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 Parental leave policies for residents are limited and/or unpublished.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?