Internal Medicine Residency Program Directors Misinterpret Leave Policies

By Anne Harding

December 26, 2019

NEW YORK (Reuters Health) - Most internal medicine program directors (PDs) misinterpret American Board of Internal Medicine (ABIM) leave policies for resident physicians, in large part because the policies don't explicitly define "one month," according to a new report in the Annals of Internal Medicine.

"With 82.7% of PDs believing they must extend training to follow ABIM policies, many residents may have had their training extended unnecessarily," Dr. Furman S. McDonald of ABIM in Philadelphia and colleagues note. "However, given ABIM's intended definition of 1 month and the ability to accumulate leave over the entirety of training, most 8-week parental leaves would not require training extensions or creative solutions."

ABIM's Leave of Absence and Vacation policy allows up to a month of leave per year, with unused time accumulating, while its Deficits in Required Training Time policy allows one additional month of leave if a trainee is assessed as competent by the end of training, the authors explain.

In light of recent reports that parental leave policies in graduate medical education are "inconsistent and variable," ABIM collaborated with the Association of Program Directors in Internal Medicine (APDIM) to survey PDs about their understanding of leave policies.

Most of the 279 PDs who responded to the survey said that they understood the Leave of Absence and Vacation policy of one month, but only 4.3% defined it correctly as five weeks.

Survey participants were asked to apply the leave policies in six hypothetical scenarios involving residents requesting leave. The percentage of those who responded correctly ranged from 1.5% to 52%.

In one scenario involving a resident who requested eight weeks of maternity leave, just 6.5% of the PDs answered correctly that it would not be necessarily to extend training, while 82.7% said training should be extended.

"They have a lot more flexibility to allow for leave than they may have realized," Dr. McDonald of ABIM told Reuters Health in a telephone interview. "They don't have to delay their fellowship, they don't have to delay perhaps starting their first job for the sake of making up a week of leave."

Dr. Kirti Magudia, who reviewed the study for Reuters Health, said it "highlights how difficult policies are to write clearly and to interpret as intended even with the best of intentions by all stakeholders. These results are reinforce our prior results at Brigham and Women's Hospital and Massachusetts' General Hospital, which showed that only 1/3 of graduate medical education (GME) trainee respondents knew or knew where to find their institution's or program's parental leave policy at the time of being surveyed."

Dr. Magudia, now a a T32 Research/Clinical Fellow in Abdominal Imaging at the University of California at San Francisco, continued in an email, "Specialty boards such as the ABIM have been blamed for requiring trainees extend training due to parental leave. It is surprising that almost all internal medicine program directors did not understand how to apply existing ABIM policy even when the ABIM is trying to be generous and fair to trainees. It is not reasonable to think that a clinical trainee would understand the ABIM policies better than their program director and successfully convince the program director that their interpretation of ABIM policies is correct."

She added: "I believe that all boards should establish formal parental leave policies for this relatively common occurrence in GME training. Given the misinterpretation of board policies that is known to occur, a specific parental leave policy would only help GME trainees and program directors access the information they need."

"I think that it is also important for ABIM to take a stand on behalf of internal medicine trainees and specify that its intention is for parental leave to be paid," Dr. Magudia said. "Perhaps, review of program/institutional parental leave policies can be a component of program accreditation/review by ABIM to ensure that there is compliance with ABIM guidelines with resulting fair treatment of GME trainees."

SOURCE: Annals of Internal Medicine, online December 24, 2019.