Time spent away from the clinical environment for parental leave has no effect on resident performance, according to a recently published study.

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The study—published in JAMA Ophthalmology—included a review of the educational records for 283 ophthalmology residents who graduated between 2015 and 2019 and found no differences, on average, between the performance metrics of the 44 residents who took parental leave and the 239 who did not.

Divya Srikumaran, MD, an associate professor and vice chair for education at the Wilmer Eye Institute at Johns Hopkins University School of Medicine, was the study’s principal investigator.

“Trainees frequently take less leave than what their institutional policy allows because they're afraid that their skills are not going to be up to par, and I hope that this data will enable them to feel more comfortable with taking time off for their personal and family well-being,” she said. “I also hope that the program director and faculty will be less concerned that there's definitely going to be a problem if a resident takes time off.”

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The study used scores from the Ophthalmic Knowledge Assessment Program and Accreditation Council for Graduate Medical Education milestones, as well as surgical volume, as measures of performance. The study found no significant differences in those metrics between the group that took leave and the one that didn’t.

The study, however, did find that—among the group that took leave—post-residency fellowship and pursuit of a career in an academic setting was less common. The reasons for that were unclear, but Dr. Srikumaran offered a few thoughts.

“Speaking for myself, after having a child it was a financially hard year to be a fellow—with the cost of child care—and so that may influence some trainees to forgo additional years of training,” she said. “The other thing that could be affecting it is whether they had less access in any way to mentorship or experiences on subspecialty rotations that influenced their desire to go into any specific subspecialty.”

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The study was conducted before the American Board of Medical Specialties’ policy on parental, caregiver and medical leave during training went into effect. That policy calls for “a minimum of six weeks of time away from training for purposes of parental, caregiver and medical leave at least once during training, without exhausting all other allowed time away from training and without extending training.” 

Looking at the study data, among the residents who took leave, the median number of weeks of parental leave taken was 4.5 weeks, with male residents taking a median of two weeks and female residents taking a median of six.

“When we say ‘median’ that means—first of all—some residents took fewer than six weeks,” Dr. Srikumaran said. “I personally think that having childbearing leave of less than six weeks is probably not enough for anyone, including our trainees who have lot of clinical and academic responsibilities. And I think that people should be comfortable taking up to 12 weeks of leave or have a hybrid return to work after six weeks with reduced responsibilities.”

One common fear among faculty members and residents is the impact leave has on coverage, Dr. Srikumaran said. There is work that can be done to plan ahead on both the trainee and program level.

“It's important for a resident to have good communication with their peers and their training program to see how they can utilize their leave with the least disruption, if possible,” she said.

“You could have nonresident providers be part of the call pool, whether that means paying fellows or faculty to cover some of that time or even paying the nonleave-taking resident providers,” she said. “If you have a resident who didn't take time off and you're asking them to cover extra shifts, it goes a long way if you make it voluntary and provide a small financial incentive as opposed to just saying: You all have to take extra call.”

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