack of mentorship, lack of same-sex mentorship, lack of gender diversity, and compensation inequality were greater concerns compared to males (Fig. 1). Financial obligations, job availability, debt burden, family obligations, and paternity/maternity leave were significant barriers for trainees with 1 or more children compared to trainees with no children (p < 0.05) (Fig. 2). In a gender-based sub-analysis, female married trainees perceived paternity/maternity leave, childcare, delayed pregnancy, and lack of same-sex mentors to be greater barriers compared to male married trainees (p < 0.05).

CONCLUSION

Our study revealed several gender-specific, parental, and marital-based barriers that may prevent IM residents from pursuing fellowship training in GI. Potential interventions for female trainees include structured mentorship pathways, better resources for parental leave, and interventions to reduce stress/burnout and improve work-life balance.

Alleviating radiologists' childcare woes: A roadmap for the 21st century

This manuscript illuminates the need for childcare support for trainees and faculty in the field of radiology, highlighting the essential need for access, affordability, and high-quality childcare services. For over four decades, women radiologists have voiced the challenges of meeting both childcare and professional responsibilities. The COVID-19 pandemic highlighted systemic inadequacies in the childcare infrastructure, exacerbating the challenges of this long-standing balancing act. The 2022 National Plan for Health Workforce Well-Being and the American Medical Association's (AMA) recent resolutions underscore the necessity of affordable, high-quality childcare in recruiting and retaining a diverse healthcare workforce. Despite the recent federal threshold categorizing childcare costs as affordable when they comprise 7% of household income, many families allocate >30% of household income to childcare. Disparities in childcare disproportionately impact women, leading to increased burnout and attrition rates in healthcare. This review explores exemplary childcare initiatives across various economic sectors that demonstrate positive returns on investment and employee retention. The manuscript provides actionable recommendations for radiology departments that can enhance workforce well-being. By addressing childcare needs, the field of radiology can improve the lives of parenting professionals and the patients they serve.

Impact of department chair gender on paid parental leave across American anaesthesiology residencies

BACKGROUND

Residency training and parenthood are conflicting pursuits for many residents, as both often occur during similar years of life. Online policy about paid parental leave for residents is important for not only mitigating this dilemma, but also ensuring that the associated health benefits can be fully capitalised on.

PURPOSE

Investigate the extent of advertised paid parental leave for anaesthesiology residencies in the USA and to explore whether this had an association with the gender of the department chair for these programmes. Analysis of Canadian anaesthesiology residencies was performed to assess whether a nation with federally protected paid parental leave yielded disparate rates of advertised paid parental leave.

METHODS

All accredited US anaesthesiology residency programme websites were reviewed to determine the gender of the department chair and the existence of advertised paid parental leave for residents. χ2 analysis was used to determine if there was a statistically significant association between the gender of anaesthesiology residency department chairs and paid parental leave advertised. Rates of advertised paid parental leave were compared with those seen in Canadian anaesthesiology residencies.

RESULTS

US anaesthesiology residency department chairs were 84% (137/164) men. Of the men-led programmes, 42% (58/137) advertised paid parental leave, while 70% (19/27) of women-led programmes advertised such benefits (p<0.05). Overall, 47% of (77/164) of US anaesthesiology residencies advertised paid parental leave, while 76% (13/17) of Canadian anaesthesiology residencies advertised paid parental leave (p<0.05).

CONCLUSION

In the USA, anaesthesiology residencies with department chairs held by women had a higher rate of advertised paid parental leave. Such findings call attention to the potential downstream effects of lacking diversity in leadership within medicine. When compared with the USA, Canada was found to have higher rates of advertised paid parental leave across their anaesthesiology residencies, potentially highlighting the impact of federal legislature on medical residents.

Family Planning Among Canadian Plastic Surgeons and Trainees

Introduction: Despite increasing advocacy for family leave policies, few studies have described the current landscape and attitudes around family planning in Canadian plastic surgery. The purpose of this study was to survey Canadian plastic surgeons and trainees to examine their experience with family planning, parental leave, and breastfeeding. Methods: An anonymized survey was distributed to all members of the Canadian Society of Plastic Surgeons and all Canadian Plastic Surgery residents through their program administrators. Survey responses were recorded and analyzed through a customized REDCap™ database. Results were reported using descriptive statistics. Results: A total of 87 plastic surgeons and trainees completed the surgery. We found 72.3% of respondents had children; 67.8% felt their colleagues were supportive of parental leave; 45.6% felt that financial concerns affected their decision to take parental leave; 61.6% felt that their career did not influence the number of children they chose to have; 21.0% accessed fertility services and 9.8% used assisted-reproductive technologies; 80% of respondents who breastfeed felt they did not have enough time to pump at work, however, 79% did not experience any discrimination or criticism for pumping at work. Conclusion: Canadian plastic surgeons most often have children after completing training and choose to take shorter parental leaves as their careers progress. Parental leave and breastfeeding practices in the workplace are reported to have increased support from colleagues compared to previous literature. However, Canadian plastic surgeons continue to struggle with infertility and seek fertility services at rates higher than the general population.

Meta-synthesis of the motherhood-related needs of women with multiple sclerosis

BACKGROUND

The treatment of multiple sclerosis, an autoimmune disease that predominantly affects women of reproductive age, has undergone considerable advancements. Nevertheless, their unique needs, particularly those related to motherhood, continue to be disregarded. This study aims to ascertain the needs of women diagnosed with MS about motherhood.

METHODS

Using the Noblit and Hare methods, meta-synthesis research was conducted on 10 qualitative studies. The relevant studies were obtained by conducting a comprehensive search using keywords in the PubMed, Scopus, Web of Science (ISI), and ProQuest databases without any time limitations until June 2023. The CASP checklist was used to assess the quality of the articles, while the technique of Brown and Clark (2006) was utilized for data synthesis.

RESULTS

Four key themes emerged from this meta-synthesis, highlighting the significance of a support system, psychoeducational counseling, knowledge promotion, and continuous, comprehensive, and unique care.

CONCLUSION

Identifying the needs of women diagnosed with MS and addressing these needs concerning motherhood can enhance the quality of services rendered and enhance women's contentment with their choice to embark on motherhood. Furthermore, recognizing these needs during subsequent stages can be utilized in formulating tailored programs catering to this specific cohort of women.

"I am the doctor": gender-based bias within the clinical practice of emergency medicine in Canada-a thematic analysis of physician and trainee interview data

OBJECTIVES

While women comprise about half of current Canadian medical students and physicians, only 31% of emergency medicine physicians identify as women and women trainees are less likely to express interest in emergency medicine compared to men. Gender-based bias continues to negatively impact the career choice, progress, and well-being of women physicians/trainees. Although instances of gender-based bias are well documented within other medical specialties, there remains a gap in the literature addressing the role of gender specific to the Canadian emergency medicine clinical environment.

METHODS

Using a qualitative study with a thematic analytical approach, participants were purposively and snowball sampled from a cross-section of centers across Canada and included emergency medicine attending physicians and trainees. A thematic analysis using an inductive and deductive approach was undertaken. All data were double coded to improve study trustworthiness. Descriptive statistics were used to characterize the study population.

RESULTS

Thirty-four individuals (17 woman-identifying and 17 man-identifying) from 10 different institutions across 4 provinces in Canada participated in the study. Six themes were identified: (1) women experience gender bias in the form of microaggressions; (2) women experience imposter syndrome and question their role in the clinical setting; (3) more women provide patient care to women patients and vulnerable populations; (4) gender-related challenges with family planning and home responsibilities affect work-life balance; (5) allyship and sponsorship are important for the support and development of women physicians and trainees; and (6) women value discussing shared experiences with other women to debrief situations, find mentorship, and share advice.

CONCLUSIONS

Gender inequity in emergency medicine affects women-identifying providers at all levels of training across Canada. Described experiences support several avenues to implement change against perceived gender bias that is focused on education, policy, and supportive spaces. We encourage institutions to consider these recommendations to achieve gender-equitable conditions in emergency medicine across Canada.

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.

The feminization of medicine in Latin America: 'More-the-merrier' will not beget gender equity or strengthen health systems

This viewpoint addresses the lack of gender diversity in medical leadership in Latin America and the gap in evidence on gender dimensions of the health workforce. While Latin America has experienced a dramatic change in the gender demographic of the medical field, the health sector employment pipeline is rife with entrenched and systemic gender inequities that continue to perpetuate a devaluation of women; ultimately resulting in an under-representation of women in medical leadership. Using data available in the public domain, we describe and critique the trajectory of women in medicine and characterize the magnitude of gender inequity in health system leadership over time and across the region, drawing on historical data from Mexico as an illustrative case. We propose recommendations that stand to disrupt the status quo to more appropriately value women and their representation at the highest levels of decision making for health. We call for adequate measurement of equity in medical leadership as a matter of national, regional, and global priority and propose the establishment of a regional observatory to monitor and evaluate meaningful progress towards gender parity in the health sector as well as in medical leadership.

Priority strategies to improve gender equity in Canadian emergency medicine: proceedings from the CAEP 2021 Academic Symposium on leadership

OBJECTIVES

Gender inequities are deeply rooted in our society and have significant negative consequences. Female physicians experience numerous gender-related inequities (e.g., microaggressions, harassment, violence). These inequities have far-reaching consequences on health, well-being and career longevity and may result in the devaluing of various strengths that female emergency physicians bring to the table. This, in turn, has an impact on patient healthcare experience and outcomes. During the 2021 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, a national collaborative sought to understand gender inequities in emergency medicine in Canada.

METHODS

We used a multistep stakeholder-engagement-based approach (harnessing both quantitative and qualitative methods) to identify and prioritize problems with gender equity in emergency medicine in Canada. Based on expert consultation and literature review, we developed recommendations to effect change for the higher priority problems. We then conducted a nationwide consultation with the Canadian emergency medicine community via online engagement and the CAEP Academic Symposium to ensure that these priority problems and solutions were appropriate for the Canadian context.

CONCLUSION

Via the above process, 15 recommendations were developed to address five unique problem areas. There is a dearth of research in this important area and we hope this preliminary work will serve as a starting point to fuel further research. To facilitate these scholarly endeavors, we have appended additional documents identifying other key problems with gender equity in emergency medicine in Canada as well as proposed next steps for future research.