Purpose: To assess gender differences among residents regarding their plans to have children during residency and determine the most influential reasons for these differences.
Method: Using the Health Belief Model as a framework, the authors created an instrument to survey 424 residents from 11 residency programs at three academic medical institutions about their intentions to have children during residency. The authors developed a scale to assess the perceived career threats of having children during residency, evaluated its psychometric properties, and calculated the effect of the mediators.
Results: The response rate was 77% (328/424). Forty-one percent of men versus 27% of women planned to have children during residency (P = .01). The instrument measured four career threats—extended training, loss of fellowship positions, pregnancy complications, and interference with career plans—on a five-point Likert scale. The scale had a Cronbach alpha of 0.84 and an eigenvalue of 2.2. Compared with men, women had higher scores for each item and a higher mean score (2.9 versus 2.1, P = .001), signifying greater belief in the potential of pregnancy to threaten careers. After adjusting for age, institution, postgraduate year, and knowledge of parental leave policies, women were less likely to plan to have children during residency (odds ratio 0.46 [95% confidence interval 0.25–0.84]). In mediation analysis, threats to career explained 67% of the gender variance.
Conclusions: Women residents intentionally postpone pregnancy because of perceived threats to their careers. Medical educators should be aware of these findings when counseling female trainees.
Dr. Willett is associate professor of medicine and associate director of the internal medicine residency program, Division of General Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Dr. Wellons is a fellow in endocrinology, Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham, Birmingham, Alabama.
Dr. Hartig is assistant professor of medicine and director of the medicine–pediatrics residency program, Division of General Internal Medicine and Division of General Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
Dr. Roenigk is a fellow in pulmonary–critical care, Division of Pulmonary and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama.
Dr. Panda is professor of medicine and chair, Department of Internal Medicine, University of Tennessee, College of Medicine, Chattanooga, Chattanooga, Tennessee.
Dr. Dearinger is assistant professor, Division of General Internal Medicine, University of Kentucky, Lexington, Kentucky.
Dr. Allison is vice chair, Department of Quantitative Health Sciences, associate vice provost for health disparities, and professor of quantitative health sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
Dr. Houston is scientist, Center for Health Quality, Outcomes & Economic Research (CHQOER), Bedford VAMC, Bedford, Massachusetts; and professor of quantitative health sciences and medicine chief, Division of Health Informatics and Implementation Science, and assistant dean for continuing medical education/medical education research, University of Massachusetts Medical School, Worcester, Massachusetts.
Please see the end of this article for information about the authors.
Correspondence should be addressed to Dr. Willett, BDB 341, 1530 Third Avenue South, Birmingham, AL 35294-0012; telephone: (205) 934-2494; e-mail: firstname.lastname@example.org.
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