512 - "I thought everyone was going to hate me for being pregnant": Unearthing the ideal worker image in GME

Poster Number: 512
Publication Number: 512.27

Background: Medicine has long been a male-dominated profession, but women now constitute more than half of U.S. matriculants in medical school. However, because medicine was predominantly the purview of men for many generations, training programs can still harbor patriarchal norms that place women at a disadvantage. The navigation of pregnancy and childbirth during medical training is one experience that can elicit challenges with respect to these patriarchal norms. Although it is known that women who become pregnant in training experience myriad challenges, research on parenthood in graduate medical education (GME) has struggled to understand why these challenges persist.

Objective: Study aim was to explore the challenges pregnant trainees and their program directors (PDs) face as trainees navigate pregnancy, as well as understand why these challenges exist.

Design/Methods: From October 2022-April 2023, we recruited 13 resident or fellow trainees who experienced pregnancy while in training and their corresponding PDs, Table 1. Data in the form of semi-structured interviews were collected, transcribed and analyzed using thematic analysis. Guiding our analysis was critical feminist theory, specifically 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 (e.g., 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. Similarly, PDs experienced these same issues, but from the perspective of their own leadership efforts, Table 2. In each case, the image of the ideal worker lurked in the background of medical training shaping both trainees’ and PDs’ experiences of pregnancy.

Conclusion(s): This study shows that even though the number of women has increased in medicine, the profession’s underlying culture continues to signal to trainees that they must live up to prior expectations set by men to be perceived as an ideal worker. An understanding of the effects of the pervasive culture of the ideal worker is crucial as U.S. GME programs seek to formalize and expand policies that support women, parents and families within medical training.