"I Thought Everyone Was Going to Hate Me for Being Pregnant": The Enduring Influence of the Ideal Worker Image in GME.

Introduction: Patriarchal norms continue to disadvantage women in Graduate Medical Education (GME). These norms are made salient when women trainees are pregnant. Although it is known that pregnant trainees experience myriad challenges, their experiences have not been examined through the lens of gendered organizations. To understand why these challenges persist, this study critically examined the experiences of pregnant trainees and their program directors (PDs) with navigating pregnancy. Methods: From October 2022 to April 2023, we recruited 13 resident or fellow trainees who experienced pregnancy while in training and their corresponding PDs. Data, in the form of semi-structured interviews, were collected, transcribed, and analyzed using thematic analysis. Guiding the analysis was feminist theory, in particular Acker's conceptualization of the ideal worker. The ideal worker norm promotes a culture of individuals who are singularly dedicated to their work with no external distractions or demands upon their time or effort. Results: Both sets of participants struggled with medicine's image of the ideal worker (i.e., a selfless and untethered professional). Trainees experienced guilt for using entitlements meant to assist them during this time, concern that their requests for help would signal personal weakness, and pressure to sacrifice their own wellbeing for work. While most PDs were aware of these phenomena, they experienced varying degrees of success in combating the negative effects of the ideal worker norm. Discussion: In each case, the image of the ideal worker lurked in the background of medical training, shaping trainees' experiences and PDs' perceptions and guidance. This study shows that even though the number of women has increased in medicine, the profession's underlying culture continues to signal that they must live up to the profession's expectations of the ideal worker.