Abstract
Medical students learned, with the rest of the world during this current pandemic, how to manage the demands of both their professional and personal lives when the normal support structures they depended on failed them. This has been especially true of U.S. medical students who are parents, of which >1100 medical students (7.3%) are according to the 2021 AAMC Graduation Questionnaires. 1 Comparing this data with the 2017 AAMC Matriculating Student Questionnaire, which reported 288 (2.3%) matriculated into medical school with dependents, highlights how the majority of medical students graduating with children likely had them during their 4 years of undergraduate medical education (UME). 2
Recently in academic medicine this minority group of students has sparked concern regarding the policies that medical schools provide (or lack) when it comes to pregnancy, breastfeeding, and parental leave. Before 2021, there was only one published study with systematic data collection of U.S. medical students regarding the accommodations they desired from their institutions to facilitate becoming parents. 3 Seven items were identified in their single-institution survey (at the University of South Dakota Sanford School of Medicine, Bye et al.) that were deemed necessary for a thorough and competent policy on the topic.
Four of the seven items requested in a parental policy include how a student could make up elements missed because of parental leave or pregnancy, how to request accommodations if pregnancy/breastfeeding interfered with expected activities, how to arrange for parental leave, and how much time a student could take off and still graduate on time with their class.
There have been calls for work on this topic, 4 and the response has been swift with published studies in 2021 by Kraus et al. and De Haan et al. showing the vast majority of medical schools lacked policies on how to arrange for accommodations for pregnancy, breastfeeding, or parental leave. 5,6 In this issue of the Journal of Women's Health, Roselin et al. investigated what policies highly ranked U.S. medical schools are offering to their students and provided recommendations for how medical schools can avoid Title IX violations as well as the propagation of intersectional discrimination. 7
Unlike the prior studies that only reviewed the publicly available websites, the authors of this recent study contacted medical schools' administrative offices to ascertain that they had the most current versions of their parental leave policies from October to December 2019. The scope was expanded to the top 50 schools in the 2019 U.S. News & Reports ranking, with primary care and research lists overlapping for a total of 59 schools, of which 3 were excluded for not having any publicly available policies and for not responding to the researchers calls or emails after additional failed outreach to student affairs staff. Fourteen schools did not respond to attempts to confirm policies, but were included in analysis as they had parental leave or leave of absence policies publicly displayed on their websites.
Similar to the work of prior studies, the search terms “parental,” “maternity,” paternity,” “pregnan(cy/t),” “childbirth,” “family,” and “leave of absence” were applied to each school's websites. The policies were then coded based on whether they were “stand-alone policies” (also known as “parental policies”) or whether the aforementioned search terms were embedded in general leave of absence policies (“LOA policies”). Kraus et al. also made this distinction in their study, whereas the De Haan et al. study did not. Roselin et al. subcategorized parental policies as either limited or substantive and LOA policies were coded as (1) no mention of parental/family leave, (2) limited, or (3) substantive.
Out of the 56 schools reviewed, only 18% (10/56) had standalone parental policies and ∼29% (16/56) had LOA policies that mentioned parental leave concerns. Of the remaining schools reviewed, 50% (28/56) had LOA policies with no mention of parental leave and 4% (2/56) had no formal leave policy. Only 8 parental policies and 5 LOA policies were considered substantive for a total of 13 of 56 (23%) substantive policies. Less parental policies required preapproval for leave compared with general LOA policies, and neither consistently provided eligibility standards. None of the surveyed parental policies required approval to resume studies compared with 43% of LOA policies, which the authors of this study noted can play into the subversive institutional message that pregnant students and new parents are perhaps not as committed to their careers.
Although there are different ways to slice the numbers, the results from the although limited body of literature on this issue overlap significantly. In 2019, Kraus et al. found that only 33% of U.S. medical schools (∼25% MD granting and ∼59% DO granting) had any parental leave policies available online or in their student handbooks. 5 Ortega et al. reviewed 42 osteopathic schools, of which only 2 (4.9%) had standalone parental policies and the majority recommended parents seek out guidance from short- or long-term LOA policies that could be extended to them. 8
De Haan et al. validated the original South Dakota survey of medical students with statistical analysis showing that there were no demographic associations with 7 items identified as being desirable in a school policy for new parents and confirming its generalizability for other student body populations. 6 In February 2021, the 7 items identified from the South Dakota survey were then used as a scale looking at 33 highly ranked medical schools (according to 2021 US News & Reports Primary care rating), with only 1 school showing all 7 items as publicly available. Results from De Haan et al. showed a one-sided 95% binomial confidence interval indicating that, at most, 14% of medical schools nationally would be expected to have all seven items.
This was in agreement with the findings from the Roselin et al. study, where only 14% of institutions reviewed had substantive stand-alone parental policies. Furthermore, the 7 items identified in the Bye et al. study were well-aligned with the “Best Practice Recommendations for UME Parental Leave Policies” by Roselin et al. that provided consideration for how schools can be in support of the American Academy of Pediatrics guidance for minimum 12 weeks of parental leave and how to preserve access to financial aid, health insurance coverage, and other enrollment benefits for student parents.
The cohesive evidence from these studies is resoundingly clear—by neglecting to provide publicly available policies for pregnancy, childbirth, and parental leave accommodations, medical schools are not protecting the physical and mental health of their student body populations. The legal expertise of the authors in Roselin et al. go so far as to insinuate that the majority of medical schools could even be in violation of Title IX regulations and thus are compounding the gender and racial disparities of UME students. It is the opinion of this writer that medical schools will favorably respond once they sense how reform is sweeping nationally and see the research that quantitatively proves there is much work to be done in this domain on behalf of future physicians.