Additional planning considerations for fellows
Research childcare options (ideally 6 months or more before leave).
- Start to explore your institution’s resources for leave and childcare options (daycare waitlists may be greater than 1 year in some cities).
Inform your program director (4-5 months before leave).
- Consider informing your program director about pregnancy at the beginning of the second trimester.
- Discuss Accreditation Council for Graduate Medical Education requirements and scheduling responsibilities.
- Explicitly discuss whether you plan to graduate on time or extend fellowship.
Inform your colleagues and patients (at least 3-4 months before leave).
- If comfortable, consider getting advice from a co-fellow and/or faculty mentor parent to facilitate transition to parenthood.
- When you feel ready, begin trading rotations and calls with co-fellows. If you have a results inbox or pager, discuss who can help cover those during your leave.
- Inform research collaborators about your leave and make preparations to keep projects progressing during your leave.
- If you have “active” clinic patients, when appropriate, begin to inform them that you will be away and provide reassurance that a colleague will be covering you. Leave clear plans with contingencies for these patients in your last progress notes.
Complete institutional paperwork and map out facilities (at least 2-3 months before leave).
- Review your options for using time toward leave, including vacation, research, or Family and Medical Leave Act–provided leave (unpaid), and what paperwork you need to fill out.
- Contact your payroll and/or human resources office to inform them of birth/adoption.
- Research potential program parental benefits, such as dependent daycare and/or health care flexible spending accounts.
- If choosing to breastfeed, explore the lactation rooms that are closest to your workroom and endoscopy suite and determine how much time you will need to set aside for pumping.
Be prepared to make adjustments as needed.
- Endoscopy-heavy rotations may be more difficult in the third trimester of pregnancy.
- Make contingency plans for early or late delivery dates, as well as if you undergo a cesarean that requires additional recovery time.
- Consider scheduling elective rotations (research, clinic) toward the end of leave and for the first month of “return to work.”
- If you plan to join limited clinic or outpatient endoscopy blocks later in your leave, make early arrangements to work regularly with these attendings.
Trainee needs assessments in gastroenterology fellowship similar to those in other specialties should be performed, and are in fact underway.19,23,24 There is a lack of data regarding the availability of fellowship program guidance and, specifically, adherence to required policies, and more data from program directors at a national level need to be collected.20 We recommend that programs engage in identifying specific needs at their institutions with the goal of eventually sharing this knowledge with other programs. Gastroenterology society recommendations for performing endoscopy while pregnant, with regard to ergonomics, infection control, and radiation exposure, would be instrumental. GI fellowships should consolidate institutional knowledge and engage key stakeholders – including trainees, prior trainees, occupational safety experts, radiation safety offices, wellness experts, and GME – to create program-specific policies that are flexible but rigorous and generous but equitable.
Dr. Liu and Dr. Summa are gastroenterology fellows at Northwestern University, Chicago. Dr. Patel is an assistant professor of medicine and a gastroenterology fellowship assistant program director at Northwestern University, Chicago. Dr. Donnan and Dr. Guentner are assistant professors of medicine at Northwestern University. Dr. Kia is an assistant professor of medicine and the gastroenterology fellowship program director at Northwestern University. They have no conflicts of interest to disclose. The authors would like to thank Michelle Clermont, MD, and Maureen K. Bolon, MD, for their discussion and assistance during the drafting of this article.