Pregnancy and infertility in orthopedics: A review of the current state.

BACKGROUND: Orthopedic surgery continues to have one of the lowest rates of female trainees among all medical specialties in the United States. Barriers to pursuing a surgical residency include the challenges of family planning and work-life balance during training. METHODS: A systematic literature search of articles published between June 2012 and December 2022 in the MEDLINE, EMBASE, and Cochrane databases was performed in January 2023 according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Studies were included if they evaluated pregnancy and peripartum experience and/or outcomes amongst orthopedic surgeons or trainees. RESULTS: Eighteen studies were included. Up to 67.3% of female orthopedic surgeons and trainees and 38.7% of their male counterparts delayed childbearing during residency. The most reported reasons for this delay included career choice as an orthopedic surgeon, residency training, and reputational concerns among faculty or co-residents. Infertility ranged from 17.0% to 30.4% in female orthopedic surgeons and up to 31.2% suffered obstetric complications. Assisted Reproductive Technology (ART) resulted in 12.4%-56.3% of successful pregnancies. Maternity and paternity leaves ranged from 1 to 11 weeks for trainees with more negative attitudes associated with maternal leave. CONCLUSIONS: Female orthopedic trainees and attending delay childbearing, experience higher rates of obstetric complications, and more stigma associated with pregnancy compared to their male colleagues. Program and institutional policies regarding maternity and paternity leave are variable across programs, and therefore, attention should be directed toward standardizing policies.

Impact of parental leave system on the childbirth plan among working married women: a three-year follow-up study of the Korean longitudinal survey of women and families.

BACKGROUND: The Korean government seeks to balance work and family and alleviate low fertility by implementing a parental leave system. This study aimed to identify the impact of the parental leave system on childbirth among married working women in South Korea. METHODS: This study used three-year follow-up data from the Korean Longitudinal Survey of Women and Families (2016, 2018, and 2020). The number of participants was 324 at baseline. Logistic regressions using a generalized estimating equation model were performed to examine the impact of parental leave on childbirth. Sub-analyses of covariates, childbirth support, and parental leave systems were conducted. RESULTS: Of workers covered by the parental leave system, 31.7% considered childbirth. Women covered by parental leave were 3.63 times more likely to plan childbirth (95% confidence interval [CI], 1.32-9.99). The tendency to plan childbirth was pronounced among those in their early 30s (adjusted odds ratio [AOR], 7.20) and those who thought that having children was necessary (AOR, 4.30). Child planning was more influenced by leave support (AOR, 6.61) than subsidies. CONCLUSIONS: Parental leave systems can have a positive impact on working married women's childbirth plans. Although this system was effective in a group interested in childbirth, it did not create a fundamental child plan. Time support is more important than money concerning childbirth plans. The parental leave system had an impact on childbirth plan. Appropriate parenting policies can effectively increase the fertility rate.

Still a 'boys' club': a qualitative analysis of how gender affects a career in anaesthesia in Australia and Aotearoa New Zealand.

Gender inequity remains an issue in anaesthesia despite increasing numbers of women training and achieving fellowship in the speciality. Women are under-represented in all areas of anaesthetic research, academia and leadership. The Gender Equity Subcommittee of the Australian and New Zealand College of Anaesthetists recently conducted a survey asking "Does gender still matter in the pursuit of a career in anaesthesia in 2022?". The survey was distributed to a randomly selected sample of 1225 anaesthetic consultants and completed by 470 respondents (38% response rate) with 793 free-text comments provided. Three overarching themes were identified: gender effects on the career and family interface; women do not fit the mould; and gender equity changes the status quo. Women respondents described a need to make a choice between career and family, which was not described by men, as well as stigmatisation of part-time work, a lack of access to challenging work and negative impacts of parental leave. Women respondents also described a sense of marginalisation within anaesthesia due to a 'boys' club' mentality, a lack of professional respect and insufficient structural supports for women in leadership. This was compounded for women from ethnically and culturally diverse backgrounds. A need for specific strategies to support anaesthetic careers for women was described as well as normalisation of flexibility in workplaces, combined with a broadening of our definition of success to allow people of all genders to experience fulfilment both at home and at work. This study is the first published qualitative data on factors affecting gender equity for anaesthetists in Australia and Aotearoa New Zealand. It highlights the need for further exploration, as well providing a foundation for changes in attitude and structural changes towards advancing gender equity.

Disparities in Postpartum Care Visits: The Dynamics of Parental Leave Duration and Postpartum Care Attendance.

OBJECTIVES: To understand differences in the relationship between parental leave duration and postpartum care across sociodemographic and income groups. METHODS: We used data from six states participating in the Center for Disease Control and Prevention's yearly PRAMS study from 2016 to 2019 with a total sample of 12,442 people. Bivariable analyses assessed demographics among those who took more or less parental leave and estimated the prevalence of not accessing postpartum care by demographics, stratified by leave length. We used propensity score weighting to estimate the predicted risk and risk ratios of not accessing postpartum care with < 7 as compared to > = 7 weeks of leave, stratified by income. RESULTS: There were significant differences in the prevalence of not accessing care stratified by leave duration, and disparities in utilization by race, ethnicity, and income. A shorter leave duration was associated with a higher risk of not accessing care (RR: 1.98 [CI 1.25-3.20] in higher income group, RR: 1.45 [CI 1.08, 1.99] in lower). The absolute risk of not accessing care was highest in the lower income group regardless of leave duration, though patterns of increased utilization with longer leave duration were consistent in both groups. CONCLUSIONS FOR PRACTICE: While shorter leave durations increased the risk of not attending postpartum care, those with lower incomes had the highest absolute risk of not attending care. Policies to support paid leave and extended leave duration are necessary, along with additional supports to increase postpartum care utilization, particularly among low-income families.

"I Thought Everyone Was Going to Hate Me for Being Pregnant": The Enduring Influence of the Ideal Worker Image in GME.

Introduction: Patriarchal norms continue to disadvantage women in Graduate Medical Education (GME). These norms are made salient when women trainees are pregnant. Although it is known that pregnant trainees experience myriad challenges, their experiences have not been examined through the lens of gendered organizations. To understand why these challenges persist, this study critically examined the experiences of pregnant trainees and their program directors (PDs) with navigating pregnancy. Methods: From October 2022 to April 2023, we recruited 13 resident or fellow trainees who experienced pregnancy while in training and their corresponding PDs. Data, in the form of semi-structured interviews, were collected, transcribed, and analyzed using thematic analysis. Guiding the analysis was feminist theory, in particular Acker's conceptualization of the ideal worker. The ideal worker norm promotes a culture of individuals who are singularly dedicated to their work with no external distractions or demands upon their time or effort. Results: Both sets of participants struggled with medicine's image of the ideal worker (i.e., a selfless and untethered professional). Trainees experienced guilt for using entitlements meant to assist them during this time, concern that their requests for help would signal personal weakness, and pressure to sacrifice their own wellbeing for work. While most PDs were aware of these phenomena, they experienced varying degrees of success in combating the negative effects of the ideal worker norm. Discussion: In each case, the image of the ideal worker lurked in the background of medical training, shaping trainees' experiences and PDs' perceptions and guidance. This study shows that even though the number of women has increased in medicine, the profession's underlying culture continues to signal that they must live up to the profession's expectations of the ideal worker.

Barriers to increasing paid parental leave in U.S. neurology residencies: a survey of program directors.

BACKGROUND: The American Board of Psychiatry and Neurology (ABPN) and the Accreditation Council for Graduate Medical Education (ACGME) require that residency programs allow at least 6 weeks of parental leave. The American Medical Association (AMA) recommends 12 weeks of paid parental leave. Despite these recommendations, there is little information about parental leave policies across U.S. neurology residencies. The objective of our study was to assess parental leave policies in U.S. adult neurology residencies and barriers to increasing the duration of leave. METHODS: We distributed an anonymous online survey to U.S. adult neurology program directors (PDs) to assess demographics, components and length of parental leave, perceived impact on residents' clinical training and academic development, and barriers to increasing the length of leave. RESULTS: We contacted 163 PDs and received 54 responses (response rate of 33%). 87% reported policies for both childbearing and non-childbearing residents. The average maximal length of leave allowed without extension of training was 8.5 weeks (range 0-13) for childbearing and 6.2 weeks (range 0-13) for non-childbearing residents. Most PDs felt that parental leave had a positive impact on resident wellness and neutral impact on clinical competency, academic opportunities, and career development. The most common barriers to providing a 12-week paid policy were concerns about equity in the program (82%), staffing of clinical services (80%), and impact on clinical training (78%). CONCLUSIONS: Although most programs in our study have parental leave policies, there is significant variability. Policies to improve parental leave should focus on addressing common barriers, such as additional solutions to staffing clinical services.

The Impacts of Paid Family and Medical Leave on Worker Health, Family Well-Being, and Employer Outcomes.

This article reviews the evidence on the impacts of paid family and medical leave (PFML) policies on workers' health, family well-being, and employer outcomes. While an extensive body of research demonstrates the mostly beneficial effects of PFML taken by new parents on infant, child, and parental health, less is known about its impact on employees who need leave to care for older children, adult family members, or elderly relatives. The evidence on employers is similarly limited but indicates that PFML does not impose major burdens on them. Taken together, the evidence suggests that PFML policies are likely to have important short- and long-term benefits for population health, without generating large costs for employers. At thesame time, further research is needed to understand the effects of different policy parameters (e.g., wage replacement rate and leave duration) and of other types of leave beyond parental leave.

Childbearing and Family Leave Policies for Physicians at US Children's Hospitals.

The objective of this study was to examine the childbirth and parental leave policies for physicians at children's hospitals. We obtained institutional policies from 15 hospitals in 2021. The median duration of full salaried leave was 8 weeks (range, 2-12 weeks). Leave policies vary widely among US children's hospitals.

A Practical Guide for Paid Family and Medical Leave in Radiology, From the AJR Special Series on DEI.

Paid family and medical leave (FML) has significant benefits to organizations, including improvements in employee recruitment and retention, workplace culture, and employee morale and productivity, and is supported by evidence for overall cost savings. Furthermore, paid FML related to childbirth has significant benefits to individuals and families, including but not limited to improved maternal and infant health outcomes and improved breastfeeding initiation and duration. In the case of nonchildbearing parental leave, paid FML is associated with more equitable long-term division of household labor and childcare. Paid FML is increasingly being recognized as an important issue in medicine, as evidenced by the recent passage of policies by national societies and governing bodies, including the American Board of Medical Specialties, American Board of Radiology, Accreditation Council for Graduate Medical Education (ACGME), American College of Radiology, and American Medical Association. Implementation of paid FML requires adherence to federal, state, and local laws as well as institutional requirements. Specific requirements pertain to trainees from national governing bodies, such as the ACGME and medical specialty boards. Flexibility, work coverage, culture, and finances are additional considerations for ensuring an optimal paid FML policy that accounts for concerns of all impacted individuals.

One size doesn't fit all: Attitudes towards work modify the relation between parental leave length and postpartum depression.

The present study aimed to investigate the relationship between parental leave length and maternal depressive symptoms at six- and twelve-months postpartum and whether this relation was influenced by women's attitudes towards leave, whether leave was paid or unpaid, and the reason they returned to work. The sample included 115 working women recruited during pregnancy as part of a larger longitudinal study. Analyses revealed that maternal attitudes toward leave influenced the association between leave length and depressive symptoms. Specifically, longer leaves were associated with increased depressive symptoms for women who missed their previous activities at work. Furthermore, women who missed work and had leave for 16 weeks or more, exhibited higher depressive symptoms at six- and twelve-months. Last, results also indicated that women who returned to work solely for monetary reasons exhibited more depressive symptoms at six-months postpartum than those who returned to work for other reasons. This study is among the first to show that women's attitudes towards parental leave and their individual reasons for returning to work are important factors to consider that may have potential implications for parental leave policies.

Changes in maximum parental leave payment in Iceland and total fertility rates.

BACKGROUND: Following the 2008 financial crisis, the Icelandic Government reduced the maximum parental payment until 2016, when it was increased again. The aim of this study was to investigate the effect of the changes in the maximum parental leave payment in Iceland during 2009 and 2016 on total fertility rates and birth rates during 2002-2019. METHODS: Publicly available aggregated data on yearly total fertility rates, birth rates, unemployment rates, gross domestic product (GDP) and maximum parental leave payments were obtained for 2002-2019. Segmented regression analyses were used to measure the impact of changes in parental leave payment on term births for the two periods in which changes were implemented (2008-2010 and 2016-2017). RESULTS: The decrease in maximum parental leave payment during 2008-2010 was associated with a 15% decrease in the estimated total fertility rate compared with the expected rate (-15.7%; 95% CI -22.7 to -8.7), whereas the increased payments during 2016-2017 indicated a possible 3% increase in the estimated total fertility rate (3.2%; 95% CI -29.1 to 35.5). Neither adjustment for the unemployment rate nor the GDP appeared to affect these results. The overall birth rate followed a similar trend and was most pronounced for women aged 25-34 years. CONCLUSIONS: These results suggest that total fertility rates in Iceland may have been affected by changes in the maximum parental leave payment that occurred in 2009 and 2016, although the effect of the 2008 financial crisis cannot be excluded despite adjustment for the unemployment rate and GDP.

Paid leave to support parenting-A neglected tool to improve societal well-being and prosperity.

Cohesive families and stimulating and caring environments promoting attachment to caregivers is fundamental for a child's physical and psychosocial growth and development. Parental care, supporting early years development, presupposes the presence and involvement of parents in children's daily life with activities that include breastfeeding, playing, reading and storytelling. However, parents have to balance their child's well-being against employment, career progression and gender equality. Universally accessible and equitably available parental leave addresses this challenge. CONCLUSION: Distinct from compulsory maternity leave, leave at full or nearly full pay for both parents benefits not only families but also societal well-being and prosperity.

New York State's Paid Family Leave Program is Associated with More Equitable and Increased Use of Paid Leave Following Childbirth.

OBJECTIVES: This study aimed to assess changes in paid maternity leave before and after New York's (NY) Paid Family Leave (PFL) law went into effect (1/1/2018) and changes in disparities by maternal characteristics. METHODS: We used specific data collected on maternity leaves by women who gave birth in 2016-2018 in NY State (outside NY City) participating in the Pregnancy Risk Assessment Monitoring System survey. Multiple logistic regressions were conducted to evaluate the effect of the PFL law on prevalence of paid leave taken by women after childbirth. RESULTS: After NY's PFL law went into effect, there was a 26% relative increase in women taking paid leave after childbirth. Use of paid leave after childbirth increased among all racial and ethnic groups. The increases were greater among Black non-Hispanic or other race non-Hispanic women, compared to white non-Hispanic women, suggesting that NY's law was associated with more equitable use of paid leave following childbirth. CONCLUSIONS FOR PRACTICE: Wider implementation and greater utilization of paid maternity leave policies would promote health equity and help reduce racial/ethnic disparities in maternal and child health outcomes.

Uncovering the Experience: Return to Work of Nurses After Parental Leave.

INTRODUCTION: To understand the experiences of emergency nurses who have returned to work after parental leave, specifically relating to the return to work transition, work-life balance, work engagement, and opportunities to continue human milk expression. METHODS: Nurses (N = 19) were recruited from 5 emergency departments within 1 hospital system in the United States Midwest. Nurses (n = 11) were eligible to participate in a one-on-one interview if they had returned from parental leave within 6 months of the interview date. Nurses (n = 8) were eligible to participate in a focus group if they had returned from parental leave within 2 years of the interview date. Interviews were structured and data collection concluded when researchers believed data saturation was reached. Interviews were audio recorded and transcribed verbatim. Data were analyzed using Braun and Clarke's qualitative thematic analysis 6-phase framework. RESULTS: Three major themes from the data were identified: (1) work engagement, (2) lactation, and (3) childcare. Work engagement was broken down into the subthemes: lack of communication, perceived engagement expectations, and actual engagement. Lactation was broken down into the subthemes: the act of pumping, lactation breaks, and lactation rooms. The coronavirus disease 2019 pandemic impact on return-to-work is described under each major theme. DISCUSSION: Our findings provide insight into the unique challenges and experiences of nurses navigating parental leave and return-to-work in the emergency department. Strategies such as provision of managerial check-ins, return to work reorientation, lactation break coverage, enhanced supplementary lactation support, and leadership-provided accommodation may lighten the burden of these challenges and improve the returning nurse's job satisfaction.

The Importance of Parental Leave and Lactation Support for Surgeons.

Despite the growing population of surgeons who will spend the bulk of their potential childbearing years in medical school, training, or early in practice, the stigma associated with pregnancy remains. The challenges of childbearing for surgeons also extend to the pregnancy experience from a health perspective including increased rates of infertility, miscarriage, and preterm labor. Given the unique demands of a surgical practice, surgeons may experience pressure to minimize the disruption of their work during and after pregnancy. This may include attempts at carrying a full workload until the day of delivery, reducing the length of planned parental leave, and not requesting accommodations for time to express milk. Concern for discrimination, clinical productivity expectations, and promotion timelines can limit a surgeon's ability to receive pregnancy-related support and adequate parental leave. Though not all surgeons will choose to pursue pregnancy, we must still acknowledge the need to support these individuals. Furthermore, this support should not be limited to the pregnancy alone but include postpartum support including that related to family leave and lactation. Here, we provide an overview of just some of the challenges faced by surgeons in the pursuit of parenthood and present the arguments for accommodations related to pregnancy, parental leave, and lactation.

Impact of current Australian paid parental leave on families of preterm and sick infants.

AIM: Parents of preterm or sick infants are at increased risk of mental health problems. The financial stress associated with an infant's prolonged hospital stay can have an additional negative effect on families' wellbeing and child development. This study explores parent use of Australian paid parental leave (PPL) and the financial impact of having an infant requiring neonatal care. METHODS: Retrospective, cross-sectional, online survey study conducted from November 2020 to February 2021. Participants were parents of babies born from 1 January 2013, admitted to a neonatal intensive care unit or special care nursery in Australia. The survey explored use of Australian Government and private sector PPL, and financial stress. Parent-reported anxiety and depression were measured using the EuroQol Group 5D-5L Anxiety and Stress Subscale. RESULTS: Two hundred and thirty-one parents responded of which 93% had a preterm infant. Seventy-three percent of infants were hospitalised for more than 1 month, and 34% were readmitted to hospital within the first year following discharge home. Eighty-three percent of parents reported moderate, severe or extreme levels of anxiety or depression. Seventy-six percent reported that having a child in hospital had a moderate-very large financial impact on their family. Parents identified main costs to be travel, food, inability to work and direct medical costs. CONCLUSIONS: Having an infant born preterm or sick has significant emotional and financial implications for families. The current Australian Government PPL scheme does not adequately support parents of preterm or sick infants, and a change is urgently needed to improve outcomes for this vulnerable population.

Are Psychiatry Programs Providing Adequate Parental Leave to Their Residents?

OBJECTIVE: During residency training, parental leave is frequently briefer than may be optimal for the well-being of the family. The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to have a parental leave policy without providing specific guidelines on its makeup, resulting in varying policies and confusion among residents planning parental leave. This study identifies differences in parental leave policies in psychiatry residencies and discusses if these policies are adequate. METHODS: A 45-question, anonymous survey was emailed to general psychiatry and fellowship program directors in the USA. RESULTS: Out of 520 program directors contacted, 186 completed the survey (35.7% response rate). Among the respondents, 94.1% had policies for maternity leave, 79.8% had policies for paternity leave, and 67.2% had policies for non-childbearing parental leave (e.g., adoption). Variations were reported in implementation, coverage, and accommodations. Most respondents (57.1%) believed that residents would benefit from more parental leave. Some (11.5%) believed that parenthood negatively affected residents' overall performance, especially regarding patient care and clinical skills; 36.5% endorsed that parenthood negatively affected overall residents' well-being; and 7.5% felt negatively when an applicant was pregnant or was planning to become pregnant during residency. Lastly, 32.9% were not confident regarding ACGME, American Board of Psychiatry and Neurology, federal, and hospital policies. CONCLUSIONS: Parental leave policies are not universal in US psychiatry residency and fellowship programs. Some program directors feel that parenthood adversely affects residents' clinical performance as well as well-being. If true, reformation of parental leave policies may be a remedy.

Organizational policies, workplace culture, and perceived job commitment of mothers and fathers who take parental leave.

Americans do not always fully utilize available parental leave policies due (in part) to fear of a commitment penalty - where taking leave (or taking longer periods of leave) lowers perceptions of job commitment. Using a survey experiment (N = 1713) to identify whether organizational leave policies affect perceived job commitment, we find that leave-taking (and taking longer periods of leave) is negatively associated with perceived commitment. However, perceived commitment is higher when workers take leave under more favorable policies, and the effect of favorable policies on perceived commitment is greater for fathers than mothers. Overall, these results can help organizations design parental leave policies that increase the likelihood that workers can take needed leave without damaging their careers.

Prevalence of mental disorders and treatment gap among Czech women during paid maternity or parental leave.

We performed a secondary analysis of the data from Czech epidemiological study on mental health to determine the prevalence of mental disorders among Czech women on maternity or parental leave and to assess the present treatment gap. Any mental disorder was present in 17.6% (n = 21) of the total sample of 119 women. The treatment gap was present among 76% (n = 16) of them. In conclusion, most women on maternity or parental leave facing a mental disorder were not receiving treatment. The present study is the first of its kind in the region of Central and Eastern Europe.

A cross-sectional survey study of United States residency program directors' perceptions of parental leave and pregnancy among anesthesiology trainees.

PURPOSE: Little is known about program directors' knowledge, attitudes, and beliefs regarding parental leave policies in anesthesiology training. This study sought to understand program director perceptions about the effects of pregnancy and parental leave on resident training, skills, and productivity. METHODS: An online 43-question survey was developed to evaluate United States anesthesiology program directors' perceptions of parental leave policies. The survey included questions regarding demographics, anesthesiology program characteristics, parental leave policies, call coverage, and the perceived effects of parental leave on resident performance. Data were collected by Qualtrics (Qualtrics, Provo, UT, USA). RESULTS: Fifty-six of 145 (39%) anesthesiology program directors completed the survey. Forty-eight of 54 (89%) program directors had a female resident take maternity leave in the past three years. When asked how parental leave affects residents' futures, 24/50 (48%) program directors felt it delayed board certification and 28/50 (56%) thought it affected fellowship opportunities. Program directors were split on their perceived impact of becoming a parent on a trainee's work. Yet, when compared with male trainees, program directors perceived that becoming a parent negatively affected female trainees' timeliness, technical skills, scholarly activities, procedural volume, and standardized test scores and affected training experience of co-residents. Program directors perceived no difference in impact on female trainees' dedication to patients and clinical performance. CONCLUSIONS: Program directors perceived that becoming a parent negatively affects the work performance of female but not male trainees. These negative perceptions could impact evaluations and future plans of female residents.

RéSUMé: OBJECTIF: On ne sait que peu de choses concernant les connaissances, les attitudes et les croyances des directeurs de programme au sujet des politiques relatives aux congés parentaux dans le cadre de la formation en anesthésiologie. Cette étude visait à comprendre les perceptions des directeurs de programme au sujet des effets de la grossesse et du congé parental sur la formation, les compétences et la productivité des résidents. MéTHODE: Un sondage en ligne comportant 43 questions a été élaboré afin d'évaluer les perceptions des directeurs de programme d'anesthésiologie aux États-Unis à l'égard des politiques en matière de congé parental. Le sondage comprenait des questions sur les données démographiques, les caractéristiques du programme d'anesthésiologie, les politiques relatives au congé parental, la couverture des gardes et les effets perçus du congé parental sur la performance des résidents. Les données ont été recueillies par Qualtrics (Qualtrics, Provo, UT, USA). RéSULTATS: Cinquante-six (39 %) des 145 directeurs de programme d'anesthésiologie ont répondu au sondage. Quarante-huit des 54 (89 %) directeurs de programme ont eu une résidente ayant pris un congé maternité au cours des trois dernières années. Lorsqu'on leur a demandé comment le congé parental affectait l'avenir des résidents, 24/50 (48 %) des directeurs de programme estimaient que cela retardait la certification médicale et 28/50 (56 %) pensaient que cela affectait les possibilités de fellowship. Les directeurs de programme étaient divisés quant à la question de l'impact perçu de devenir parent sur le travail d'un résident. Pourtant, par rapport aux résidents de sexe masculin, les directeurs de programme étaient d'avis que le fait de devenir parent affectait négativement les résidentes en matière de ponctualité, de compétences techniques, d'activités académiques, de volume procédural, de résultats aux tests standardisés et de l'expérience de formation de leurs co-résidents. Les directeurs de programme n'ont perçu aucune différence d'impact sur le dévouement des résidentes à l'égard de leurs patients ou sur leur performance clinique. CONCLUSION: Selon les directeurs de programme, le fait de devenir parent a une incidence négative sur la performance professionnelle des résidentes, mais non des résidents. Ces perceptions négatives pourraient avoir une incidence sur les évaluations et les plans futurs des résidentes.