Supplemental Digital Appendix 1 2019 APDIM Annual Fall Survey of Residency Program Directors Informed Consent Page and Section on Parental Leave Policies in Internal Medicine Residency

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Supplemental Digital Appendix 1

2019 APDIM Annual Fall Survey of Residency Program Directors Informed Consent Page and Section on Parental Leave Policies in Internal Medicine Residency

For 15 years, the APDIM Survey Committee has collected representative data on graduate education in internal medicine (IM). APDIM Surveys provide residency program directors with 1. useful information on national trends, for planning and negotiation; and 2. a voice to the Accreditation Council for Graduate Medical Education (ACGME) and other regulatory bodies about the perspectives and challenges of IM training. The aggregated summary results are presented at academic medicine professional association meetings, in peer-reviewed journals, and online at www.im.org/data/apdim- surveys. Immediately after submitting your responses, you will receive them via email.

This study's protocol (Number: 19-AAIM-107) was reviewed and granted exempt status by Pearl IRB (U.S. DHHS OHRP #IRB00007772) under 45 CFR 46.104(d) category 2. You are invited to participate because you are a residency program director whose ACGME-accredited program ("continued" or

"initial" status prior to July 1 of the previous Academic Year) is an APDIM member as of August 2019.

Participation is voluntary; refusal to participate will not affect your or your program's APDIM

membership. Although the survey software will alert you if you leave certain questions empty, you may skip any that you do not wish to answer.

Your data will be recorded using Secure Socket Layer encryption and remain confidential. No results containing identifiers of you or your program will be published in any manuscripts or summary results files. Before any Survey Committee section authors access the survey dataset, all personal and program identifiers will be removed by Alliance for Academic Internal Medicine (AAIM) Surveys staff, who serve as principal investigators and will first handle your information.

If you encounter technical problems or no longer are the director of your institution's IM

residency program, please contact AAIM Surveys staff at [email protected] or 703-341-4540. Questions about survey content may be directed to the APDIM Survey Committee Chair via [email protected] as well. If you feel that your rights as a participant have not been upheld, please contact Pearl IRB at [email protected] or 317-602-5917.

Please expect to allocate about 20 minutes to Section I and 20 minutes to the remaining sections-- possibly less time, depending on your responses. If necessary, you may exit and return later without losing your data. Please use the unique survey link in your email invitation message; you will be returned to where you left off. DO NOT USE your browser's "Back" or "Forward" buttons to navigate the survey. Instead, you must use the survey "<<BACK" and "NEXT>>" buttons at the bottom of each page.

*****ESSENTIAL FOR COMPLETING THE SURVEY*****

1. The survey is compatible with most tablet devices, but if you encounter technical problems please check that your device's operating system is updated. Using smartphones is discouraged, due to programming that might cause unexpected errors or problems with survey navigation.

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2. Timeframe: Unless otherwise specified, this survey applies to the most recently completed academic year (AY). Consider anybody enrolled or participating in your residency training program on December 31, 2018 as part of that AY.

3. Cohort: Questions apply to IM residents in a three-year IM training program. Unless otherwise specified, DO NOT INCLUDE DATA FOR THE FOLLOWING: 1. trainees enrolled in a transitional year program or preliminary program; 2. subspecialty fellows or trainees from programs not included in your ACGME program number.

4. Ready access to your program demographics will help with completing Section I. YOUR PROGRAM COORDINATOR(S) / ASSOCIATE PROGRAM DIRECTOR(S) MAY COMPLETE ALL OR PART OF SECTION I. Use caution when sharing your unique survey URL, and please check the information entered by others before submitting your final responses.

5. For further technical assistance and support FAQs about navigating this survey, please click here (a separate browser tab/window will open).

Thank you for participating in this important survey! We hope that the results will help our community, our residents, and future training of physicians in internal medicine.

Q1 By clicking below, you acknowledge that your participation is voluntary.

▢ Begin the survey: click here and then click "PROCEED" (below).

Display This Question:

If Q1 != Begin the survey: click here and then click "PROCEED" (below).

Q2

TO CONFIRM: Do you acknowledge that your participation is voluntary?

o Yes (you will BEGIN the survey)

o No (you will EXIT the survey completely and not be able to return)

Skip To: End of Survey If Q4 = No (you will EXIT the survey completely and not be able to return) End of Block: Introduction

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SECTION IV: Parental Leave Policies in Internal Medicine Residency

Note: For the following and subsequent questions, "non-birthing parent" refers to a non-gestational parent.

Q62 Which of the following are in place in your residency program?

Answer carefully: your response(s) will be used in subsequent questions. Check all that apply.

▢ A written maternity leave policy for your residents

▢ A written parental leave policy for residents that applies to non-birthing parents

▢ ⊗Neither of these are in place for our program

Skip To: Q67 If Q62 = Neither of these are in place for our program

If Q62 = A written maternity leave policy for your residents

Or Q62 = A written parental leave policy for residents that applies to non-birthing parents

Q63 Do the following have access to your leave policy/policies without having to request them?

No Yes

Residents? o o

Residency program applicants? o o

If Q62 = A written maternity leave policy for your residents

Or Q62 = A written parental leave policy for residents that applies to non-birthing parents

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Q64 From where does the policy originate? Check all that apply.

Q62 = A written maternity leave policy for your residents Written Maternity Leave Policy

Q62 = A written parental leave policy for residents that applies

to non-birthing parents Written Parental Leave Policy

(Non-birthing)

The institution ▢ ▢

The department of medicine ▢ ▢

The residency program ▢ ▢

Medical school (graduate

school) ▢ ▢

Other (please specify): ▢ ▢

If Q62 != A written maternity leave policy for your residents

Q65 Please explain why you do not have a written residency program-level maternity leave policy.

__________________

If Q62 != A written parental leave policy for residents that applies to non-birthing parents

Q66 Please explain why you do not have a written residency program-level parental leave policy.

__________________

If Q62 = Neither of these are in place for our program

Q67 Please explain why you do not have a written residency program-level maternity or parental leave policy.

__________________

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Copyright © the Association of American Medical Colleges. Unauthorized reproduction is prohibited. 5 Q68 If training is extended, who pays the resident’s salary and benefits during the extended time?

Check all that apply.

▢ Institutional GME funds (from sources other than hospital contributions)

▢ Hospital funds

▢ Department of medicine funds (from sources other than hospital contributions)

▢ Other (please specify): _____________

▢ Maternity leave is paid for differently than parental leave (please explain): ______________

▢ ⊗No salary nor benefits are provided during extended training

Q69 For which of the following does your program have a set policy? Check all that apply.

▢ A minimum number of weeks mandated for maternity leave

▢ A maximum number of weeks allowed for maternity leave

▢ A minimum number of weeks mandated for parental leave (non-birthing)

▢ A maximum number of weeks allowed for parental leave (non-birthing)

▢ ⊗None of the above

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If If For which of the following does your program have a set policy? Check all that apply.

q://QID610/SelectedChoicesCount Is Greater Than or Equal to 1 And Q69 != None of the above

Q70 What is the...?

Numerals only, up to one decimal point if applicable

Q69 = A minimum number of weeks mandated for maternity leave

Minimum number of weeks mandated for maternity leave

Q69 = A maximum number of weeks allowed for maternity leave

Maximum number of weeks allowed for maternity leave

Q69 = A minimum number of weeks mandated for parental leave (non-birthing) Minimum number of weeks mandated for

parental leave (non-birthing)

Q69 = A maximum number of weeks allowed for parental leave (non-birthing)

Maximum number of weeks allowed for parental leave (non-birthing)

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If If Which of the following are in place in your residency program?Answer carefully: your response(s)...

q://QID558/SelectedChoicesCount Is Not Empty

And Q62 != Neither of these are in place for our program

Q71 Which of the following does your maternity leave policy/policies specify? Check all that apply.

▢ If scheduling is adjusted for residents during pregnancy

▢ How scheduling is adjusted for residents during pregnancy

▢ If scheduling is adjusted for residents upon return from maternity leave

▢ How scheduling is adjusted for residents upon return from maternity leave

▢ Accommodations for lactation

▢ Other (please specify): ______________

▢ ⊗None of the above

If If Which of the following are in place in your residency program?Answer carefully: your response(s)...

q://QID558/SelectedChoicesCount Is Greater Than or Equal to 1 And Q62 != Neither of these are in place for our program

Q72 Which of the following does the policy specify? Check all that apply.

Q62 = A written maternity leave policy for your residents Written Maternity Leave Policy

Q62 = A written parental leave policy for residents that applies

to non-birthing parents Written Parental Leave Policy

(Non-birthing) Role of peer residents in

covering for residents on leave (beyond existing practices for when residents cover for other residents)

▢ ▢

If sick leave and vacation time

must be included in leave ▢ ▢

The amount of pay and benefits

available while on leave ▢ ▢

How the duration of extended

training is determined ▢ ▢

If residents who extend their training receive pay and benefits during the extension

▢ ▢

Other (please specify): ▢ ▢

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If Q62 != Neither of these are in place for our program

Q73 Which of the following applies to your (maternity/parental) leave policy?

o We changed it during the past Academic Year (2018-19)

o We have already changed it for the current Academic Year (2019-20)

o We plan to change it for the current Academic Year (2019-20) but have not yet done so o We have not changed it during the past two academic years and do not plan to

o Unsure/Do not know

Q74 For which of the following does your program routinely utilize non-clinical work (e.g., non-call rotations, research) or part-time rotations as related to maternity leave? Check all that apply.

▢ Immediately before the resident begins maternity leave

▢ During maternity leave

▢ During the first few rotations back from maternity leave

▢ ⊗Our program does not utilize non-clinical work or part-time rotations for any of these reasons

If If For which of the following does your program routinely utilize non-clinical work (e.g., non-call...

q://QID566/SelectedChoicesCount Is Greater Than 0

And Q74 != Our program does not utilize non-clinical work or part-time rotations for any of these reasons Q75 How are non-clinical work (e.g., non-call rotations, research) or part-time rotations utilized for residents who take maternity leave?

__________________

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Copyright © the Association of American Medical Colleges. Unauthorized reproduction is prohibited. 9 Q76 Excluding vacation and sick leave, how many weeks of salary support do residents receive for...

Numerals only, up to one decimal point if applicable

Maternity leave?

Parental leave (non-birthing)?

Q77 How many residents in your program took leave for birth or adoption during the 2018-2019 academic year for...

Whole numbers only

Maternity leave?

Parental leave (non-birthing)?

If Q62 = A written parental leave policy for residents that applies to non-birthing parents

Q78 Which of the following are specified in your parental (non-birthing) leave policy? Check all that apply.

▢ Fathers

▢ Same-sex partners

▢ Non-birth mothers

▢ Adoptive parents

▢ Other (please specify): ___________________

▢ ⊗Policy applies to all, and does not specify whom it applies to

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Q79 What is your level of agreement with the following statement:?

There should be a national “standard” residency program-level parental leave policy.

o Strongly disagree o Somewhat disagree o _Neutral

o Somewhat agree o Strongly agree

If Q79 = Strongly disagree Or Q79 = Somewhat disagree

Q80 Please explain why you do not agree that there should be such a policy.

__________________

If Q79 = Neutral

Q81 Please explain why you are neutral about whether there should be such a policy.

__________________

If Q79 = Strongly agree Or Q79 = Somewhat agree

Q82 Please explain why you agree that there should be such a policy.

__________________

Q83

You have completed 4 sections!

End of Block: SECTION IV: Parental Leave Policies in Internal Medicine Residency Programs

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Supplemental Digital Appendix 2

Core Characteristics of Responding and Nonresponding Internal Medicine Residency Programs: 2019 Survey of U.S. Internal Medicine Residency Program Directors

Respondents (n=293)

Nonrespondents

(n=129) Total (n=422) No. (Column %) No. (Column %)

No. (Column

%) P-value*

Program Type (AMA-FREIDA)

University-based 104 (35.5) 30 (23.3) 134 (31.8) 0.059

Community-based 49 (16.7) 28 (21.7) 77 (18.3) 0.478

Community-based, university-affiliated 135 (46.1) 69 (53.5) 204 (48.3) 0.208

Military-based 5 (1.7) 2 (1.6) 7 (1.7) 0.855

Census Region (U.S. Census Bureau)**

Northeast 87 (29.7) 38 (29.9) 125 (29.8) 0.971

Midwest 62 (21.2) 37 (29.1) 99 (23.6) 0.199

West 41 (14.0) 18 (14.2) 59 (14.1) 0.954

South 103 (35.2) 34 (26.8) 137 (32.6) 0.167

VA Affiliation: Yes (ACGME) 110 (37.5) 37 (28.7) 147 (34.8) 0.053

Accreditation Status (ACGME)

Continued or continued with warning 267 (91.1) 116 (89.9) 383 (90.8)

0.772

Initial or initial with warning 26 (8.9) 13 (10.1) 39 (9.2)

Mean (SD) Mean (SD) Mean (SD) P-value***

Program size: No. ACGME approved

positions (Median)^ 52 (41.9) 48 (37.5) 50 (40.8) 0.229

ABIM pass rate 2016-2018 (%); n=252,

n=111 91.1 (6.9) 91.1 (7.1) 91.1 (6.9) 0.965

Program director tenure as of 2019

(years; ACGME) 5.7 (5.8) 6.2 (6.2) 5.8 (5.9) 0.454

Program accreditation year (ACGME) 1976.5 (23.3) 1977.9 (25.0) 1977.0 (23.8) 0.586 Female residents (2018-19; %) (AMA-

FREIDA); n=263, 113, 376 41.9 (8.5) 41.2 (9.5) 41.7 (8.8) 0.494

Male residents (2018-19; %) (AMA-

FREIDA); n=263, 113, 376 58.1 (8.5) 58.7 (9.5) 58.3 (8.8) 0.494

Program director age (years) as of 2019

(respondents only); n=288^^ 5.7 (5.8)

AMA-FREIDA: American Medical Association Residency and Fellowship Database; ACGME: Accreditation Council for Graduate Medical Education; ABIM: American Board of Internal Medicine; VA: Veterans Affairs; SD: Standard Deviation.

*Bivariate (Adjusted Wald [Pearson]) test of association with one degree of freedom) used for categorical variables: alpha=0.05.

**Excludes programs from two U.S. territories, due to small cell sizes/data confidentiality.

***Welch’s t-test; alpha=0.05.

^Equality-of-medians test (Continuity corrected Pearson Chi-Square): alpha=0.05.

^^Obtained from survey responses only.