Paediatric residency programs: Guidelines for short term leaves (minimum standards)

RESIDENCY PROGRAM: RELEVANT ISSUES

Leave of absence during residency presents significant challenges to residency program directors and colleagues. While unpredictable events resulting in lost time from a program do occur, the most common reason for absence is parental leave. Women now make up more than 50% of paediatric residents, and a significant number become pregnant during their training. Male residents are now more likely to participate in parenting, and other unavoidable short term disability leaves can occur. Scheduling in residency programs does not take these inevitable events into account, creating considerable disruption in an already highly stressful situation.

Ensuring that residents’ absences do not compromise patient care is an important issue. Often, remaining residents in the department adjust their schedules and work additional hours to provide coverage for critical work and on-call time. The difficult task of reassigning work usually becomes the responsibility of the chief resident, with varying degrees of support provided by the program director. Limited resources usually preclude hiring nonresidents, such as staff physicians and nurse practitioners, to cover for leave.

Without carefully set guidelines, the remaining residents may be overwhelmed by vigorous educational and additional service demands. Combined with sleep deprivation and a lack of attention to personal care, this pressure can lead to feelings of being used and overburdened. Fatigued residents are prone to make mistakes, compromise educational and work goals, and blame the system for failure. Not only may residents feel resentful of those taking leave, but there may be a loss of compassion for patients.

In addition to finding coverage for clinical work, it is the program’s responsibility to ensure that the resident requiring leave fulfils the educational requirements of the program. Additional costs to the system may be incurred. Funding for medical education is increasingly constrained, and stipends and benefits may not be provided during leave of absence and make-up time. This adds to the stress suffered by often financially burdened residents.

NATIONAL SURVEY

In an effort to address the issues in Canada, the Residents Section of the Canadian Paediatric Society gathered information from across the nation on program policies. Paediatric programs across Canada vary considerably in the amount of leave granted. Some examples of the amount of leave granted are presented in Table 1.

TABLE 1:

Examples of the amount of leave available to residents in Canadian residency programs

Dalhousie University, Halifax, Nova Scotia	No set policy for short term leave ’Unaccredited’ time including leave secondary to illness or parental leave with no penalty for a maximum of 14 weeks Remaining residents cover call nights as necessary
McGill University, Montreal, Quebec	Department is currently developing a policy for short term leave Maternity leave of 20 weeks at 95% pay plus additional 10 weeks if necessary at 65% pay Marriage leave of seven days with pay, seven additional days without pay Remaining residents cover call nights to maximum of 10 calls per month
Université Laval, Québec, Québec	19 of 20 paediatric residents are women Maternity leave and compensation policy set under an agreement between the Association des médecins résidents du Québec and the provincial government
University of Alberta, Edmonton, Alberta	Parental leave (maternity/adoption) is 18 weeks without pay and requires extension of training as determined by program director Paternal leave is one week without pay Remaining residents cover call nights as necessary
University of Calgary, Calgary, Alberta	Maternity leave is 20 weeks without pay Other leaves of absence are 12 weeks with pay, at the discretion of program director Remaining residents cover call nights as necessary
University of Toronto, Toronto, Ontario	Guidelines are set by Professional Association of Interns and Residents of Ontario and the Teaching Hospitals Committee Maternity leave is 17 weeks, with four weeks advance notice, for first time parent (maternity or adoption) and 18 weeks following the birth of the child Back-up system is available for acute shortage in call (eg, due to illness) Clinical associates are hired to fill prolonged gaps in the call schedule so that the extended leave is not covered by the remaining residents

Information provided in this table is subject to change at the discretion of individual programs

UNDERLYING THEMES

Defined policies for short term leaves can reduce stress and enhance equity for residents who need leave and for their colleagues. There is a need to define and differentiate educational goals from service roles and to ensure strict adherence to educational guidelines to minimize excessive service demands. This can decrease the burden on the remaining residents. Residents need to play a more active role in policy development to define the educational and service functions of programs at both the local and national level.

CONCLUSIONS

The first national guidelines for paediatric residents on short term leaves of absence follow and were prepared during the Residents Section 1997 Business Meeting and Workshop in Halifax, Nova Scotia. These guidelines outline minimum standards for Canadian paediatric residency programs. However, the Residents Section encourages individual residency programs to add to these guidelines, and to offer enhanced packages to their residents and more flexibility with on-call hours when possible.

GUIDELINES

Vacation

• All residents are entitled to four weeks paid vacation each year, four times seven consecutive days; if five consecutive days are taken, a weekend is attached.

Additional time off

• In addition to vacation time, residents are entitled to a minimum of seven days of additional paid leave for conferences, examinations or other educational purposes.

Parental and adoptive leave

• Residents are entitled to parental or adoptive leave of up to 17 unpaid weeks. If a resident is unable to return at the end of this time, the leave may be extended at the discretion of the program director.

• Written notice must be submitted at least four weeks in advance or as early as possible so that scheduling changes can be made.

• Residents have the option of no in-house call after completing 31 weeks’ gestation for maternal leave in an uncomplicated pregnancy or sooner if medical advice is given.

• Remaining residents will not do more than a total of seven calls/month for first- and second-year residents, and five calls/month for third- and fourth-year residents. If necessary, the department should look to other venues to cover remaining calls.

• Employment cannot be terminated because of parental leave.

• A resident may require an extension of the program for equivalent period as determined by the program director.

• Paternity leave will be granted for up to seven unpaid days. The resident must submit notice at least four weeks in advance or as early as possible. If required, the resident can request up to 17 weeks parental leave as noted above.

Personal or sick leave

Residents are entitled to up to three months paid leave. The resident may not be required to make up this time at the discretion of the program director.