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

Working conditions during pregnancy: a survey of 3590 European anaesthesiologists and intensivists

BACKGROUND

Pregnancy adds challenges for healthcare professionals, regardless of gender. We investigated experiences during pregnancy, attitudes towards pregnant colleagues, family planning decisions, and awareness of regulations among European anaesthesiologists and intensivists.

METHODS

A cross-sectional online survey was conducted among 3590 anaesthesiologists and intensivists from 47 European countries. The survey, available for 12 weeks, collected data on demographics, working conditions, safety perceptions, and the impact of clinical practice and training demands on family planning. Quantitative data were analysed using descriptive statistics, whereas qualitative data underwent thematic content analysis.

RESULTS

Only 41.4% (n=678) of women were satisfied with their working conditions during pregnancy, and only 38.5% (n=602) considered their working environment safe. The proportion of women who changed their clinical practice during pregnancy and who took sick leave to avoid potentially harmful working conditions increased over time (P<0.001 for both). Men had children more often during residency than women (P<0.001). Pregnant colleagues' safety concerns influenced clinical practice, with women and men who had experience with their own and partner's pregnancy being more likely to modify their practices. Work and training demands discouraged plans to have children, particularly among women, leading to consideration of leaving training. Awareness of national regulations was limited, and respondents highlighted a need for better support and flexible working conditions.

CONCLUSIONS

Improved support and working environments for pregnant colleagues and ability to express preferred clinical areas for work are needed. Department heads should commit to safety and family friendliness, and men transitioning to parenthood should not be neglected.

Neonatology Staffing Practices: An In-Depth Exploration of Leaders' Perspectives

OBJECTIVE

To describe neonatology leaders' perspectives on ideal staffing practices, including clinical work, nonclinical roles, shift characteristics, and flexibility. Although the current state of neonatology staffing issues is reported in the literature, a description of ideal, recommended staffing practices is lacking.

STUDY DESIGN

We performed a qualitative study, using purposive sampling to interview 26 neonatology leaders. Semi-structured interviews included open-ended questions on ideal staffing practices in 4 categories: clinical and nonclinical aspects of work, shift characteristics, and flexibility in the work environment. We conducted a directed content qualitative analysis of interview transcripts.

RESULTS

Leaders described their perspectives of ideal staffing practices. All clinical hours should count toward total clinical time and clinical full-time equivalent, and many nonclinical efforts should be compensated with time or money. Most stated varying workloads reflective of team structures and patient factors should be considered. Maximum in-house shift length should be ≤ 24 hours and weekend assignments should be equitable, irrespective of career track. Most endorsed flexibility at the individual physician level with a clear plan for covering variable staffing acute and chronic needs.

CONCLUSIONS

Neonatology leaders recognize current staffing challenges and the need to evolve toward more ideal staffing practices. However, competing interests and complexities drive maintenance of the status quo and make change difficult for healthcare organizations and academic departments. Future work needs to create and measure optimal, standardized, and transparent staffing practices with appropriate adjustments for clinical, administrative, teaching, and scholarly obligations.

Fostering Inclusivity in the Clinical Learning Environment

Despite the Supreme Court's decision on race-based admissions, academic medical centers, medical societies, and accreditation bodies remain committed to recruiting a diverse workforce. Many medical schools and graduate medical education programs created initiatives to expand their census of underrepresented in medicine (UIM) as the key to addressing health care disparities. As a result, an influx of an UIM physician workforce has entered clinical learning environments, often without consideration of the inclusivity of these settings. To create inclusive, safe, and comfortable CLEs, we must first recognize the challenges faced by UIM trainees, students, and faculty and the complex ways in which discrimination manifests. Ultimately, having inclusive CLEs allows all learners, especially those from historically excluded identities, to thrive in their training and working environment, making it essential to retain the diverse workforce necessary. Using case examples, we discuss strategies of inclusivity and ways in which we can maintain clinical learning environments where learners feel safe and supported through their training.

Professional activity and experience after a residency training program in ObGyn: A 10-year analysis

OBJECTIVE

To describe the profile and professional trajectory of the obstetrics and gynecology (ObGyn) graduates over the past decade, at a referral university hospital.

METHODS

A cross-sectional study was conducted, utilizing a survey that targeted graduates of the ObGyn residency program from the last decade, asking about demographics, medical undergraduate, residency details, post-residency trajectory, satisfaction levels, and social media usage. A descriptive analysis was performed. Comparative analyses, including gender-based differences, were assessed using chi-squared or Fisher exact tests (P < 0.05).

RESULTS

Among 126 graduates, 84 agreed to participate (66.67%), predominantly comprising females with an average age of 33 years. Most identified themselves as white. The majority had pursued their undergraduate studies at the same institution (78.6%) and subsequently acquired specialized titles in ObGyn from the national society. Most of them were employed in both public and private sectors (71.08%). Male graduates held the majority of medical shifts in obstetrics. A significant gender-based salary discrepancy was noted, favoring males. More than half of the professionals utilized social media for work-related purposes. Many expressed the necessity for supplementary education beyond public health, particularly career management.

CONCLUSION

The findings highlight a predominance of female and white individuals among the graduates. Overall, graduates expressed contentment with their education and professional engagements. A gender-based income disparity was identified, favoring male graduates. Studies like this can provide insights for improving medical residency education.

A National Survey of Pregnancy and Parenthood among Nephrology Trainees: A Focus on Nephrology Fellowship

Key Points

Parental leave policies for physician trainees are inconsistent. Nephrology fellows are largely unaware of parental leave policies and pregnancy accommodations in their programs. Individual nephrology programs should improve awareness about national and local program policies among trainees.

Background

National and international policies on parental leave for physician trainees are inconsistent. Physician trainees, including nephrology fellows, may be at higher risk of pregnancy complications. Physician trainees face barriers in meeting their breastfeeding goals and in finding childcare because of nontraditional work hours with extended or unpredictable shifts. We examine awareness of current policies in US nephrology fellowship programs regarding parental leave, pregnancy/breastfeeding accommodations, and fellows' perspectives on family planning.

Methods

An anonymous, online survey of US nephrology fellows was undertaken from June 9 to August 24, 2023.

Results

One hundred twenty nephrology fellows submitted the survey. Most of the fellow respondents were unaware of parental leave policies of their training programs (63%), the Accreditation Council for Graduate Medical Education (75%), and/or the American Board of Medical Specialties (75%). Forty-two percent were unaware of the duration of parental leave at their program. Nearly 45% of all respondents were unsure if their program limited night shifts or shifts >24 hours for pregnant trainees. Forty-three percent reported they were unsure of lactation accommodations, and 40% were unsure of access to subsidized childcare. When fellows received work accommodations for pregnancy or parenthood, their work obligations were largely covered by co-fellows (60%) or attendings (38%). Over 60% of fellows agreed or strongly agreed that they would avoid a pregnancy in fellowship because of concern that they would have to extend their training. Of the 40 fellows who chose to pursue pregnancy or parenthood during medical training, 75% did not change their career plans as a result.

Conclusions

Most nephrology fellows were unaware of parental leave policies and pregnancy/lactation accommodations. While the topic itself has a broad effect to all physician trainees, there is a need for improved awareness about national and local program policies among trainees across individual nephrology programs.

Bereavement scheduling policy for emergency medicine residents: A descriptive pilot study

Background

The Accreditation Council for Graduate Medical Education has tasked residency programs to prioritize resident wellness, reduce trainee stress, and prevent burnout. Grief and bereavement can significantly impact residents' wellness during difficult clinical training schedules. There are no best practices on how to support residents during this time.

Methods

In a split academic county emergency medicine (EM) residency, this pilot study documents a resident-driven change to scheduling practices for bereavement leave. An advisory group of residents, chief residents, and program directors informally polled peer institutions to develop bereavement leave guidelines. Considerations were made to balance resident wellness, education, and patient care in developing a bereavement scheduling policy.

Results

The bereavement policy was adopted in January 2023, aiming to "support the resident during a difficult time and reduce concerns around shift coverage" following the death of a family member without impacting sick call. The number of covered days depended on the relationship of the resident to the deceased. Residents covering bereavement days for their peers were financially compensated. During the first 7 months following implementation, five residents utilized the policy. These residents noted this to be the most positive impact on the residency during the past year. Based on resident feedback, the scope was expanded to include grave medical illness of a family member as an implementation criterion.

Conclusions

This article outlines the creation, implementation, and benefits of a bereavement scheduling policy within an EM residency. Describing this approach will provide guidance for other residencies to adopt similar wellness-focused strategies.

Current State of Safe Pregnancy Policies for the US Surgical Trainee

Objective

Define current practices and protocols in surgical training programs for pregnant trainees.

Study Design

Cross sectional.

Setting

Academic surgical training programs in the United States.

Methods

A validated 20-question survey was sent via email to program directors and coordinators of US surgical training programs, including otolaryngology head & neck surgery (OHNS), plastic surgery, vascular surgery, and general surgery. The survey was issued in November and December 2022 and data were collected until January 2023. This study was approved for exemption by the Minimal Risk Research IRB at the University of Wisconsin Madison (ID number 2022-1370).

Results

Surveys were emailed to 608 surgical programs, and the response rate was 23.5% (143/608) including 45 OHNS programs. When asked if their program has a policy in place for pregnant trainees, 84.4% responded yes, and 82.4% responded that they were satisfied with their policy. Subsequent questions addressed individual policies and risk factors facing pregnant trainees. 60.3% of programs report providing protected time off for miscarriages. Only 36.9% provide information to pregnant trainees regarding workplace exposures that pose a risk of fetal anomaly or miscarriage. Only 47.1% incorporate rest breaks for pregnant trainees, and only 20% protect the number of hours a pregnant trainee operates per week. 24.2% adjust overnight shifts or call schedules for pregnant trainees, and of those that adjust call shifts, 20% require pregnant trainees to "make up" these missed call shifts. Less than half (40%) of programs have a contingency plan in place for supporting nonchild-bearing residents who may take on the work of their colleagues during pregnancy or postpartum.

Conclusion

While a majority of training programs report a pregnancy policy in place for trainees, most of these policies appear to be severely deficient in addressing critical aspects of surgical training that place both fetus and mother at significant risk of complications. This data indicates a need for a safe pregnancy protocol in order to protect both surgeon and fetus.

A Gravid Situation: General Surgery Faculty Support for Pregnant Surgical Residents

INTRODUCTION

The perceptions of teaching faculty toward pregnant general surgery residents have been overlooked despite the daily interactions amongst these groups.

METHODS

A 32-question survey designed to measure general surgery teaching faculty perceptions toward pregnant residents was distributed electronically from March 2022 to April 2022 to general surgery teaching faculty in the United States. Descriptive statistics were used to characterize responses and differences in perceptions, and qualitative analysis identified recurring themes from free-text responses.

RESULTS

Among 163 respondents included in the final analysis, 58.5% were male and 41.5% were female. Despite 99.4% of surgeons feeling comfortable if a resident told them they were pregnant, 22.4% of surgeons disagreed that their institutions have supportive cultures toward pregnancy. Almost half (45.4%) have witnessed negative comments about pregnant residents and half (50.3%) believe that pregnant surgical residents are discriminated against by their coresidents. Nearly two-thirds of surgeons (64.8%) believe that someone should have a child whenever they wish during training. Given recent reports, 80.2% of surgeons recognized that female surgeons have increased risks of infertility and pregnancy complications. Recurring themes of normalizing pregnancy, improving policies, and creating a culture change were expressed.

CONCLUSIONS

In this national survey, although there appears to be positive perceptions of pregnancy in surgical training amongst those surveyed, there is acknowledged necessity of further normalizing pregnancy and improving policies to better support pregnant residents. These data provide further evidence that though perceptions may be improving, changes are still needed to better support pregnancy during training.

A Qualitative Study of Internal Medicine Subspecialty Fellowship Program Directors' Perspectives on Short-Term Hospitalist Employment Prior to Fellowship

Background Some internal medicine (IM) residents pursuing subspecialty training choose short-term hospitalist employment prior to fellowship, or "pre-fellowship hospitalist years." Residency and fellowship program directors (PDs) advise residents on this decision, but PD experience with fellows pursuing pre-fellowship hospitalist years and the impact on fellowship applications is unknown. Objective We aimed to explore perceptions of fellowship PDs regarding experience with fellows who pursued pre-fellowship hospitalist years, including perceived effects on how such years affect fellowship application candidacy. Methods A purposive sample of 20 fellowship PDs in the most highly competitive and commonly selected IM fellowships (cardiology, pulmonology/critical care medicine, hematology/oncology, gastroenterology) from 5 academic institutions were approached for participation in fall 2021. Interviews included semi-structured questions about pre-fellowship hospitalist employment. Utilizing rapid qualitative analysis, interview transcripts were summarized and reviewed to identify themes and subthemes describing fellowship PDs' perspectives of pre-fellowship hospitalist years. Results Sixteen fellowship PDs (80%) participated. PDs identified 4 major themes as important for trainees considering pre-fellowship hospitalist years: (1) Explain the "Why"-why the year was pursued; (2) Characteristics of the Hospitalist Position-what type of employment; (3) The Challenges-potential concerns faced with pre-fellowship hospitalist years; and (4) Describe the "What"-the experience's contribution to resident professional development. Conclusions Fellowship PDs in 4 competitive IM subspecialities placed a strong emphasis on explaining a clear, logical reason for seeking short-term hospitalist employment prior to fellowship, describing how it fits into the overall career trajectory, and selecting activities that demonstrate continued commitment to the subspecialty.

A narrative review of occupational scheduling that impacts fatigue and recovery relevant to veterinarian well-being

Background

Sleep insufficiency is a worldwide affliction with serious implications for mental and physical health. Occupational factors play a large role in determining sleep habits. Healthcare workers are particularly susceptible to job-mediated sleep insufficiency and inadequate rest in general. Little is published on sleep practices among veterinarians, and overall recognition of the impacts of inadequate rest within the veterinary profession is poor.

Objectives and procedures

This review describes occupational factors affecting sufficiency of rest and recovery, reviews veterinary-specific and relevant adjacent literature pertaining to sleep patterns, and discusses potential solutions for addressing occupational schedules contributing to sleep insufficiency and inadequate rest. Online databases were searched to extract contemporary literature pertaining to sleep, insufficient rest, and occupational factors, with a focus on veterinary medicine and other healthcare sectors.

Results

Occupational factors leading to inadequate rest among healthcare workers include excessive workloads, extended workdays, cumulative days of heavy work hours, and after-hours on-call duty. These factors are prevalent within the veterinary profession and may contribute to widespread insufficient rest and the resulting negative impacts on health and well-being among veterinarians.

Conclusion and clinical relevance

Sufficient sleep quantity and quality are critical to physical and mental health and are negatively affected by many aspects of the veterinary profession. Critical review of current strategies employed in clinical practice is essential to promote professional fulfillment, health, and well-being among veterinarians.

Navigating Personal Health Crises, Imposter Syndrome, Sexual Harassment, Clinical Mistakes, and Leadership Challenges: Lessons for Work-Life Wellness in Academic Medicine: Part 3 of 3

In this final manuscript of the three-part series, the authors address issues of imposter syndrome, pregnancy, and parental leave, second victim phenomenon, sexual harassment, response to suicide, and managing a budget while advancing diversity, equity, and inclusion. The case scenarios have learners and non-clinicians as their main characters, bringing attention to the cross-cutting nature of the complex issues we see both in and around a career in medicine.

Scheduling practices for pregnant emergency medicine residents

Background

Night shift work is associated with adverse pathophysiologic effects on maternal and fetal well-being. Although emergency medicine (EM) residents work frequent night shifts, there is no existing guidance for residency program directors (PDs) regarding scheduling pregnant residents. Our study assessed scheduling practices for pregnant EM residents, differences based on program and PD characteristics, barriers and attitudes toward implementing a formal scheduling policy, and PDs' awareness of literature describing adverse effects of night shifts on maternal-fetal outcomes.

Methods

We conducted an anonymous, web-based survey of U.S. EM residencies (N = 276). Quantitative data were summarized; chi-square analysis and logistic regression were used to assess relationships between program and PD characteristics and schedule accommodations. Qualitative description was used to analyze an open-ended question, organizing findings into major and minor themes.

Results

Of the 167 completed surveys (response rate 61%), 67% of programs reported no formal policy for scheduling pregnant residents but made adjustments on an individual basis including block changes (85%), decreased (46%) or no night shifts (34%), and working shifts earlier in pregnancy to cover later shifts (20%). Barriers to adjustments included staffing constraints (60%), equity concerns (45%), or impact on wellness (41%) among all residents and privacy (28%). PDs endorsed scheduling adjustments as important (mean 8.1, 0-10 scale) and reported guidance from graduate medical education governance would be useful (60%). Larger program size, but not PD gender or proportion of female residents, was associated with an increased likelihood of scheduling modifications. Twenty-five percent of PDs reported little knowledge of literature regarding night shift work and pregnancy. Qualitative themes supported quantitative findings.

Conclusions

Most EM residency programs do not have formal scheduling policies for pregnant residents, but most PDs support making adjustments and do so informally. More education and guidance for PDs are needed to promote the development of formal policies.

Pregnancy During Surgical Training: Are Residency Programs Truly Supporting Their Trainees?

OBJECTIVE

Despite recent national improvements in family leave policies, there has been little focus on program-level support for surgical trainees. Trainees who may require clinical duty adjustments during pregnancy, who experience pregnancy loss, or who struggle with balancing work obligations with the demands of a new infant may face stigma when seeking schedule accommodations. The aim of this study was to describe program and colleague support of surgical trainees for pregnancy-related and postpartum health needs.

DESIGN

Survey questionnaire. Participants responded to multiple-choice questions about their history of pregnancy loss, their experience with reduction of clinical duties during pregnancy, and their breastfeeding experience. Those who took time off after miscarriages or reduced their clinical duties during pregnancy were asked whether they perceived their colleagues and/or program leadership to be supportive using a 4-point Likert scale (1-strongly agree, 4-strongly disagree) which was dichotomized to agree/disagree.

SETTING

Electronically distributed through social media and surgical societies from November 2020 to January 2021.

PARTICIPANTS

Female surgical residents and fellows.

RESULTS

258 female surgical residents and fellows were included. Median age was 32 (IQR 30-35) years and 76.74% were white. Of the 52 respondents (20.2%) who reported a miscarriage, 38 (73.1%) took no time off after pregnancy loss, including 5 of 10 women (50%) whose loss occurred after 10 weeks' gestation. Of the 14 residents who took time off after a miscarriage, 4 (28.6%) disagreed their colleagues and/or leadership were supportive of time away from work. Among trainees who reported at least 1 live birth, only 18/114 (15.8%) reduced their work schedule during pregnancy. Of these, 11 (61.1%) described stigma and resentment from colleagues and 14 (77.8%) reported feeling guilty about burdening their colleagues. 100% of respondents reported a desire to breastfeed their infants, but nearly half (46.0%) were unable to reach their breastfeeding goals. 46 (80.7%) cited a lack of time to express breastmilk and 23 (40.4%) cited inadequate lactation facilities as barriers to achieving their breastfeeding goals.

CONCLUSIONS

A minority of female trainees takes time off or reduces their clinical duties for pregnancy or postpartum health needs. National parental leave policies are insufficient without complementary program-level strategies that support schedule adjustments for pregnant trainees without engendering a sense of resentment or guilt for doing so. Surgical program leaders should initiate open dialogue, proactively offer clinical duty reductions, and ensure time and space for lactation needs to safeguard maternal-fetal health and improve the working environment for pregnant residents.

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.