A Brief Overview
Residency represents one of the most demanding periods in medical training. Emergency medicine (EM) residents are expected to manage high-stress situations, endure long and irregular hours, and quickly adapt to a rapidly changing work environment. Amidst these professional demands, many residents also navigate major personal milestones, such as childrearing. Many residents decide to grow their families while in training.1,2 The complexities associated with competing demands of work and family—and the best ways to support these residents through their training—remain underexplored in the medical literature.
An anonymous survey was sent out to all EM residents in ACGME-approved residency programs in May-June 2024 (IRB 20240511). A total of 223 residents completed the survey. Demographic data are shown in Figure 1. Most residents who completed the survey are married or in a committed relationship, heterosexual, and white.
Figure 1
|
Demographics |
|
|
|
PGY year |
||
|
|
|
|
Duration of residency |
||
|
|
|
|
Location of program |
||
|
|
|
|
Type of program |
||
|
|
|
|
Sex |
||
|
|
|
|
Race |
||
|
|
|
|
Sexual Orientation |
||
|
|
|
|
Martial Status |
||
|
|
|
In this paper, we highlight survey questions that were asked to all participants. Subsequent papers will investigate the complexities of pregnancy and pumping while in the ED. All respondents were asked: “Have you thought about having a child (or another child) in residency, but then decided against it?” 71 respondents said “no,” while 50 said “yes,” of whom 15 identified as female, 34 identified as male, and 1 identified as other. Participants who said “yes” were then asked to identify all applicable reasons from a list of 10. Results are shown in Figure 2. The primary concern among residents was child care availability. EM residents have constantly changing schedules with many evening, night, and weekend shifts. It is difficult to have reliable child care at all hours of the day. Many residents also worried about not having time with the child and the substantial time demands associated with parenting. The goal of residency is to become the best EM doctor that you can be, and personal wellbeing can significantly influence that goal, either positively or negatively. It is important that programs are supportive of residents who want to grow their families, such as offering a virtual elective following parental leave or providing schedules earlier in advance so that residents can make the required arrangements for child care. Financial concerns were also cited as a reason many residents decided not to have a child in residency. There is also a need for systemic advocacy, such as encouraging the ACGME to mandate increased resident salaries across institutions.
Figure 2
|
Reason |
N = 50 |
|
|
Fertility issues |
5 |
|
|
Financial concerns |
32 |
|
|
Concerns about residency schedule while pregnant |
21 |
|
|
Concerns about working night shift while pregnant |
8 |
|
|
Concerns about residency scheduling postpartum |
18 |
|
|
Concerns about child care |
36 |
|
|
Concerns about not having time with the child |
33 |
|
|
Concerns about the time commitment |
33 |
|
|
Do not want to extend residency |
26 |
|
|
Want to have a child in a future year of residency |
12 |
|
All respondents were asked: “Have you worked with a pregnant co-resident?” and subsequently, “Did you feel working with them was an imposition?” Of 198 residents who worked with a pregnant co-resident, 14 (7%) responded “yes,” that working with them was an imposition. Furthermore, residents were asked, “Have you worked with a co-resident who was pumping?”, and subsequently, “Did you feel working with them was an imposition?” While 160 residents responded that they have worked with a pumping co-resident, only 7 (4%) responded that it was an imposition. While less than 10% of residents found their pregnant and pumping co-residents to be an imposition on shift, pregnant and pumping residents felt themselves to be an imposition. Eight out of a total of 28 (29%) pregnant residents responded “yes” to “Did you feel like you were an imposition to your co-residents on shift while pregnant?” and 9 out of 10 (90%) responded “yes” to “Did you feel like an imposition to your co-residents while pumping on shift?” This stark contrast between perceptions related to pregnancy and pumping on shift highlights a key area in which programs can be more supportive of pregnant and pumping residents. If pregnant/pumping residents feel like an imposition to their co-residents, but their co-residents do not feel that this is the case, then even small gestures of support may have a meaningful impact. At the beginning of shift, co-residents might express support through simple comments, such as “I know you’re pumping, please go whenever you need to”, “Please do not overexert yourself, take breaks when you need to,” or “Here, I got you a water bottle from the cafeteria so that you can remain hydrated during the shift.” These simple acts will help create a more supportive work environment for your co-residents who have added stresses related to pregnancy and pumping, and, in turn, less burnout among this special resident population.
A nuanced understanding of these dynamics can help improve the training environment and also foster a more sustainable and fulfilling career path for future emergency medicine physicians. Ultimately, ensuring that EM residents can successfully balance their professional responsibilities with their personal lives will enhance their overall well-being, promote gender equity within the medical field, and improve patient care outcomes.
References
- Gasior AC, Bergus KC, Beeler WH, et al. Pregnancy in Medical Training: A Survey of Physician Moms on Their Experiences During Residency and Fellowship. J Surg Educ. 2024 Jan;81(1):84-92. Epub 2023 Nov 1.
- Holliday EB, Ahmed AA, Jagsi R, et al. Pregnancy and Parenthood in Radiation Oncology, Views and Experiences Survey (PROVES): Results of a Blinded Prospective Trainee Parenting and Career Development Assessment. Int J Radiat Oncol Biol Phys. 2015 Jul 1;92(3):516-24.