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From the Editor

Contributions and Sacrifices of Medical Students and Health Care Workers With Family Responsibilities Deserve Our Attention and Respect

Roberts, Laura Weiss MD, MA1

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doi: 10.1097/ACM.0000000000004211
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I had my first child just after completing my second year of medical school. Women made up the minority of our class, and I knew of only one other student with a child in the entire school.

One day, one of my classmates, eyeing my belly, said to me, “You’re pregnant? I thought you were going to be a good doctor!” Realizing what he had said, he coughed, panicked, and ran off. I still do not know exactly what was meant by his offhand comment. At best, it was an awkward response to my visible nonconformity with the expectations of a “proper” medical student. At worst, the spontaneous remark represented an insensitive and biased dismissal of my capacity to become a competent physician while also being a mother.

Once my new daughter arrived, I took several months off to spend with her. My classmates moved on to their clinical rotations, and I started to connect with other young mothers in our university neighborhood. When I was facing the anguish of returning to my medical training full time, the other mothers shook their heads, expressing their doubt and concern. “What’s going to happen to your baby? I could never do it.”

An outlier in both the roles of medical student and mother, I learned very quickly to stay quiet, protecting my tender heart and recognizing that my dual identity distanced me both from my peers and my friends. Eventually, I came to understand that my insights as a mother made me a better physician and my identity as a physician enhanced my strengths as a parent. Now, with more kids and more doctoring, it all seems to have sorted itself out.

The lessons from this early experience continue to inform my understanding of the kinds of challenges encountered by physicians and other health professionals who have children or who carry significant family responsibilities during their training years. For these reasons, I was particularly interested in a number of excellent submissions focused on parenting and on the vulnerability of medical students and health care workers’ families, particularly in the time of a pandemic, that were sent to our journal in this past year. Five of these articles 1–5 and an Invited Commentary 6 appear in this issue of Academic Medicine.

The paucity of data on pregnancy and parenting in medical school 1 and the underdevelopment of parental leave policies for medical students 2 are highlighted in 2 articles in this collection. Durfey et al 1 suggest that the growing literature on parenting in graduate medical education and faculty life 7–15 has failed to adequately address the topic of parenting in medical school. The findings of Kraus et al 2 support this “hemineglect” hypothesis; they found that only 33% of 199 MD-granting and DO-granting medical schools have parental leave policies available online or in their medical student handbooks. Kraus et al conclude that many schools lack parental leave policies that are easily accessible online or in student handbooks, separate from other kinds of leave, allow for at least 12 weeks, and permit students who are parents to complete their educations in their original timelines.

My own early empirical work suggests that among physicians-in-training, addressing personal health needs, including reproductive health needs, and caring for family can inspire a lifetime of dedicated, compassionate patient care practices. 16–26 As noted by Callahan and Salazar, 5 personal health experiences can lead to appreciation and empathy for the patient experience. More worrisome are the systematic data and narratives illustrating how medical training can be disruptive of personal and family relationships of health care professionals. 7–10 Several studies 11–15,27 suggest that physicians-in-training experience considerable role strain and stigma associated with parenting or family responsibilities. These data fit with the broader literature indicating that health professionals, in general, set aside their personal physical and mental health needs. 17,28,29 The curricular implications of these findings merit ongoing investigation and discussion in the current context of medical training.

The health risks, childcare needs, and financial burdens experienced by health care worker families in the time of the pandemic are the focus of the work by Donroe et al 6 and by Robinson et al. 3 In both articles, the authors emphasize the responsibility of health care institutions to support and protect their faculty, trainees, and staff. Donroe et al recommend mental health resources, childcare and home assistance networks, and additional administrative efforts to help faculty, trainees, and staff to share their concerns and identify solutions in a supportive work environment. Robinson et al highlight the importance of access to affordable childcare, and Donroe et al identify dual health care professional households, single-parent households, and households with an ill family member as especially vulnerable to added health issues and stress.

In their heartening Innovation Report, Lane et al 4 describe their experience of rapidly setting up a childcare support network for essential health care workers at their institution. Their article joins recent reports and narratives30,31 published in our journal related to insufficient childcare resources in medicine during the COVID-19 pandemic. Lane et al outline the organizational and communication skills, public health knowledge, and morale and personal fulfillment dimensions of this local effort. The COVID-19 pandemic demonstrated societal inadequacies and health inequities throughout the world, and it also revealed the resourcefulness and generosity within communities to support essential health care workers, as illustrated in this report.

This collection enlarges upon the emerging literature that recognizes health professionals as whole people—people who have chosen the path of service to others in health care and who also have responsibilities in caring for their loved ones. 5 But the unique considerations for medical students who are parents and carry significant personal responsibilities appear not to have received sufficient attention by education researchers or policymakers. The contributions and sacrifices of medical students and health care workers and their families may go unnoticed and unspoken but deserve our full consideration professionally and our deep respect personally.

References

1. Durfey SNM, White J, Adashi EY. Pregnancy and parenting in medical schoolHighlighting the need for data and support. Acad Med. 2021;96:1259–1262.
2. Kraus MB, Talbott JMV, Melikian R, et al. Current parental leave policies for medical students at U.S. medical schools: A comparative study. Acad Med. 2021;96:1315–1318.
3. Robinson LJ, Engelson BJ, Hayes SN. Who is caring for health care workers’ families amid COVID-19? Acad Med. 2021;96:1254–1258.
4. Lane ECA, Tran AA, Graulty CJ, Bumsted T. Rapid mobilization of medical students to provide health care workers with emergency childcare during the COVID-19 pandemic. Acad Med. 2021;96:1302–1305.
5. Callahan KP, Salazar EG. Finding light in the uncertain. Acad Med. 2021;96:1281.
6. Donroe JH, Rabin TL, Hsieh E, Schwartz JI. A broader view of risk to health care workers: Perspectives on supporting vulnerable health care professional households during COVID-19. Acad Med. 2021;96:1233–1235.
7. Lavergne MR, Gonzalez A, Ahuja MA, Hedden L, McCracken R. The relationship between gender, parenthood and practice intentions among family medicine residents: Cross-sectional analysis of national Canadian survey data. Hum Resour Health. 2019;17:67.
8. Stack SW, Jagsi R, Biermann JS, et al. Maternity leave in residency: A multicenter study of determinants and wellness outcomes. Acad Med. 2019;94:1738–1745.
9. Kin C, Yang R, Desai P, Mueller C, Girod S. Female trainees believe that having children will negatively impact their careers: Results of a qualitative survey of trainees at an academic medical center. BMC Medical Educ. 2018;18:260.
10. Hill EK, Stuckey A, Fiascone S, et al. Gender and the balance of parenting and professional life among gynecology subspecialists. J Minim Invasive Gynecol. 2019;26:1088–1094.
11. Stack SW, Jagsi R, Biermann JS, et al. Childbearing decisions in residency: A multicenter survey of female residents. Acad Med. 2020;95:1550–1557.
12. Weaver AN, Willett LL. Is it safe to ask the questions that matter most to me? Observations from a female residency applicant. Acad Med. 2019;94:1635–1637.
13. Mattessich S, Shea K, Whitaker-Worth D. Parenting and female dermatologists’ perceptions of work-life balance. Int J Womens Dermatol. 2017;3:127–130.
14. Strong EA, De Castro R, Sambuco D, et al. Work-life balance in academic medicine: Narratives of physician-researchers and their mentors. J Gen Intern Med. 2013;28:1596–1603.
15. Shankar R. Paternity leave: Traversing the landscape as trainee and faculty [published online ahead of print April 7, 2021]. Acad Psychiatry. doi:10.1007/s40596-021-01448-5
16. Roberts LW, Warner TD, Moutier C, Geppert CM, Green Hammond KA. Are doctors who have been ill more compassionate? Attitudes of resident physicians regarding personal health issues and the expression of compassion in clinical care. Psychosomatics. 2011;52:367–374.
17. Roberts LW, Kim JP. Informal health care practices of residents: “Curbside” consultation and self-diagnosis and treatment. Acad Psychiatry. 2015;39:22–30.
18. Roberts LW, Warner TD, Smithpeter M, Rogers M, Horwitz R. Medical students as patients: Implications of their dual role as explored in a vignette-based survey study of 1027 medical students at nine medical schools. Compr Psychiatry. 2011;52:405–412.
19. Moutier C, Cornette M, Lehrmann J, et al. When residents need health care: Stigma of the patient role. Acad Psychiatry. 2009;33:431–441.
20. Dunn LB, Green Hammond KA, Roberts LW. Delaying care, avoiding stigma: Residents’ attitudes toward obtaining personal health care. Acad Med. 2009;84:242–250.
21. Dunn LB, Moutier C, Green Hammond KA, Lehrmann J, Roberts LW. Personal health care of residents: Preferences for care outside of the training institution. Acad Psychiatry. 2008;32:20–30.
22. Roberts LW, Warner TD, Rogers M, Horwitz R, Redgrave G; Collaborative Research Group on Medical Student Health Care. Medical student illness and impairment: A vignette-based survey study involving 955 students at 9 medical schools. Compr Psychiatry. 2005;46:229–237.
23. Roberts LW, Warner TD, Trumpower D. Medical students’ evolving perspectives on their personal health care: Clinical and educational implications of a longitudinal study. Compr Psychiatry. 2000;41:303–314.
24. Roberts LW, Warner TD, Carter D, et al. Caring for medical students as patients: Access to services and care-seeking practices of 1,027 students at nine medical schools. Acad Med. 2000;75:272–277.
25. Roberts LW, Hardee JT, Franchini G, Stidley CA, Siegler M. Medical students as patients: A pilot study of their health care needs, practices, and concerns. Acad Med. 1996;71:1225–1232.
26. Lane LW, Lane G, Schiedermayer DL, Spiro JH, Siegler M. Caring for medical students as patients. Arch Intern Med. 1990;150:2249–2253.
27. Periyakoil VS, Chaudron L, Hill EV, Pellegrini V, Neri E, Kraemer HC. Common types of gender-based microaggressions in medicine. Acad Med. 2020;95:450–457.
28. Coverdale J, West CP, Roberts LW. Courage and mental health: Physicians and physicians-in-training sharing their personal narratives. Acad Med. 2021;96:611–613.
29. Brady KJS, Trockel MT, Khan CT, et al. What do we mean by physician wellness? A systematic review of its definition and measurement. Acad Psychiatry. 2018;42:94–108.
30. Sarma S, Usmani S. COVID-19 and physician mothers. Acad Med. 2021;96:e12–e13.
31. Rabinowitz LG, Rabinowitz DG. Women on the frontline: A changed workforce and the fight against COVID-19. Acad Med. 2021;96:808–812.
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