My name is Sana Yunus, and I am a first-year fellow at Baylor College of Medicine for the Child and Adolescent Psychiatry Program. I welcome you all to today's session. Before I start, I just want to bring to your attention that this session is being recorded for the AP on Demand. And at times when we're interacting or you guys have any questions, we would really appreciate if you can ask those questions on those mics that are there in the center to make sure that the question is heard by everyone and is recorded appropriately. To begin with, all of us, we do not have any relevant financial disclosures to make today. I'll give you a little bit of brief overview in what we would be doing today. And starting a little bit about introductions, which means that we will be introducing ourselves. But we would be very curious and interested to hear from you all about who you are and a little bit about your role in the work that you're doing. So we'll start with that. We'll touch base about the global perspectives, keeping in view psychiatry training and parenting throughout the world, trying to understand what things look like across the globe, and honing down into various challenges that are faced by psychiatry trainees as they are navigating that training world and being parents or in the process of becoming parents. We'll go towards finding probable solutions to these challenges, what the role of the program could be, what the role of your department could be, and then keeping a view on throughout, for how those thoughts apply to minoritized trainees. As we want to do that, a couple of things, like we want this to be an interactive session. I know it's a small group for now. Hoping that some more people would join us. But as we are progressing, I think the structure of our presentation will be some presentations followed by some small group discussion. So we would really appreciate if we can come close together and talk. Another thing to keep in mind is that we will be using what we call Poll Everywhere. So it's super simple. You guys can scan this QR code. It would take you to the link. Or you could text, as mentioned, invisibility222333. We'll keep using the same one. So when you answer the questions, don't cross out on that window. So when we activate the next kind of questions, it will take you to the next question and keep showing the responses while we are talking. So that's where we are. And that's the first order and first task for this afternoon, to log in and start kind of looking into some of the questions that are popping up on you all's phones. I'll give you maybe a minute or so. Would you mind going back to the previous slide, please? Yes. There we go. And as you guys are filling those out, I'm going to hand this, I'm going to move away and hand it over to Dr. Manal Khan so that she can also start sharing in a bit about who she is. Yes, so moving on to the next slide. Like we're having a little bit of a technical issue, we'll have to come back to it. Apologies for that. Okay. We will get into the next section. We'll be giving our introductions and talking about why this topic is important to us. So a little bit about me. Hi. My name is Manal. I'm an assistant professor of psychiatry at UCLA. I did my intern year in psychiatry at Duke and then my PGY2 to PGY4 years at University of Washington, Seattle. And then I did my fellowship in child and adolescent psychiatry at UCLA. I have two children. One was born during residency and the other during fellowship. I became pregnant with my first child during the intern year and then had to transfer to UW because I wanted to be where my husband was and he was in Seattle working for Amazon. Therefore I came to Seattle at the beginning of July, fully pregnant and ready to deliver in August. That was the start of my PGY year two. I promise I did not share this to confuse you. I shared this to highlight that when I transferred from Duke to UW, eight months pregnant and ready to deliver, I had established OBGYN care in a new city just before my delivery. I had no roll over sick days and vacation days because I was transferring between programs and I was not eligible for leaves that become available after one year of employment. It is also important to note that at that time I was a visa requiring international medical graduate and therefore I did not have the option to prolong my training. All of these restrictions left me with one choice, to use all of my vacation, which was three weeks at that time, to create my maternity leave. My program creatively paired it with research month to prolong it to seven weeks. However, during that research month, I had to attend didactics and take call. This also meant that during my first year of motherhood, I was without vacation after August until the next academic year began. To make this work, I had to lean into my immigrant, Jagaru side. Jagar is a South Asian word that loosely translates to make do. I had to be scrappy, creative, and resourceful in how I approached this dual learning curve. The picture here shows the merger of my two identities. This A-cap linear is keeping the binky of my kiddo from being lost. The second picture shows me on a Christmas, I believe, with my pumping equipment right next to me when I'm about to start my shift. And the third picture is actually milk for tea in my baby's bottle because I couldn't find the right equipment to carry my milk, so I just used my baby's bottle for it. And the fourth is our books together. Books on potty right next to books on psychodynamic psychotherapy. Through this slide, I want to highlight the special challenges faced by immigrant parents. We don't have access, especially during training, with all sorts of travel and immigration barriers and bans to travel to our secure base, our country of origin, for emotional refueling. Our parents and families may not be able to travel to support us during new parenthood. Some of us come from collectivistic cultures where child-rearing is a joint activity and are now navigating it on our own in a new culture without much support. There are significant financial stressors and our vacation plans are not straightforward. I cannot just travel to Pakistan and return in a week. It makes no sense because the travel is extremely long and expensive, and once you are there, you want to be there for more than three days. My second experience of motherhood was much different. At that time, I was a permanent resident in the U.S., so I had my green card. I stayed within the program and hence had accumulated sick days and vacation days that rolled over. There was designated maternity leave, and with all of that together, I had nine weeks off and then I still had all of my vacation time, which was intact. I want to end this introduction by quoting Vinnie Quat, who famously said that there is no such thing as a baby. The baby exists through the dyadic relationship with the parent. Our babies deserve to be in the presence of their parents. I come from a country that is often chastised for human rights violation and gender-based discrimination and still manages to give three to six months of maternity leave. And for the U.S., with all of its resources, wealth, and knowledge about child development, we must do better. Our babies do deserve better. So, with that. Hi, everyone. Good afternoon. My name is Jonathan Helt. I am one of the Associate Program Directors for the UCLA Psychiatry Residency, so I'm here to not only talk about my own experience but also to give kind of the program leadership perspective on parental leave as well. So just very briefly about me, I kind of always knew that I wanted to be a father, and I think for me, as a member of the LGBTQ community, I knew that this was going to be a different set of challenges, and so I'm very, very fortunate in that we were able to work with a friend of mine, somebody that I actually met during a research year when I was in medical school, who agreed to carry our child for us. So this is our first ever picture of our daughter, Ellie, there on the right, and she had a bit of a glow-up that we'll get to in just a little bit. As I was preparing to take parental leave, I have two employers. I work not only for UCLA but for the Veterans Affairs VA Hospital as well. I think going into this, I assumed UCLA would be easy with parental leave, the VA would be hard. UCLA is part of the University of California, very progressive, very supportive. The VA was a federal, it's very much a federal entity. I thought this would be like pulling teeth to be able to get time off. My experience was actually the exact opposite. When I messaged about parental leave, I was told that at UCLA there was no parental leave unless if I was the one who personally delivered. It was only for being unable to work for reasons of personal illness, injury, or disability. There was nothing to do with bonding or being there for the birth of your child. Conversely, at the VA, actually just less than a year before my daughter was born, they enacted 12 weeks of paid parental leave, basically no questions asked, no strings attached. Very, very different experience with both of those. Luckily at UCLA, actually because I started asking these questions of our HR, they did reach out to other institutions like UCSF and UC Irvine and were able to scrape together six weeks, which then expanded to eight weeks as part of their formal policy. With that, I got some time to bond with my daughter, Ellie. I took about 10 weeks off for parental leave. Got to see her for a smile and really kind of have some good time together. It's been really just a joy getting to know her. We traveled to Italy when she was nine months old and had some other trips and experiences since then. Yeah, just a little about me, and I'll hand it over to Sanaa. Thank you. Okay, I'll talk a little bit about myself and then towards the end, we'll try to bring what you guys had shared about y'all. I would start by saying that I identify as Pakistani, Muslim, mom of two gorgeous children. Been in the US for a little less than five years, and the move over here was a little bit different because I was already in training in Pakistan, just a little bit of background to help understand this journey. I got married while I was in medical school. My husband used to live over here in the US. It sounded like a career disaster for me to leave my medical school in the middle and move to this far, far away land, hoping that I would be able to get a medical school there. We decided that we're going to live in Pakistan, and he moved back there. He's originally from Pakistan. We lived there, got married, had a kid. At that time, his sister had applied for his immigration, so we were like, okay, it's going to happen. It took a little bit of gap year. While I was having my son, two years, three years passed, the immigration was not happening, so it's like we can't just keep our lives on hold, so I started my residency in Pakistan in psychiatry at the Al-Han University. When I started, my son was four years old. I had a village around me who was helping me raise him. He had two sets of grandparents, a great-grandfather, a great-grandmother. Everybody was taking care, so child care was not something that was something on my mind. Not just that, it was protective in many ways because they were all keeping me away from some of the guilt that I would feel from just hearing things like, my son was missing me or something. They would just kind of cushion that quite a bit, so that was very helpful. I get into my second, third year of training, and I have another child, my daughter Maryam, and I'm still at Al-Han University a resident. Three months of maternity leave, no questions asked. It's paid. The hospital has a daycare program in the hospital, a little bit, like five minutes walk from the main hospital, so bring your child to work, drop them to the daycare, go to work. When you're ready to go back, kind of pick them up, and in the interim, the village was still there. Night calls and stuff, my mom is there too, and my husband is there to take care of everything else. Kind of smooth sailing, fast forward, fellowship happens, and that's when this immigration happens, which is like 13 years have passed, a sudden email from the U.S. Department of Immigration that it has been processed, you can schedule your appointment, and I think that at that time, it was a conversation that the pros and cons. We decided that we're going to move over here, and life was different. So now I'm coming in with a daughter who's about to turn five, a son who's turning 11, so a preteen and a kindergarten-going child. Things were difficult, not in terms of just children in general, but like in a program. What does that look like when you're an intern? Like who do you talk to in terms of what school my kids are going to go to, where should I be living? That conversation, those real conversations. And then figuring out a master calendar, like when children are younger, and I've had that in my first residency, you're not as much worried about how many various birthdays they're invited to, but for older kids, that's a thing. There's sports, there's after-school stuff, is there aftercare available or not, so on and so forth. And in addition to that, the developmental stage has changed. So if they have kind of gone through their separation and deviation or not, are they going to text you that they're missing you, versus they were crying with their grandma and the grandma didn't tell me about it because she didn't want me to feel bad. So that kind of changed, and I think that coming in as a trainee, navigating those questions were difficult, not just because I was a parent coming in with older children, but I was an international medical graduate. So I'm aware of quite a few biases that are already there. One would be for international medical graduate, two, an international medical graduate in a program which does not have a lot of IMGs, so you're like in 13, a class of 13, there's one IMG. Then you are a woman, then you are a parent, and then you're a parent of older children. Who do you bounce off these ideas to? Your residents, your peers are most likely not in that age in their life. If they are, they're probably having children now, probably your attendings are in a similar spot, but there's an hierarchy there. So keeping all of those, I would say that the stance was that of isolation in many ways, and today, just being here, I think my hope is that with this presentation, it will allow us to keep, for all of us to have an open mind, to be curious and inclusive of people who, in some ways, so to say, are non-traditional trainees in a very traditional system. Thank you so much. I'll hand it over to my colleague. Hi, everybody. I'm Juliet Edgecomb. I'm a child psychiatrist and mental health services researcher at UCLA, and to add to my colleague's remarkable stories, perhaps one additional dimension that I bring to this is I'm a researcher, and having gone, graduated college in 2008, and then finished clinical training in 2023, becoming a physician scientist and child psychiatrist takes 15 years, which means that that coincides with when women traditionally, if they want to have biological children, have children, during a time when there is a significant pressure to accelerate in terms of productivity, scientific productivity, even beyond clinical training. So needless to say, this has been a challenge and a journey. I have a one-year-old and a four-year-old, and I think that as my colleagues bring up different topics today, my challenge for you is to think not only how can we support trainees who are clinicians, but also trainees who envision themselves as physician scientists in psychiatry who are parents as well. And I'll leave you with a slightly humorous comment that during all of this, one of my main forms of social support is my sibling, who happens to be a trauma surgeon and a mom of a two-year-old and a three-year-old, and she said, Juliet, being a mom of two toddlers makes being a trauma surgeon relaxing. At least I can think my own thoughts. And so with that, I'll turn it over to Dr. Khan, who's going to talk about parental leave. Let's go back. Sorry, guys, I did a dry run and was working fantastically, but obviously not right now. Okay, there we are. So some of the answers that you folks typed in, do you have children? So 38% of the respondents here said that they have children, and 63% said no. Okay, let's see. Oh, this way? Okay. Then let's see. What is your current role at work? So we have a lot of psychiatry residents here, 63%. It seems like psychiatry subspecialty fellows, so we have fellows and faculty members. And there are some others as well. So a lot of trainees and then some faculty people as well. Okay. Sorry? Oh, this one? Oh, perfect. Okay. If you have children, did you have them while you were in training? So 50% yes, and 50% not applicable because they don't have children. So it seems like 100% of those who have children have had them during training. Are you planning on having children in the future? 63% said yes, 38% said no. Okay. Maybe it's also a little bit complicated because people who already have children might not be thinking about it. Okay. Do you see your program as parent-trainee friendly? Okay. 50% definitely, and 50% somewhat. Give one example which makes your program parent-friendly. So colleagues are very understanding. Flexibility in work hours, times for nursing during work hours. Encouragement and support regarding taking parental leave. There is one resident who has kids. So it's probably some kind of modeling there. No fuss about taking paternity or maternity leave. Parent leave six weeks is available. Good fertility medical coverage, LGBTQ friendly. They work with you to try to ensure that you are able to take as much time as possible and attendings are understanding and supportive. So it seems like a lot of it is kind of rooted in support from the community. So whether it's attendings, whether it's leadership, whether it's your colleagues. Okay. Give one example which makes your program parent-trainee unfriendly. They don't offer childcare, nursing time during work hours, delayed graduation as a result of growing family and residency. Parenthood is not talked about in proactive, open way. It feels like something I should not talk about. So kind of invisibility a little bit. No room for pumping for a while. No childcare benefits, no ability to prolong parental leave with taking on vacation time, very few sick days per year. The one thing that makes it challenging is that your responsibilities do not change. So postpartum with the same number of calls split across fewer months was not easy. Yes, I think that is a big one. Okay. OK, so we'll be talking about the parental leaves from a global perspective. So let's take a look at the world map and see how we compare with other countries when it comes to parental leave. So the first one is about paid maternity leave. We are almost unique in that regard, in that we don't offer any paid maternity leave to new mothers, not even less than 14 weeks. Our neighbors and the countries that we like to associate ourselves with give either 29 to 51 weeks, or they give more than 52 weeks. So we are probably the biggest red one over there in this setup. So when it comes to paid paternal leave to incentivize the participation of fathers in child care activities, again, we don't offer any. You can see how we compare with other countries in the world. So kind of looking at our neighbors as well and seeing how we compare with them, how we compare with some of the other countries too. And then lastly, this slide shows whether mothers and fathers are given paid time off to address the health care needs of their children. And anyone who has children here will tell you that you will receive the phone from a daycare, and they will say that your kid has sneezed twice in a row, and you need to come and pick them up. And COVID-19 also kind of like highlighted the fragility of that system a little bit as well. So kind of like looking at that, if we get any paid time to take care of our children. And it seems like we can in the US take time off, but it's not paid. And then again, keeping in mind how we compare to the rest of the world. And I think with that, we move into our first activity. So with that, we'll request you to go back to your Poll Everywhere slide that I had requested. If you had accidentally closed that out, do kind of log back in over there. Another thing that once you are looking into the question, keep in mind that we'll be asking you to kind of come into a small group situation so that we can talk a little bit about it. I think what we want you to think about it, what do you think are some of the challenges that are faced by parent trainees? And spill your heart out. Oh, perfect. I think this one is working. I don't have to toggle around. Awesome. Okay, this is wonderful, guys. And as you're typing, like, you know, we're coming in groups, you know, the idea is to come into groups and think a little bit more about this question in a little bit more depth. Our goal would be to have, like, about 15 minutes to think about this topic together. And it would be great if one person in the group could be the scribe or the person who could bring those thoughts back to all of us together so that everybody can hear the thoughts as well. So let's do that. Let's do that. Oh, I'll keep just one. Okay. All right. So, yeah. You guys can all come. Forward. Okay. Okay. So I will use this space to kind of highlight the challenges that you all spoke about. So, okay. Okay, so first of all, parenthood during training is not an unusual experience. In a survey done in 2013, 40% of the respondents shared that they wanted to have children during their GME training. So parenthood during training should be expected in some ways. Parenthood has consequences for trainees. It can impact speciality choice, graduation timeline, practice intentions post-graduation, and attrition following training. It is also important to recognize the role overload that some of our women trainees might experience as mothers since sometimes they tend to be primary caretakers for children as well. And that data has shown that they do spend longer time in training compared to their male colleagues. Challenges associated with parenthood during training include timing of the parenthood, impact of the parenthood on the health of the mother and their children, parental leave, access to lactation facilities, child care, long work hours call, unpredictable changes to the work and home environment, especially with the COVID, and then stigma. As I'm saying this, I also want to recognize that the language in it is a little bit gendered. So I just want to call that out, that it's mother and children. So I just want to call that out. Okay. So let's look at the timing of the parenthood. Residency and fellowship training coincides with the time during which a lot of people plan their families. The average age of completion of medical training in the U.S. is 31.6 years overall. And then for surgical trainees, it is 36.8 years. Female physicians are twice at risk for infertility compared to general population. So 24.1% versus 10.9%. The average age of diagnosis is 33.7 years. To address this, residents and fellow section at AMA put forward a policy paper to advocate for not only educating medical students and trainees about the natural course of female fertility, how the natural course of female fertility interacts with medical education and training, but also ask for insurance coverage and inclusion of fertility treatments for students and trainees. It is important to acknowledge the cost of these treatments for trainees who are often overworked and underpaid. The cost of the oocyte cryopreservation is $10,000 per cycle, and often multiple cycles are required. The cost of medications that go with it is $3,000 to $4,000, and storage costs up to $500 per year. This is in addition to a very extensive and meticulous outpatient treatment program, and we all know how easy it is to take time off for our dental workup or for our, like, PCP appointments, right? Also, it is important to recognize that there is precedent. Facebook, Google, and Apple offer these facilities to their employees all the time kind of thing. Okay. Then, both maternal and fetal health, and I will try to change the language as much as I can, but both parental and fetal health is at risk during pregnancy generally, and especially during training. There are some of the things that trainees and their babies, these are some of the things that they are at risk for. Growth retardation is 7.5 times more likely in babies that are born during training. A survey to pediatric residents revealed that 36% of the respondents reported complications, and out of those who reported, 35% had serious complications requiring hospitalization. Okay. This slide highlights the comparison between outcomes for parents and infants when they are given eight weeks off versus when they are not given eight weeks off, or less than eight weeks. So, less than eight weeks, more than eight weeks. And if you look at the first two kind of indicators, so if you are less than eight weeks, then your chances of breastfeeding less than six months is 33% compared to 89% if you get more than eight weeks, if you get equal to or more than eight weeks off. Then, negative postpartum depression screen, 33% versus 70%. So, that's a huge difference, right? Satisfaction with the decision of having children during training, 56%. That's the last one. So, the 56% versus 75%. Okay. So, I will invoke Winnicott again, just because I'm a child psychiatrist and I do like his work. Again, he said there's no such thing as a baby. The baby exists through the diet. And for anyone who's like a psychoanalytic nerd in the room, the primary maternal preoccupation or the maternal reverie lasts up until six months. So, six months is when the baby enters a milder stage of hatching, right, and starts to recognize their separateness from the mother. So, this is really important for us to keep in mind as we are discussing ACGME. Like, we will be discussing ACGME policies when they talk about, you know, now they have mandated six weeks of parental leave off. So, six weeks versus six months. Six weeks is a good start, but it's not a destination kind of a thing. Okay. So, this is, again, from UW. It's a survey. And most respondents, so they ask them, what are the determinants of the maternity leave length? And if you can see, it is determined by the financial situation and job-related pressure. So, you know, family finances, they want to graduate on time. I'm understanding that when you graduate on time, you can start on time and you can start getting paid again. Board certification exam, again, a job-related thing. Fellowship or job started. So, those are some of the things that determine the length of the parental leave. Oh, sorry. We have already done these. This is a duplicate. Okay. So, let's talk about lactation. Data shows that most trainees want to breastfeed. Please remember that trainees have very little time off. And they have long work hours. So, it's crucial for them to have access to clean and easily accessible lactation facilities. It is also important to have downtime during workday so that they are actually able to pump. So, if you have, like, an appointment from, let's say, 12 to 1, and then 1 to 2, then 2 to 3, you don't have any time. Sometimes, I joke about this, but sometimes I say that if I take a break to pee, I will be late for another meeting. So, how do you make things happen? Then, let's talk about childcare. It's a considerable financial stressor for parent trainees. Please keep in mind the exuberant student loans that most trainees have and that most of them have to relocate and might not have family nearby to assist with childcare activities. The schedules of daycares do not align with the schedules of residency and fellowship. You have to be on a wait list. As you were saying, you have to let them know as soon as you can see so that you can be on a wait list. Then, the daycares exclude your child when they show the first sign of an illness. They are not open during holidays. We are still working during holidays. Again, the COVID-19 put a lot of strain on the system as well. This is a saying from an IM resident who I think was unionizing. She said that the cost of daycare in a month is about half of my salary in total, and the cost is essentially the entirety. They are unionizing, I think, right? Okay. Okay. Then, during training, you have long work hours and a pretty brutal schedule, which leaves very little time for new trainees to recover between shifts. They say that you need eight hours after 16 hours of work. How many parents can recover in those eight hours when they are new parents, right? Then, lastly, let's talk about the stigma attached with parenthood during training. We are socialized into believing that any time off, whether it is sick days, vacation days, or parental leave, is equivalent to falling short. Parent trainees feel guilty about taking time off, which can be perceived as increasing the workload of their colleagues due to staffing issues. The system kind of pitches trainees against trainees in some ways, right? Residency programs, just like psychiatric organizations, might have additional pathways and committees for career enrichment and development. If those committees take place outside work hours, parent trainees might not be able to attend, which then impacts their access to opportunities for collaborations and scholarly activities. I don't know how many of you are ACAP members, but it usually meets between 5 to 6 or 6 to 7 or something like that. If those are the timings that you're meeting with your committees and councils and components and stuff like that, then you're missing out on opportunities. There's also a perception amongst program directors as per a survey that parent trainees and only, curiously, women parent trainees are less clinically and scholarly productive, a perception that is actually not rooted in reality as per data. They think that they are falling behind. Only the female trainees are falling behind. Therefore, on top of other challenges, people's perceptions are another challenge that parent trainees have to face. So this concludes my slides, and these are the references in there. So if anyone's interested, they're on the app as well. Keep those thoughts in mind and return to your phone for just a minute before we resume into our small group. Again, having child psychiatry background, I didn't bring my badge today, but one of my attachments in my badge is like genie from Aladdin, and I showed that genie to my kiddos in my clinic and asked them, oh, if you had genie, what three wishes would you have? So I want you to be genie for a second and think about what if you had the power in the world? No administrative red tape, nothing to stop you. What would you change? How would you change that? Start thinking along those lines. You guys are making about graduation, making the challenges that we talked about, actually working, changing those in real time. Let's think together, again, give ourselves about 12 to 13 minutes, thinking about how would it actually happen? How do we see it to happen in our programs? What is the conversation? What are we thinking about? How are we mentalizing ourselves as parent trainees? How are we mentalizing our program leadership? How are we mentalizing our peers as well who are not parents and in the same boat or a similar boat in this wild ocean that we're all in? So let's think together and see where this goes. So we weren't sure exactly what the distribution was going to be in terms of program leadership versus more trainees. And it sounds like the group here is largely trainees, so I'll try to keep it geared towards that. There might be some sections that I'll fly through. There's ones that I'll probably spend more time with. But just some information. I think a lot of this information is really just to help provide some context. I may actually, just in the interest of time, skip to the next slide. I may actually, just in the interest of time, skip through this part. This is actually pre-2022 when the ACG mandated the six weeks, so this is not necessarily as relevant anymore. So one thing that did come up in our discussion, though, is about how the impact of parental leave affects other trainees, your co-residents, your classmates. And I was actually very positively surprised that, generally speaking, most program directors don't think that training experience is too negatively impacted by parental leave. Although it is worth pointing out that the only negative there is the impact on the co-residents rather than on the person taking the leave. So definitely something that I think people are thinking about. But if you look at the overall spread, the majority of program directors think it's a neutral impact, or even a positive one, to see one of your classmates being able to take time that they need for their family. So, okay. So that was all the before. Let's focus on now. As of July 1st, 2022, there is a minimum across the nation any ACGME accredited program gets six weeks off for medical, parental, and caregiver leave. So the details of this policy, this is offered regardless of the type of parent or the type of delivery. This does include adoption. It is mandated to be six weeks paid leave at 100% of salary. And there does need to be at least one additional week of paid time off outside of the six weeks. So if your program is telling you, for example, yes, you can take the six weeks, but you get no extra vacation that year, that's not correct. You need at least one additional paid week off outside of those weeks. Other than that, though, the six paid weeks can include vacation and or sick days. Importantly, this can occur at any time. You can match at a program, need to give birth July 1st, and this all applies to you. There's no need to have served a certain amount of time. And importantly, the health and disability benefits do need to be continued. For your programs, this I think is a very positive thing but can be viewed as somewhat of an unfunded mandate where it's basically ACGME telling them find coverage, pull money out of a hat that you might not already have. So with that in mind, I wanted to focus on some strategies that programs can use in terms of covering the gap. I think step one, two, and three really is to have a plan and to consider posting this for both current and prospective applicants. With these six weeks in mind, people are going to want to know even before they're at the point of being, you know, six months pregnant, how am I going to approach this if this were to come up. So I think there is some data suggesting that most programs don't actually post their plans, and I want to really push and encourage programs to post it, make it publicly available even at the time of people applying. You can also encourage your program to involve your institution's GME. There's often kind of this, like, we're going to go it alone sense that program directors can have when they're dealing with this, and it's important to realize that, like, every single program, not only at your institution but in the country, is having to come up with strategies around this mandate. So doing what you can to kind of share and connect with people at other programs, ask how they've done it there and what you might be able to bring back to your own institution is really valuable. This is why I think, like, this conversation we're having here is really probably the most important part, like our discussion here, is that you can make these connections and get ideas and be able to share those with each other moving forward. As much as possible, we encourage programs to offer paid parental leave that is separate from sick vacation and other forms of leave. And one thing that's important to keep in mind is that the ABPN requirements do require four weeks of vacation per year, but that is averaged over four years. So if somebody wanted to, for example, they could, say, take extra weeks of vacation during the year that they know that they're going to be on leave to take care of a child and then take less vacation the following year to make that up or to average that. So that is one strategy that's available. Some other creative solutions to promote bonding while still working are things like some of you brought up, like scheduling research electives, seeing if it's possible to do remote work. I've heard this one brought up. I don't know if it's possible to do successfully remote work with a small child around, but just throwing that out there for some food for thought. And then someone had brought up the idea of whether it's possible to do a part-time schedule. There's nothing actually preventing a program from offering a part-time schedule. In our urban program, we didn't end up implementing it. The resident chose to do kind of a different strategy, but we were able to get approval for a part-time schedule for somebody who was considering having a child the following year. So we were able to negotiate and manage that. And we were going to be able to offer kind of full health benefits during that time too. And then something that I think more programs should start to look at is increasing the size of the program. There's studies showing that trainees are less likely to extend training when there's more residents per class. And now with the six weeks mandated by ACGME, I think there's going to be more and more people who are taking parental leave and being able to have a bigger class size to offset that can be one potential solution here. So those are some of the kind of maybe the hard interventions we can do, but I also want to talk about some of the softer interventions we can do in terms of culture. There's this idea that people talk, people communicate with each other in terms of their perception of how friendly a program is towards people having children. This was a very kind of frustrating study showing that after having a child, peer perception of other residents improved, but not mothers. And you can kind of see a big sexism and gender gap in terms of how parents are perceived after having their child versus before in terms of their peer evaluations. So this sort of culture is really, really important and something that we need to actively push against because this culture has an impact in terms of future recruitment and lower retention of current faculty. So yeah, we talked about some of the hard structures for changing the culture, but there's also some soft structures as well. As much as is in your power, as much as you're able to advocate with leadership for, look at ways that the current culture isn't supportive of parents. Some programs have like a happy hour culture where a lot of important relationships are built in the non-working hours when parents need to go home and be with their children. Timing of meetings, especially now with Zoom, being able to schedule meetings in kind of the off hours, like 5 to 7 p.m., which any parent knows is kind of the witching hour for your children where it's not really possible to do that. Even for me, even for presenting here, I'm here for about 27 hours or so because I have to get back to childcare responsibilities. The APA was very clear that there's no flexibility in terms of scheduling and the language around this was like, if there are extreme circumstances, we can consider putting your presentation on a different date. But it's like, is just being able to take care of a child in extreme circumstances? Probably not. But it kind of shows like the culture of how friendly places can be in terms of making it work for parents. And then oftentimes there can be like inappropriate disparaging remarks. If you notice those, I really encourage you to speak with senior leadership. And then finally, to create a culture of inclusion of children and family at work events. I've brought Ellie to both of our work retreats and she's had a great time each time. But I think before I did that, I generally didn't actually see children at work retreats. And I thought that this was kind of an important thing to do, not only for myself, but also to kind of set a culture for the trainees in my program. So just some thoughts. I know we have about 10 minutes left. I wanted just to kind of regroup and kind of finish off with discussion.

parental leave

medical trainees

psychiatry

ACGME policies

support structures

flexible scheduling

stigma

systemic changes