The study, led by Mohammad Zaib of the Department of Medicine at MTI-Lady Reading Hospital in Peshawar, together with Usman Mahboob of Khyber Medical University and Naheed Mahsood of Khyber Girls Medical College, set out to understand why residents with chronic illness choose to perform their clinical duties while unwell. Presenteeism, the act of attending work despite being sick, is common among postgraduate residents, yet the authors note it has received negligible attention in the policies that shape graduate medical education. Rather than measuring how often it happens, the team wanted to understand what it feels like from the inside, and what forces push young doctors to sacrifice their own health in service of their patients and their careers.

To capture that lived experience, the researchers employed a qualitative phenomenological design, an approach that seeks to describe the essence of a shared experience through the eyes of those who live it. They conducted semi-structured interviews with twelve postgraduate residents drawn from different medical specialties in hospitals across Khyber Pakhtunkhwa province in Pakistan. Semi-structured interviews allowed participants to speak freely about their experiences while ensuring that key topics were covered consistently. The researchers then analyzed the transcripts using Braun and Clarke’s reflexive thematic analysis, a widely used method in which researchers systematically code the data and develop themes that capture patterns of meaning across the accounts. The study received ethics approval from the Advanced Studies and Research Board of Khyber Medical University, and all participants provided written informed consent, with confidentiality and the right to withdraw explicitly guaranteed.

A distinctive strength of the work lies in its theoretical framing. The researchers interpreted their findings through two complementary psychological theories. The first is Conservation of Resources theory, which holds that people strive to obtain, retain, and protect resources they value, and that stress arises when those resources are threatened, lost, or invested without return. The second is Self-Determination theory, which describes human motivation in terms of three basic psychological needs: autonomy, competence, and relatedness. Together, these frameworks allowed the team to explain presenteeism not as an isolated individual choice but as the outcome of an interaction between motivational stress and resource-related pressures. A resident who fears losing income, career standing, or professional respect is experiencing a resource threat; a resident whose sense of purpose depends on being present at the bedside is experiencing a motivational pull. In the lives of chronically ill residents, both forces operate at once.

From the analysis, five major themes emerged, and together they sketch a portrait of a group caught between what they believe they owe their patients and what their bodies and circumstances demand. The first theme, described by the authors as the essence of duty, revealed an internalized professional identity in which physical presence at the workplace defined what it meant to be a good doctor. For these residents, showing up while sick was not seen as recklessness but as the very expression of medical virtue. Absence, by contrast, carried the sting of failure and guilt. This finding illustrates how deeply the culture of medicine equates commitment with corporeal presence, a norm that leaves little room for the realities of chronic disease.

The second theme, the reality of precarity, exposed the material conditions underlying that commitment. Participants described financial precariousness and persistent anxiety about their careers, including fear of economic victimization, rooted in a dearth of resources. In a training system where residents often depend on their positions for income and future employment, the prospect of taking sick leave can feel economically dangerous. Conservation of Resources theory illuminates this dynamic clearly: when material resources are scarce, any threat to them, such as a supervisor’s disapproval or a lost paycheck, is magnified, and residents respond by protecting their jobs at the expense of their health.

The third theme, the moral burden, captured the painful conflict between self-care and responsibility to patients. Residents described feeling morally torn when illness forced them to weigh their own needs against the care they believed their patients deserved. This tension is precisely where Self-Determination theory becomes explanatory: the residents’ motivation to work while ill was not purely external pressure but also an internalized sense of duty that shaped their identity. Yet when motivation is driven by obligation and fear rather than by genuine autonomy, the theory predicts, psychological well-being suffers. The fourth theme, the erosion of self, confirmed that prediction in lived detail. Participants reported that ongoing presenteeism and exhaustion were adversely affecting both their well-being and their learning, undermining the very competence that residency is designed to build. A chronically exhausted resident absorbs less, errs more, and burns out faster, a cycle that threatens not only the individual but also patient safety and the integrity of the training program itself.

The fifth theme, the yearning for support, expressed what residents said they needed to break this cycle: empathetic institutional systems, financial stability, and psychological safety. They wanted workplaces where admitting illness would not invite stigma or penalty, where leave policies were equitable, and where the basic economic anxieties of training life did not make every sick day feel like a gamble. The authors argue that sustainable graduate medical education requires a balance between the service needs of hospitals and organizational support for trainees, including the promotion of autonomy, financial and psychosocial support, and fair leave policies. In their conclusion, they place the safeguarding of residents’ health at the center of professional development, patient safety, workforce stability, and the integrity of medical education itself.

The significance of the study extends beyond the hospitals of Khyber Pakhtunkhwa. Presenteeism among healthcare workers is a global concern, because a sick clinician who keeps working can transmit illness, make errors, and model unhealthy norms for the next generation of doctors. What this research adds is a theoretically grounded explanation of why the problem persists even among highly motivated professionals. It is not simply that residents lack awareness of the risks; it is that the architecture of their training, combining scarce resources, rigid expectations of presence, and moralized notions of duty, makes working while ill the rational and even virtuous-seeming choice. Changing that calculus requires policy, not exhortation. The authors’ findings suggest that reforms addressing financial security, psychological safety, and equitable sick leave would attack the resource threats that Conservation of Resources theory identifies as the engine of the problem, while reforms that expand resident autonomy would satisfy the motivational needs described by Self-Determination theory.

For a phenomenon so consequential, presenteeism among chronically ill residents has been remarkably under-studied, and this phenomenological account is a step toward making it visible. The study’s limitations are those inherent to qualitative work: twelve participants in one region of Pakistan cannot represent every training system, and the findings describe experiences rather than quantify prevalence. Yet the depth of the themes, and their coherence with established psychological theory, give the work explanatory power that surveys alone cannot provide. The image that emerges is sobering: young doctors, already carrying the weight of chronic disease, performing their duties through pain and exhaustion because their profession has taught them that a good doctor is one who is always there. Until medical education systems learn to value the health of their trainees as highly as their attendance, presenteeism will remain the hidden price of medical training, paid in the well-being of the very people entrusted with patients’ lives.

Subject of Research: Presenteeism among postgraduate medical residents with chronic illness

Article Title: Exploring the lived experiences of presenteeism among postgraduate residents with chronic illness

Article References: Zaib, M., Mahboob, U., & Mahsood, N. (2026). Exploring the lived experiences of presenteeism among postgraduate residents with chronic illness. Discover Psychology. https://doi.org/10.1007/s44202-026-00937-8

Image Credits: AI Generated

DOI: 10.1007/s44202-026-00937-8

Keywords: presenteeism, postgraduate medical education, chronic illness, conservation of resources theory, self-determination theory, qualitative research, reflexive thematic analysis, resident well-being, occupational health, Pakistan, medical training, patient safety

The concept of psychological safety originated in the business literature, first described by organizational psychologist Edgar Schein and later popularized by Harvard professor Amy Edmondson, whose 1999 research showed that teams learn better when members feel safe to take interpersonal risks. The idea migrated into graduate medical education alongside competency-based training, interprofessional education, and the growing emphasis on diversity, equity, and inclusion. A parallel concept, the microaggression, was first defined by psychiatrist Chester Pierce in 1970 and popularized by psychologist Derald Sue in 2007, who described these as brief, everyday exchanges that send denigrating messages to individuals because of their group membership. The review underscores that microaggressions directly corrode psychological safety, silencing the very diverse perspectives that inclusive programs claim to want. In 2023, the Accreditation Council for Graduate Medical Education formally elevated psychological safety to a core principle of residency training, giving the concept regulatory weight.

The stakes are far from abstract. A widely cited 2018 survey found that 38.5 percent of residents experienced burnout symptoms weekly and 4.5 percent reported suicidal thoughts within the previous year. Residents who faced discrimination, abuse, or harassment at least a few times per month were significantly more likely to experience both burnout and suicidal ideation. The review also draws on evidence linking psychological safety to measurable performance: psychologically safe learning environments improve resident performance and have been associated with better patient outcomes both inside and outside the operating room. In surgery, where a junior team member’s hesitation to question a supervising surgeon can mean the difference between a caught error and a patient harm, the clinical consequences of silence are particularly acute.

To assemble the evidence base, the authors conducted a three-phase PubMed search covering US-based literature from 2014 to 2026, following the SANRA guidelines for narrative reviews. The first search targeted psychological safety in surgery and yielded 17 included articles from 88 abstracts; the second examined the intersection of well-being, DEI, and surgery, contributing 9 articles; and the broadest search on DEI in surgery added 20 more, with 8 additional studies identified through reference mining. The final synthesis comprised 12 quantitative surveys, 4 qualitative studies, 6 mixed-methods studies, 4 cohort or database studies, and 12 review articles, with the remainder consisting of perspective papers and program descriptions. The authors acknowledge the inherent limitations of the narrative design, including single-reviewer screening and the possibility of selection bias, but argue that the heterogeneity of the field, dominated by qualitative and perspective work, makes narrative synthesis the appropriate tool.

The barriers the review identifies cluster into three interlocking systems. The first is hierarchical culture. A qualitative interview study of surgical trainees identified four recurring threats to psychological safety: public humiliation, tension around questioning attendings, the culture fostered by faculty, and flawed system factors such as operating room staffing and leadership instability. A national survey confirmed that residents’ comfort in raising concerns to attendings varies with post-graduate year, program culture, and prior experiences with specific supervisors. Even morbidity and mortality conferences, designed as learning forums, can devolve into blame and shame when discussions are unstructured, discouraging trainees from engaging openly. When junior members fear retribution for speaking up, near misses go unreported and the entire team’s performance suffers.

The second barrier is harassment and discrimination, and the numbers are stark. In a national survey, patients and their families were the most frequent sources of gender and racial discrimination, reported by 46.3 percent and 47.4 percent of residents respectively, but attending surgeons were the most frequent sources of sexual harassment and abuse, at 27.2 percent and 51.9 percent. Overall, 72.2 percent of surgery residents reported experiencing microaggressions, most commonly from patients, followed by staff, faculty, and co-residents. Nearly one-third said microaggressions negatively affected their training, and 14.1 percent considered leaving residency because of them. In one national survey, 30.8 percent of residents who reported mistreatment experienced retaliation. Female trainees face implicit biases that actively discourage them from surgery, with higher expectations but fewer role models, mentors, and sponsors, while LGBTQ+ trainees report similar discriminatory experiences that leave them feeling unsupported.

These patterns are consistent across surgical subspecialties and fall hardest on trainees underrepresented in medicine, or URiM. Among vascular surgery residents, 36.3 percent of Asian and 56.3 percent of Black trainees reported racial discrimination. A multicenter study found URiM general surgery residents had higher anxiety, emotional exhaustion, and depersonalization, and comparable disparities have been documented in otolaryngology, orthopedic surgery, and pediatric surgery. In plastic surgery, 68.8 percent of residents reported microaggressions, with higher rates among female, Asian, and non-heterosexual trainees. The cumulative toll is measurable: URiM trainees reported burnout rates of 76 percent compared with 63 percent among their non-URiM peers. Structural barriers compound the interpersonal ones, including weaker academic support, scarce mentorship, social isolation, and the so-called minority tax, the extra emotional labor and time diverse trainees and faculty spend on diversity work itself.

The consequences extend to attrition, one of the most costly failure modes of surgical training. While the proportion of female residents in surgery has improved over the past 18 years, the percentage of URiM residents has remained essentially unchanged. A study of racial and gender disparities in attrition across surgical specialties found that female and URiM residents had significantly higher relative risk of leaving training, with the highest rates among Black and African American residents: 10.6 percent intended attrition and 5.2 percent unintended attrition, compared with 6.2 percent and 1.8 percent among White residents. A weak sense of belonging, which has been associated with non-White race, lower academic performance, and adverse health outcomes, appears to be a key mediating mechanism, creating a feedback loop in which isolation erodes belonging, which in turn erodes performance and retention.

Yet the review is not merely a catalog of dysfunction; it identifies concrete facilitators that programs can implement. Culturally concordant mentorship, pairing URiM trainees with mentors who share aspects of their background, emerges as a key driver of psychological safety, with institutional, national, and peer mentorship models all showing benefit. Structured mentorship has been proposed as a race-neutral strategy for improving networking, and dedicated roles such as chief residents for diversity and inclusion offer novel advocacy channels. On the curricular side, the review highlights Kimberly Manning’s Five Ds Upstander Training, which teaches individuals to Direct, Distract, Delegate, Delay, and Display Discomfort in response to bias, and the Microaggressions Triangle Model, which addresses microaggressions from the perspectives of recipient, source, and bystander. DEI toolkits for program directors changed recruitment practices for 31 percent of directors who used them. Institutional innovations range from Minority Housestaff Organizations that provide liberated spaces for URiM trainees, to embedded psychiatrists in training programs, to proposed Education Ombudspersons whose primary role is fostering psychological safety.

The authors conclude that creating psychologically safe surgical training environments requires deliberate, multifaceted institutional commitment rather than isolated gestures. Leaders who respond to concerns with gratitude rather than annoyance, teams that emphasize interdependence, and faculty trained in inclusive teaching all contribute to a culture where vulnerability is normalized. Programs must recruit and retain diverse trainees and faculty, distribute diversity work equitably to avoid overburdening the marginalized individuals such initiatives are meant to support, and maintain multiple reporting pathways, including anonymous ones, that trainees can trust. Notably, only 32.4 percent of trainees report receiving formal training on managing microaggressions, and over half have received no training on explicit or implicit bias, suggesting an enormous gap between the evidence and current practice. As the review makes clear, psychological safety is not simply a matter of comfort; it directly shapes resident well-being, retention, performance, and the quality of care patients receive, and closing the gap will require sustained, systemic effort across every level of surgical education.

Subject of Research: Psychological safety, well-being, and diversity, equity, and inclusion in surgical residency training

Article Title: Psychological safety and well-being

Article References: Diaconescu, A., Arora, T. K., & Lindeman, B. (2026). Psychological safety and well-being. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 190. https://doi.org/10.1007/s44186-026-00607-2

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00607-2

Keywords: psychological safety, surgical education, resident well-being, burnout, microaggressions, URiM trainees, mentorship, DEI, harassment, attrition, operating room culture, ACGME

The stakes of the question are considerable. Burnout and depression among resident physicians are among the most consistently documented problems in graduate medical education. A widely cited 2015 meta-analysis in JAMA found that more than one in four resident physicians screened positive for depression or depressive symptoms, and more recent work published in JAMA Network Open in 2024 has tracked the duration of new-onset depressive symptoms during residency, showing that the burden is not merely transient. Research in the New England Journal of Medicine has also linked long work hours to depression in first-year physicians. Against this backdrop, residency programs have experimented with a dizzying array of wellness initiatives, from resilience workshops to mindfulness sessions, often with disappointing results. Critics have argued that many such programs place the burden of coping on the individual trainee while leaving the underlying structure of work untouched, a mismatch captured in prior studies of wellness curricula that concluded that one size does not fit all.

The Toronto team approached the problem from a different angle. Rather than adding another wellness activity on top of an already saturated schedule, they asked what would happen if residents were simply given back a recurring, protected block of flexible time each week, time that could be used for learning, reflection, administrative catch-up, or recovery, according to each resident’s own needs. The idea, credited in the paper’s acknowledgements to Dr. Susan Abbey, was dubbed A&P time, and it was embedded into the routine operations of the residency program rather than offered as an optional extracurricular. The design principle was that the time had to be genuinely protected: shielded from clinical duties, pages, and the ambient pressure to be perpetually available.

This framing draws on a growing body of theory in medical education around what researchers call adaptive expertise. In contrast to routine expertise, which allows clinicians to perform familiar tasks efficiently, adaptive expertise is the capacity to handle novel, ambiguous, and complex situations, to reason through problems that do not map neatly onto prior experience. Scholars including Mylopoulos and colleagues have argued that medical education systems tend to optimize for routine competence while systematically underdeveloping the habits of reflection, experimentation, and self-directed inquiry that adaptive expertise requires. Unstructured time, paradoxically, may be one of the few reliable incubators of those habits. When every hour of a resident’s week is scheduled, there is no room for the exploratory, self-directed learning that turns knowledge into judgment.

There is also a practical precedent. A 2020 study in JAMA Otolaryngology–Head & Neck Surgery examined weekly protected nonclinical time in a surgical residency and found associations with lower burnout and improved well-being among residents. The Toronto case study extends this line of inquiry into psychiatry, a specialty where the emotional demands of the work are distinctive and where the boundary between professional and personal depletion can be especially porous. By treating the intervention as a program evaluation rather than a formal experiment, the researchers were able to capture rich, contextualized feedback from the residents who actually lived with the schedule change, analyzing their responses using established thematic analysis methods.

The regulatory environment matters here as well. Both the Accreditation Council for Graduate Medical Education in the United States and the Royal College of Physicians and Surgeons of Canada, which accredits the Toronto program, have general standards that require programs to protect time for education and to attend to trainee well-being. In practice, however, those requirements often collide with the relentless arithmetic of clinical service coverage. Education time is frequently the first casualty of staffing shortfalls, and wellness programming is frequently layered on top of unchanged workloads, producing what earlier researchers have described as mixed messages about wellness and work. The Toronto intervention is notable precisely because it attempts to reconcile the two: the protected block is framed simultaneously as learning infrastructure and as a well-being measure, on the theory that the two functions reinforce each other rather than compete.

The findings of the case study, as reported in the article, highlight how residents used and experienced the flexible time in ways that varied widely from person to person, echoing the earlier lesson that uniform wellness offerings fail because trainees’ needs are heterogeneous. Some residents directed the time toward scholarly projects or targeted study; others used it to catch up on the administrative backlog that otherwise bleeds into evenings and weekends; others treated it as recovery time. The unifying thread was not the specific activity but the experience of autonomy and protection, the knowledge that a defined portion of the week belonged to the resident rather than to the service. That sense of ownership, the authors suggest, is what converts a scheduling change into a support for both learning and well-being.

The study also engages with a deeper tension in medical training, one articulated in a 2024 New England Journal of Medicine perspective on distinguishing necessary from unnecessary discomfort in training. Medical education has traditionally valorized hardship, operating on the assumption that enduring difficulty is itself formative. But the evidence on resident depression and burnout has steadily eroded the case for indiscriminate suffering. The Toronto team’s intervention occupies a thoughtful middle position: it does not remove the genuine challenges of clinical work, which remain the core of learning, but it removes a specific and arguably unnecessary form of discomfort, the chronic scarcity of self-directed time. In doing so, it reframes well-being not as a set of coping skills to be taught but as a structural property of the training environment itself.

Methodologically, the work is a case study, and the authors are appropriately measured about what that means. It describes a single program’s experience, evaluated as exempt from review by the University of Toronto Research Ethics Board, with data and evaluation materials available on request from the corresponding author. The qualitative approach, grounded in Braun and Clarke’s thematic analysis, prioritizes depth and transferability over statistical generalization. The researchers acknowledge the residents who participated and note that their feedback directly shaped ongoing program development, an iterative quality that distinguishes program evaluation from one-off research. Funding was provided in part by an Academic Scholars Award from the Department of Psychiatry at the University of Toronto, awarded to Dr. Chaukos, and the authors report no conflicts of interest.

For residency programs elsewhere, the takeaways are likely to resonate well beyond psychiatry. The intervention is cheap, requiring no new curriculum, no additional faculty, and no novel technology, only the political will to defend a recurring block of time against the constant encroachment of service demands. The evidence base, spanning the otolaryngology burnout study, the broader literature on adaptive expertise, and now this Toronto case study, converges on a common insight: time is not a neutral container for training but an active ingredient in it. How a program structures a resident’s week sends a signal about what it values, and programs that protect flexible, self-directed time may be making a measurable investment in both the competence and the durability of the physicians they produce. As graduate medical education continues to grapple with a mental health crisis among trainees, the simplest interventions, giving residents back a few protected hours and trusting them to use them well, may prove among the most powerful.

Subject of Research: Weekly protected flexible time in a psychiatry residency as an intervention to support resident learning and well-being

Article Title: Unstructured Time, Structured Support: Weekly Protected Flexible Time to Support Resident Learning and Well-Being

Article References: Stergiopoulos, E., Berseneva, M., Tan, A., Mylopoulos, M., & Chaukos, D. (2026). Unstructured Time, Structured Support: Weekly Protected Flexible Time to Support Resident Learning and Well-Being. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02430-9

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02430-9

Keywords: residency training, physician well-being, burnout, medical education, adaptive expertise, protected time, psychiatry, graduate medical education, program evaluation, mental health, thematic analysis, University of Toronto

The survey was conducted as a cross-sectional study between September and December 2024, targeting residents in programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) across specialties. A total of 1,332 residents in postgraduate years one through four completed the survey; after excluding respondents who did not identify their gender or who completed less than half of the instrument, 1,280 responses representing 165 institutions remained for analysis. Because the survey was distributed through institutional networks rather than a single enumerable sampling frame, the authors note that a traditional response rate could not be calculated, a methodological caveat that shapes how the findings should be interpreted. Even so, the scale and geographic breadth of the sample make it one of the most comprehensive snapshots of reproductive experiences in graduate medical education assembled so far.

The demographic profile of the respondents reflects the changing face of the physician workforce. The overwhelming majority, 932 residents or 72.81 percent, identified as women, a proportion consistent with the fact that women now make up roughly half or more of entering medical school classes and are disproportionately the ones navigating pregnancy during training. Among the women respondents, about one quarter, 241 individuals or 25.86 percent, reported being pregnant at some point during residency. That figure underscores how routine pregnancy has become in the training pipeline, and yet, as the data show, the institutional machinery surrounding it remains uneven at best.

Perhaps the most clinically striking findings concern pregnancy-related health outcomes. Of the residents who were pregnant during training, 97, or 40.25 percent, reported experiencing pregnancy-related conditions, a burden of morbidity that raises questions about the physical demands of residency itself, including long call shifts, overnight duty, prolonged standing, and high-stress clinical environments. Pregnancy loss was reported by 39 residents, representing 16.18 percent of those who were pregnant during training. While the study was not designed to establish causal links between workload and adverse outcomes, the prevalence of complications and loss within this cohort provides a quantitative baseline that researchers and program directors have largely lacked, and it gives concrete weight to calls for evidence-based duty accommodations for pregnant trainees.

The survey also reached into the domain of fertility and family building more broadly. A small but notable fraction of respondents reported seeking reproductive specialist care: 87 women, or 9.33 percent of female respondents, and 23 men, or 6.61 percent of male respondents, consulted a reproductive specialist during training. These numbers touch on a growing conversation in medicine about assisted reproductive technologies (ART), delayed childbearing, and the financial and logistical barriers that residents face when pursuing fertility care on modest trainee salaries and rigid schedules. The inclusion of male residents in these figures is a reminder that family-building challenges during training are not exclusively a women’s issue, even though the burdens of pregnancy itself fall squarely on those who carry it.

When the researchers examined why pregnant residents struggled to obtain accommodations, a clear hierarchy of barriers emerged. The most frequently cited obstacle was staffing needs, reported by 137 residents, or 56.85 percent of those commenting on barriers. In other words, the most common reason pregnant trainees were denied or delayed in receiving modified duties was that their programs simply could not cover the clinical gaps their absence would create. This finding exposes a structural vulnerability in residency staffing models, which typically run with minimal slack and depend on every trainee filling a defined clinical role. When one resident needs reduced hours or lifted lifting restrictions, the burden ripples through the entire schedule.

Close behind staffing concerns were program-level and institutional-level requirements. Individual program requirements were cited by 116 residents, or 48.13 percent, while institutional requirements were cited by 108, or 44.81 percent. Taken together, these figures suggest that pregnant residents frequently encountered rules, whether written or informal, at multiple administrative levels that constrained what accommodations were available to them. The authors’ conclusion highlights three intertwined problems: unclear policies, inconsistent accommodations, and limited communication of available resources. A resident at one hospital might receive modified call schedules and ergonomic relief without difficulty, while a resident one mile away at a different institution might face opaque requirements and no clear point of contact, even when formal policies exist on paper.

The implications extend well beyond individual well-being, though that alone would justify attention. Residency is the crucible in which the physician workforce is formed, and the years of training overlap precisely with peak reproductive years. When trainees delay childbearing, experience pregnancy loss, or leave training dissatisfied because of unsupported pregnancies, the costs accumulate across the profession, contributing to burnout, attrition, and inequities that disproportionately affect women and, the authors suggest, intersect with broader concerns about underrepresented in medicine (UriM) trainees. The study was supported by the George B Quatman Foundation and The Research and Advocacy in Gender Equity Foundation, reflecting a growing philanthropic and professional investment in quantifying these workforce dynamics. The research protocol was reviewed and approved by the Advarra Institutional Review Board, participation was voluntary with informed consent obtained, and responses were anonymized to maintain confidentiality.

The authors’ recommendations center on structural fixes rather than individual resilience. Clearer policy frameworks, they argue, are needed at both the program and institutional levels, so that pregnant residents know in advance what accommodations they are entitled to and how to request them. Strengthened institutional communication, potentially through designated institutional officials (DIOs) and program directors, could ensure that existing resources actually reach the trainees who need them. The findings also implicitly support staffing innovations, such as float pools, cross-coverage systems, and flexible scheduling architectures, that would reduce the extent to which any single resident’s accommodation is treated as an unsolvable coverage crisis. Because the survey captured trainees across ACGME-accredited specialties and 165 institutions, the patterns it documents are unlikely to be idiosyncratic to a handful of programs; they point to systemic features of how graduate medical education is organized in the United States.

What makes this study resonate beyond academic medicine is the broader story it tells about institutions adapting, or failing to adapt, to a workforce that can no longer be assumed to be childless, male, or endlessly available. Nearly three-quarters of the respondents were women, a quarter of them were pregnant during training, and two in five of those pregnancies involved medical complications. Against that backdrop, barriers cited by roughly half of respondents, staffing, program rules, institutional requirements, read less like administrative details and more like a design flaw in the training system itself. The authors frame their conclusions cautiously, noting that clearer policies and better communication may improve trainee well-being and advance a more equitable and sustainable medical workforce. The data they have assembled give program directors, hospital administrators, and accreditation bodies a concrete evidence base for making those changes, and they give current and future residents something they have often lacked: confirmation that the difficulties they face during pregnancy in training are widespread, measurable, and, crucially, fixable.

Subject of Research: Pregnancy experiences and accommodation barriers among U.S. medical residents during graduate medical education

Article Title: Pregnancy and accommodations during residency training- insights from a multi-institutional survey of U.S. trainees

Article References: Bellini, L. M., Dine, C. J., Fisher, R. E., Wagner, C., Moyer, D., Weber, K., & Mladenovic, J. (2026). Pregnancy and accommodations during residency training- insights from a multi-institutional survey of U.S. trainees. BMC Medical Education. https://doi.org/10.1186/s12909-026-10211-z

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10211-z

Keywords: pregnancy, residency training, graduate medical education, ACGME, accommodations, resident well-being, gender equity, pregnancy loss, workforce policy, medical education, reproductive health, survey research