Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California.
Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California.
JAMA Netw Open. 2023 Dec 1;6(12):e2349937. doi: 10.1001/jamanetworkopen.2023.49937.
Physicians and medical students who desire to build families face significant barriers due to the structure and culture of medicine.
To understand the barriers and facilitators to family building for all people in medicine-not only individuals who can become pregnant-through an open-ended, qualitative analysis of survey responses.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used a survey conducted in April and May 2021 with a broad sample of physicians and medical students. Participants were recruited through social media, targeting physician and medical student communities. Physicians (residents, fellows, and physicians in independent practice) and medical students of all gender identities and sexual orientations were included. Informed by a postpositivist approach, coding reliability thematic analysis was performed on 3 open-ended survey questions on family-building experiences (what they would do differently, what advice they have for others, and anything else they wished to share).
Identified themes were mapped to the social-ecological model, a model used in public health to examine how a spectrum of factors is associated with health outcomes.
A total of 2025 people (1860 [92%] women; 299 [15%] Asian, 151 [8%] Black, and 1303 [64%] White; 1730 [85%] heterosexual; and 1200 [59%] physicians who had completed training) responded to at least 1 of 3 open-ended questions. Themes mapped to social-ecological model levels included: (1) cultural, eg, medical training being at odds with family building; (2) organizational, eg, lack of institutional support for the range of family-building routes; (3) interpersonal, eg, impact of social support on family building; and (4) individual, eg, socioeconomic status and other individual factors that facilitate or inhibit family building. Recommendations to improve family-building experiences include implementing family-building curricula at medical schools, providing adequate parental leave for all physicians and medical students who become parents, and providing insurance coverage for all family-building routes.
In this qualitative study of physicians and medical students, self-reported barriers to family building were identified at each level of the social-ecological model. Addressing these barriers is critical to creating a more equitable family-building environment for physicians and medical students.
由于医学的结构和文化，想要组建家庭的医生和医学生面临着巨大的障碍。
通过对医学领域所有人（不仅仅是能够怀孕的人）的家庭组建障碍和促进因素进行开放式、定性分析，了解家庭组建的障碍和促进因素。
设计、设置和参与者：这项定性研究使用了 2021 年 4 月至 5 月期间对广泛的医生和医学生样本进行的一项调查。通过社交媒体，针对医生和医学生群体进行了参与者招募。包括各种性别认同和性取向的医生（住院医师、研究员和独立行医的医生）和医学生。该研究基于后实证主义方法，对 3 个关于家庭组建经验的开放式调查问题（他们会有何不同、他们对他人有何建议以及他们希望分享的其他任何内容）进行了编码可靠性主题分析。
确定的主题被映射到社会生态模型中，该模型用于公共卫生领域，以研究一系列因素如何与健康结果相关。
共有 2025 人（1860[92%]名女性；299[15%]名亚裔，151[8%]名非裔，1303[64%]名白人；1730[85%]名异性恋者；1200[59%]名已完成培训的医生）至少回答了 3 个开放式问题中的 1 个。映射到社会生态模型各个层次的主题包括：（1）文化方面，例如，医学培训与家庭组建不一致；（2）组织方面，例如，缺乏支持各种家庭组建途径的机构支持；（3）人际方面，例如，社会支持对家庭组建的影响；以及（4）个人方面，例如，促进或阻碍家庭组建的社会经济地位和其他个人因素。改善家庭组建体验的建议包括在医学院开设家庭组建课程、为所有成为父母的医生和医学生提供足够的育儿假，以及为所有家庭组建途径提供保险。
在这项针对医生和医学生的定性研究中，在社会生态模型的各个层次都确定了家庭组建的自我报告障碍。解决这些障碍对于为医生和医学生创造一个更公平的家庭组建环境至关重要。
