Parental leave in medical school: supporting students as parents

Methods

The Rocky Vista University (RVU) Institutional Review Board (IRB) considered this research exempt from IRB review and approval processes. We narrowed our focus to osteopathic medical schools to establish and characterize parental leave policies within a congruent UME population sharing similar philosophies in education, training, and practice. Main and branch campus colleges of osteopathic medicine were identified from the American Association of Colleges of Osteopathic Medicine (AACOM) directory (Table 1) [9]. We conducted our data collection via two methods. We initially reviewed the student handbook and school policies of each osteopathic medical school obtained from university websites, utilizing the search terms “parental,” “maternity,” “paternity,” “pregnant,” “pregnancy,” and “leave of absence” (LOA). In January 2021, we emailed each Student Affairs department individually, requesting information about parental leave policies that might exist outside of each school’s respective student handbooks. One follow-up email was sent in February 2021 to the schools who had not yet responded. We defined a parental leave policy as explicitly dedicated to expectant parents or those parents planning on adoption. Medical leave or other short- and long-term LOA policies were not considered a parental leave policy. We preplanned policy classification into three groups:

1. Category 1: Clearly defined parental leave policy

2. Category 2: Vaguely defined parental leave policy

3. Category 3: No parental leave policy

Subjective data from electronic communication with administrative personnel was documented in an attempt to describe parental leave policies more broadly in narrative form.

Results

Forty-two main and branch campus colleges of osteopathic medicine were identified (Figure 1). One of the 42 institutions (2.4%) did not have a student handbook available nor return email communication, while the remaining 41 schools had an available student handbook. Email responses were received from 17 schools (40.5%). Of note, our home institution was not contacted directly, because that information was readily available from previous institutional communications and policy development. Two of the 41 US osteopathic medical schools (4.9%) had an established parental leave policy in place (Category 1), whereas 39 (95.1%) did not (Category 3). Email responses indicated that expecting students were encouraged to follow short- or long-term LOA policies.

Figure 1:

Flow diagram of inclusion, exclusion, and categorization of parental leave policy.

For both Category 1 parental leave policies, the common features included coordination with the Student Affairs departments, notification of preclinical or clinical education administrators, necessitation of supporting documents including physician letters, and modification of the student schedule or accommodations (i.e., retaking a semester, LOA, or additional time in the program) for missed work.

Discussion

A majority of US osteopathic medical schools do not have established paternity/maternity policies outlined in student handbooks. Without well-established policies, students must weigh family planning against extending the time necessary to complete his or her medical education. When requesting parental leave, students are advised to take a short- or long-term LOA. If a student requires a LOA during their medical education, it is unclear if the student may continue his or her education during leave (i.e., contribute to preclinical/clinical coursework during the LOA). If a student may not participate in the preclinical/clinical curriculum during this leave, the necessary requirements cannot be met, putting the student at a disadvantage and fragmenting his or her expected medical school trajectory. This not only applies to graduation deadlines, but also has lasting impacts on future career planning, such as eligibility for audition rotations and residency applications. Depending on the LOA length, a student may be required to extend his or her training by a year, which is a financial and time-consuming burden. If a student arranges a shorter LOA (one not disrupting schedule/academic goals), the allocated time may not allow for appropriate healing after childbirth, bonding between infant and caregiver, or adjustment to parenthood.

Within GME, a survey study including 214 female resident respondents compared maternal and infant well-being outcomes in 25 maternity leaves. Compared with maternity leave lengths <8 weeks, residents with leave time >8 weeks were less likely to have postpartum depression (negative screen 70% vs. 33% with leave time <8 weeks) or burnout (negative burnout screen 38% vs. 33%), more likely to breastfeed longer (breastfeed ≥6 months 89% vs. 33%), and to have more satisfaction with parenthood (75% vs. 56%) [10]. Establishing written, well-defined parental leave policies support not only residents but also their newborn and families [11]. As GME and specialty societies issue consistent calls over accessible, clear, and detailed parental leave policies for residents, the same call must be extended to UME [12].

An independent review of student handbooks, websites, and policies was conducted in 2019 [13]. Researchers evaluated 199 MD- and DO-granting institutions to describe the current parental leave policy in the US [13]. Sixty-five schools mentioned parental leave in policy, including 25.2% of MD-granting institutions and 59.1% of DO-granting institutions [13]. Of the 26 DO policies, only 30.8% included both the mothers and fathers, 0% addressed the academic year of the student, and 42.3% were included under a medical or personal LOA [13]. Investigators confirmed the limited availability of a parental leave policy in the UME [13]. In our present review, fewer parental leave policies were identified, which was likely a result of our parental policy definition centering on expectant parents and adoption while excluding medical and personal LOA policies.

Our institution, Rocky Vista University College of Osteopathic Medicine (RVUCOM), approved a pregnant and parenting student policy during our study period. This policy outlines student absences related to pregnancy and childbirth, addressing the return to academics after delivery and parental leaves. Students are encouraged to meet with Student Affairs to arrange an acceptable schedule. Enacting advanced policy measures protects students in their pursuit of both medical education and parenthood. Although time off for expectant parents is not guaranteed, this transition aims to foster a culture of institutional support and proper leave following childbirth.

Furthermore, Colorado’s Proposition 118 passed in 2020 authorizing paid family and medical leave for 12 weeks, with four additional weeks for pregnancy or childbirth complications for employees [14]. Although medical students are not considered employees, the climate changes surrounding pregnancy and childbirth are significant, demonstrating our society’s dedication to advancing parental leave practices.

Of note, two authors of this paper (S.R.O. and J.M.B.) had children during medical school prior to university implementation of the pregnant and parenting student leave policy. Continuing medical education in the postpartum period was a complicated matter. Medical leave time after childbirth ranged from 3 days to 8 weeks among our peers; alternatively, students elected to take a gap year. The decision to start a family during medical school was difficult, as each stage poses unique challenges for new parents. However, we appreciate the overlapping roles of a parent and physician and believe that the skills learned will benefit our careers as physicians. We gained empathy, strong communication skills, and time management techniques. As a patient or family member, we learned to advocate for ourselves and others, voicing concerns in a healthcare setting. Overall, the birth of our children benefited us both personally and professionally. We hope UME adopts policies to protect and support students who are starting a family.

Conclusions

Overlapping UME and childbearing years requires standardization of parental leave policies for medical students. Students expect clear, well-defined guidelines, scheduling flexibility, and approachable administrators who understand individual circumstances. ACGME-accredited residency programs and specialty organizations support standardized policies and protocols. Medical schools must follow suit, adopting parental leave options that do not disrupt students’ schedules and creatively finding ways for students to continue their education (e.g., parental leave electives counting for educational credit). Melding parenthood and medicine creates a better work–life atmosphere with greater satisfaction for individuals assuming two simultaneously difficult roles. As medical schools adopt parental policies and encourage a family-friendly environment, students may not have to choose between their medical education and family planning. Instead, trainees will be able to experience the joys of both medicine and parenting.