Parenthood and Parental Leave Decisions in Pediatric Residency

Parental leave experiences for the non-childbearing general surgery resident parent: A qualitative analysis

BACKGROUND

Stigma surrounds parental leave during general surgery residency, yet 25% to 29% of general surgery residents have children. Parental leave experiences of non-childbearing general surgery resident parents have not been described. This study aimed to describe the non-childbearing population's parental leave experiences.

METHODS

Using a purposive sampling strategy, semi-structured interviews (n = 20) were conducted via Zoom (August 2021-March 2022) with current general surgery residents or fellows who had at least 1 child during residency as the non-childbearing parent. Interviews explored participants' experiences with parental leave policies, timing, structure, motivations/influences for taking leave, career/training impacts, and reflections on their experiences. Transcripts were analyzed using thematic content analysis. Participant demographics were analyzed using univariate analysis.

RESULTS

Of the 20 participants, there were 31 unique parental leave experiences. The following 6 themes were identified from interviews: program/professional policies, cultural climate, support (institutional and social), parental leave experiences, impact, and recommendations. Participants cited needing to rely on informal support (eg, the assistance of other residents) to arrange leave and feeling compelled not to take the full time allowed in order to not burden co-residents or because others took less time. Overall, participants felt dissatisfied with their parental leave experiences.

CONCLUSION

Non-childbearing general surgery resident parents underuse parental leave due to perceived or actual lack of access to leave and stigma. This results in dissatisfaction with their parental leave experiences and has the potential to lead to negative professional and personal outcomes. There is a critical need for improved support through cultural change and policy revision, implementation, and adherence.

The impact of the radiology career on family planning: A survey of practicing radiologists and trainees

PURPOSE

As the field of medicine witnesses evolving attitudes towards work-life balance, barriers to family planning emerge as an important theme. Though these challenges have been investigated in many fields, there has been little work done on this subject within radiology. Here we present the first formal survey of radiologists on topics related to family planning.

MATERIALS AND METHODS

In this single-institution prospective study, a 40-question comprehensive survey was developed and distributed via email. Responses from 76 participants were analyzed.

RESULTS

Of the 76 respondents, a diverse number of ages, points in the career path, and practice settings were represented. A majority of respondents were male (52/76; 68 %) and married (56/75; 73.7 %). Respondents reported a miscarriage rate of 25 %, which is slightly higher than the reported rate for the general population of 20 %. Significantly more female respondents reported a negative stigma associated with being pregnant as a radiologist as compared to their male colleagues (60.9 % vs. 15.4 %; p < 0.001)). Male respondents reported significantly less parental leave than their female colleagues, most commonly reporting zero weeks of leave as compared to 10 weeks for female respondents (p < 0.001). Numerous respondents cited lack of childcare support as a major issue.

CONCLUSION

We have identified several key areas of concern, including a need for improving parental leave policies, addressing pregnancy stigma, and increasing access to childcare support. Overall, our study lays the groundwork for discussions and policy changes within radiology at both the institutional and national level to ensure the continued interest of trainees and satisfaction of radiologists.

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.

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.

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.