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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.
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.
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.
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.
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.
Executive members: Drs Lois Sim (1996/97 president), University of Alberta, Edmonton, Alberta; Anna Karwowska (1997/98 president), University of Calgary, Calgary, Alberta; Michelle Ponti (1998/99 president), The University of Western Ontario, London, Ontario
Liaisons: Drs Leigh A Allwood, Memorial University, St John’s, Newfoundland; Janice Barkey, University of Manitoba, Winnipeg, Manitoba; Roxana K Bolaria, McGill University, Montreal, Quebec; Sarah Dyack, University of Alberta, Edmonton, Alberta; Henriette Fortin, Université Laval, Quebec, Quebec; Keyvan Hadad, University of British Columbia, Vancouver, British Columbia; Dawn S Hartfield, University of Saskatchewan, Saskatoon, Saskatchewan; Tanya Kodeeswaran, University of Ottawa, Ottawa, Ontario; Ramsay C MacNay, McMaster University, Hamilton, Ontario; Michelle M McNeill, The University of Western Ontario, London, Ontario; Paul C Nathan, University of Toronto, Toronto, Ontario; Derek Prevost, Queen’s University, Kingston, Ontario; Marie-Noel Primeau, Université de Sherbrooke, Sherbrooke, Quebec; Laura K Purcell, Dalhousie University, Halifax, Nova Scotia
Reviewed by the Canadian Paediatric Society Board of Directors