Path to parenthood for medical residents and fellows: the impact of leave policies on parent trainees at Oregon Health and Science University.

Background: Residents and fellows in graduate medical education (GME) programs across the USA often complete training during childbearing years, presenting challenges for pregnant and parenting trainees balancing work and family. Institutional policies must better support these trainees. Previous studies show supported trainees experience reduced burnout, better health, and improved patient outcomes.

Objective: This study assessed the experiences and unmet needs of pregnant and parenting GME trainees and presents their recommendations for improved support.

Methods: Using a sequential explanatory mixed-methods design, we examined the unmet needs and challenges of pregnant and parenting trainees, and their recommendations for improvement. We distributed a survey to all GME trainees across all specialties at Oregon Health and Science University (OHSU) in 2023. Ninety-eight out of 160 eligible participants completed the survey (~60% response rate).

Results: Despite existing policies, trainees at Oregon Health and Science University faced persistent challenges. We identified three themes and related recommendations from our analysis of quantitative and open-ended survey data: (1) Leave and coverage-barriers to adequate parental leave and inconsistent enforcement of GME policies; [2] Lactation-meeting breast/chest-feeding goals required immense effort due to limited resources; and [3] Health and childcare-existing policies negatively impacted fertility, childcare access, and mental health. Respondents recommended standardized, flexible leave policies; transparent processes for work adjustments and planning; improved access to private, well-equipped lactation spaces; and tailored mental health and wellness programs to support the perinatal period.

Conclusions: Barriers persist for trainees starting families. Institutional leaders have actionable opportunities to improve equity and institutional support of parenting trainees. Key messages What is already known on this topic: GME trainees face significant challenges during childbearing years, including inconsistent parental leave policies, limited institutional support, and increased risk of stress and burnout, which negatively impact their health and patient-care outcomes. What this study adds: This study contributes trainees' recommendations for institutional reforms necessary to address persistent gaps in support for parenting trainees, such as insufficient parental leave, inadequate lactation accommodations, and barriers to mental health care. How this study might affect research, practice, or policy: Incorporating trainee perspectives is crucial to developing effective interventions. Institutions and national standards should prioritize equitable parental leave, flexible scheduling, and comprehensive supports to foster a culture that aligns with trainees' personal and professional goals. Research Questions How do Accreditation Council for Graduate Medical Education requirements and institutional policies reinforce or mitigate structural inequities that impact parent medical trainees? What systemic barriers and supports shape access to perinatal health and mental health resources for parent medical trainees? How might medical trainees' perspectives influence the development and implementation of Accreditation Council for Graduate Medical Education requirements and institutional policies that better support medical trainees ability to balance professional training and family responsibilities?