Taking Leave From Residency Does Not Hurt Board Exam Performance

Residents who took parental leave did at least as well on their board exams as their colleagues who did not take any extended leave during residency, according to an analysis of physical medicine and rehabilitation (PM&R) residency programs.

Residents who took parental leave due to academic remediation, becoming a parent, personal health, or unspecified reasons passed Part I of the board exam at a similar rate to residents who did not take any extended leave (91.3% vs 91.8%; OR 0.93, 95% CI 0.53-1.61).

On Part II of the Board exams, the oral exam, residents who took parental leave scored significantly better than their non-leave taking colleagues (94.4% vs 86.6%; OR 2.36, P

Residents who took extended leave (7 or more days) for medical or parental reasons fared no worse than residents who did not take extended leave, which could help residency program directors to develop more supportive extended leave policies, the authors wrote in the American Journal of Physical Medicine & Rehabilitation.

McDeavitt said these findings should also give residents more confidence to take parental leave when they need it.

“This is the first real data we have that should give people a degree of confidence and reassurance that, if you’re going on leave of absence to take maternity leave, it’s not going to impact you in terms of your academics, your performance, your ability to successfully perform on your board examinations,” McDeavitt, chair of the American Board of PM&R, told MedPage Today.

The analysis was part of an effort by the American Board of PM&R to use a data-driven approach to its board certification process, McDeavitt said. This data played a part in the board’s recent decision to increase the amount of extended leave available for residents from 6 additional weeks to 10 additional weeks of leave.

He acknowledged that residents still may hesitate to take that leave.

“I think that bias potentially occurs on the part of program directors, and maybe more importantly, I think it probably occurs on the part of residents,” he said. “These data should give comfort to the residents that are considering parental leave. Take your parental leave. Don’t feel badly about it. You’re gonna be fine. And it should give comfort to program directors. That’s the most fundamentally important thing, I think out of this study.”

McDeavitt also thinks that other specialty boards should consider conducting similar analysis if the data is available, especially because it is a simple study to replicate.

The analysis included 10,803 residents who completed their PM&R training between 1998 and 2020. In total, 643 (6%) residents used extended leave during their training. Of the four most common documented reasons for taking an extended leave, 108 were academic-related, 191 were parental, 73 were personal health-related, and 271 were unspecified.

Women accounted for 76% of extended leave takers and 96% of extended leave.

The pass rate for Part I of the board exam was highest among the no-leave group (91.8%) and lowest among the academic remediation group (79.2%). The pass rate for Part II of the board exam was highest for the parental leave group (94.4%) and lowest for the academic remediation group (67.5%).

While similar analysis would be interesting to see across other specialties, Elizabeth Malinzak, MD, an anesthesiologist at Duke University School of Medicine and the president of Women in Anesthesiology, speculated that the results might be different for each specialty, due to varying board exam schedules that could benefit or harm residents depending on the timing of their extended leave.

Negative perceptions are still a concern when it comes to taking parental leave, she noted, pointing to studies showing stigma related to male residents taking parental leave and a need for more support of female residents after maternity leave. She also highlighted her research on negative perceptions toward parental leave from anesthesiology program directors in residency and fellowships.

“I think it is the perceptions by others that harms female and male residents, rather than the actual policies for parental leave,” Malinzak told MedPage Today via email. “There is still a ‘stigma’ associated with taking parental leave as a resident — that you are behind clinically and academically when you return, that you burden your colleagues, etc.”

Malinzak said she has noticed progress toward more acceptance toward extended leave time for parental reasons, though.

“Many specialty board and institution parental leave policies have evolved so that trainees can take more time off, without having to use all their vacation or make up a considerable amount of time, and this leads to less stress for residents taking leave, and better wellbeing for trainees,” she said. “Overall, parental leave is becoming more accepted and expected.”