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King Z, Zhang Q, Liang JW, Levy MS, Plowden TC, Jeelani R, Marshall AL, Barnett R, Caban-Martinez AJ, Brown A, Mueller CM, Brown-Johnson C, Salles A. Barriers to Family Building Among Physicians and Medical Students. JAMA Netw Open 2023; 6:e2349937. [PMID: 38153730 PMCID: PMC10755597 DOI: 10.1001/jamanetworkopen.2023.49937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/14/2023] [Indexed: 12/29/2023] Open
Abstract
Importance Physicians and medical students who desire to build families face significant barriers due to the structure and culture of medicine. Objective To understand the barriers and facilitators to family building for all people in medicine-not only individuals who can become pregnant-through an open-ended, qualitative analysis of survey responses. Design, Setting, and Participants This qualitative study used a survey conducted in April and May 2021 with a broad sample of physicians and medical students. Participants were recruited through social media, targeting physician and medical student communities. Physicians (residents, fellows, and physicians in independent practice) and medical students of all gender identities and sexual orientations were included. Informed by a postpositivist approach, coding reliability thematic analysis was performed on 3 open-ended survey questions on family-building experiences (what they would do differently, what advice they have for others, and anything else they wished to share). Main Outcomes and Measures Identified themes were mapped to the social-ecological model, a model used in public health to examine how a spectrum of factors is associated with health outcomes. Results A total of 2025 people (1860 [92%] women; 299 [15%] Asian, 151 [8%] Black, and 1303 [64%] White; 1730 [85%] heterosexual; and 1200 [59%] physicians who had completed training) responded to at least 1 of 3 open-ended questions. Themes mapped to social-ecological model levels included: (1) cultural, eg, medical training being at odds with family building; (2) organizational, eg, lack of institutional support for the range of family-building routes; (3) interpersonal, eg, impact of social support on family building; and (4) individual, eg, socioeconomic status and other individual factors that facilitate or inhibit family building. Recommendations to improve family-building experiences include implementing family-building curricula at medical schools, providing adequate parental leave for all physicians and medical students who become parents, and providing insurance coverage for all family-building routes. Conclusions and Relevance In this qualitative study of physicians and medical students, self-reported barriers to family building were identified at each level of the social-ecological model. Addressing these barriers is critical to creating a more equitable family-building environment for physicians and medical students.
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Affiliation(s)
- Zoe King
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California
| | - Qiang Zhang
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles
| | - Jane W. Liang
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Morgan S. Levy
- University of Miami Miller School of Medicine, Miami, Florida
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Torie C. Plowden
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Roohi Jeelani
- Department of OB/GYN, Division of Reproductive Endocrinology and Infertility Wayne State University School of Medicine, Detroit, Michigan
- Kindbody Fertility Clinic, Chicago, Illinois
| | - Ariela L. Marshall
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis
| | - Rebecca Barnett
- University of Miami Miller School of Medicine, Miami, Florida
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Alberto J. Caban-Martinez
- University of Miami Miller School of Medicine, Miami, Florida
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Alyssa Brown
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Claudia M. Mueller
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Cati Brown-Johnson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Arghavan Salles
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
- Clayman Institute for Gender Research, Stanford University School of Medicine, Palo Alto, California
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Grace B, Shawe J, Stephenson J. Exploring fertility knowledge amongst healthcare professional and lay population groups in the UK: a mixed methods study. HUM FERTIL 2023:1-10. [PMID: 36600193 DOI: 10.1080/14647273.2022.2153349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
As the average age of first-time parents continues to rise, there has been a concerted effort by educators, policy makers and several reproductive health groups to improve fertility awareness. This study explored fertility knowledge of lay men and women and healthcare professionals (HCPs) using the same test instrument, providing a new and unique perspective compared with previous studies. Results were obtained from 1082 survey respondents: 347 HCPs, 319 men and 413 women, 105 of whom were trying to conceive (TTC). A total of 35 interviewees were purposively sampled to include 9 HCPs, 13 men and 13 women from the reproductive age range and of varying ethnic and educational backgrounds. Interview data were transcribed and analysed using the framework method. The proportion of HCPs correctly answering the survey knowledge questions was 47.1 (95% CI = 41.7%, 52.5%) compared to 44.4% for women (95% CI = 38.9%, 50.1%); 49.9% (95% CI = 39.0, 59.9%) for women TTC; and 32.5% (95% CI = 27.1%, 37.9%) for men. HCPs were ranked as the most trusted source for seeking fertility information. Overall HCPs did not demonstrate better fertility knowledge than lay participants, with inconsistencies regarding where responsibility lies for providing the right information to patients. HCPs need to improve their knowledge about fertility to help improve patient's fertility awareness.
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Affiliation(s)
- Bola Grace
- Department of Sexual and Reproductive Health, Faculty of Population Health Sciences, UCL Institute for Women's Health, University College London, London, UK
| | - Jill Shawe
- Faculty of Health, University of Plymouth, Plymouth, UK.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Judith Stephenson
- Department of Sexual and Reproductive Health, Faculty of Population Health Sciences, UCL Institute for Women's Health, University College London, London, UK
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