Lurking in the shadows: time as an actor in the narratives of pregnancy within graduate medical education

Previous studies suggest that time factors heavily into trainees’ decision-making around issues of pregnancy within graduate medical education (GME). Trainees are often dissatisfied with parental leave policies and tension exists as they navigate training interruptions. However, our understanding is limited because prior studies have conceptualized only two main actors involved in this negotiation, program directors (PDs) and trainees. This study aimed to understand the role of a third ever present character that has been overlooked - Time. We recruited 13 pairs of residents/fellows who had been pregnant during GME training and their PDs. We conducted semi-structured interviews on trainee and PD experiences, which were then analyzed utilizing narrative analysis to interrogate how individuals assigned meaning to time. Time loomed in the background of all trainees’ and PDs’ experiences as they negotiated pregnancy. Depending on context, time was positioned either as an ally, assisting trainees with achieving their personal and professional goals, or as a foil, sabotaging their experience. As an ally, time was positioned as a malleable commodity that was flexed to meet the individual trainee’s needs. As a foil, time was an immovable barrier exerting rigid constraints. How time was experienced by the trainee was strongly influenced by the attitudes and actions of the PD. This study positions time as a main actor in trainees’ narratives of pregnancy. The role time plays largely reflects the value assigned to conformity with traditional timelines and whether a program has revised their perspectives to position time as a side character.