An Argument for Flexible Specialty Board Exam Dates: Reducing Gender Disparity and Improving Learner Wellness

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Bates and colleagues1 recently wrote a thoughtful Commentary about barriers women face in academic medicine. The authors outlined a call for change to address salary parity, increase availability of mentorship and sponsorship, remove disparity in research funding, and create career flexibility to improve recruitment and retention. This piece prompted me to reflect on tangible structural barriers in medicine facing families, particularly our profession’s flexibility around maternity and personal leave. These barriers mirror themes surrounding broader efforts to support resident wellness and resiliency.
A recent experience brought one specific barrier to my attention. At a graduate medical education committee meeting, of which I am a resident representative, our program directors were discussing a new policy allowing 12 weeks of maternity leave for military service members. Admittedly, the 12 weeks I would receive as an active duty army resident are a luxury compared with what most civilian programs offer. There is increasing support for the soldier–mom; however, medicine lags behind in supporting the healer–mom. One administrator stated, “Well, tell your residents it is possible, but taking 12 weeks has major consequences.” The primary consequence was the residents’ ability to take their specialty boards after graduation. In a specialty like internal medicine, whose 2017 exam dates are only in August, delaying graduation has implications for residents’ careers and financial progress. It means loss of income and job opportunities tied to board certification. And this occurs right out of the gate, when female residents may be trying to jump-start academic careers and fight against the barriers Bates and colleagues describe.
The limited board exam dates affect more than just the women who elect to have children during residency. It also impacts residents taking a leave of absence for personal or mental health. Imagine the potential strain on well-being when a burned-out resident must consider cutting medical leave short in order to graduate in time to take his boards. Further, some believe the limited board exam dates are in pedagogical conflict with competency-based education. They suggest graduation should occur when competency is achieved, and the specialty boards may consider planning for this future possibility. In this era of computer-based testing, flexible testing dates are surely a reasonable reality. This would be one tangible step to support women physicians, but it could also have a positive impact in improving resident well-being. Bates and colleagues are leading the call to action, but now we all must innovate to address the nitty-gritty of meaningful change.
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