Approaches to family-friendliness at the Medical Faculty of Tübingen (MFT).

The feminization of the medical profession, demographic change with an impending shortage of physicians, Generation Y - these issues are new challenges for medical schools in terms of their social responsibility and the training of the next generation of highly qualified scientists. This study, conducted by the University Hospital of Ulm throughout Baden-Württemberg via an online survey provides a valuable data basis which can be used to optimise support activities. A disproportionately high percentage of students with children in Tübingen must, as an additional challenge, cope with a lower than average monthly income. Students with children need organisational support in this doubly challenging situation. The Dean's Office can provide valuable assistance as an advocate (contact with the departments/institutions), provide organisational help (course guidance, individual support) and infrastructure (childcare/changing rooms, etc.). In Tübingen, high intrinsic motivation (willingness to engage in self-managed care networks) is also found amongst students, something that needs to be integrated into the development of the existing support networks.

The New Challenges

The feminization of the medical profession [1], demographic change with an impending shortage of physicians and Generation Y [http://www.usatoday.com/money/workplace/2005-11-06-gen-y_x.htm, 05.04.2011], [2] - those buzzwords and their associated challenges (compatibility with family life, work-life balance, etc.) demonstrate the tasks of the MFT in terms of its social mission towards society for training highly qualified medical students. Points such as the individual support of students in the context of new families and the more frequently occurring organizational challenges for them begin during medical undergraduate studies. Long term projects must be constantly improved, especially in everyday life, during periods of increased stress (e.g. during university exams, doctorate studies) but also at the interface of training and career (the transitions from pre-clinical studies, clinical studies and the transition to work, etc.) through new implemented and existing projects. The results of this study provide a valuable contribution in this endeavour.

Characteristics of pregnant students and students with children in Tübingen

The percentage of female students of human medicine in Tübingen with 61% is slightly above the national average (59% overall)1, while the proportion of students with children at the MFT with 7% is disproportionately high (4.2% overall)2. On the one hand, this is a welcome fact showing that study conditions in Tübingen have already been developed towards making studying compatible with children but on the other hand, it emphasizes the responsibility of the Dean’s Office to create individual opportunities for the large number of students with children to do justice to their trust. At the same time, this poses the social and economic challenge of supporting these students towards their professional life in an appropriate fashion. As an aid, a closer look at our students with children who during the summer semester 2010 participated in an online survey on family-oriented medical studies at the University Hospital in Ulm, Baden-Württemberg3 [3]:

With a monthly income that is significantly below the average in Tübingen, 41.9% of these students work alongside their studies (12h/week on average). This leads to additional planning challenges and a double burden. Individually assigned and designed timetables are even more important in such cases. Integration into the Tübingen tutoring program offers another way, combining necessary paid-for work with more time for studies (“Disadvantages of starting a family at university: less time to study” MFT 83.3%, total 84.3%). Peer-teaching offers them professional benefits and closer links with individual departments and the opportunity to earn money by teaching.

Two thirds (67.7%) of the student parents in Tübingen deliberately planned their pregnancy during their university time (only 62.9% overall) and see the biggest advantage in not having to postpone having children (“Advantages of starting a family while at university”. Highest response in Tübingen: “Having children is not postponed” 81.2% MFT versus 71.2% overall, “More time for child-rearing” MFT 67.1%, 44.1% overall). This strong intrinsic motivation of our students is reflected in their willingness to participate in a self-governed student support network (“true” and “more or less true” MFT 73.3%, 63.9% overall). This resource is currently still used too little. In the future, students will have to be given the opportunity to continue support programs on their own which were set up by the Dean's Office, for example through forums/blogs for student parents offering the opportunity of sharing experiences and mutual support (“Unfulfilled need for advice” in terms of “student counselling by student parents” MFT 56%, 50% overall). This could allow for the burden of having a family while at university to be shared (“less time for learning” 83.3% and “less time for oneself” 73.6%) and to reduce these based on their own initiatives.

In terms of the timing of pregnancy, children are primarily born during the clinical part of studies, including the Internship Year (53.0%, with a national average of 45.4%). There is also a clear difference in the number of children born prior starting studies when compared to the nationwide average (MFT 25.3%, 35.9% overall). This means that in Tübingen not only a higher percentage of students with children are enrolled but also that this changing part of life is increasingly dealt with during studies. This could be a reason for the slightly increased delay of studies (“Have your studies been delayed when compared to the normal study length": Yes: MFT 68.2%, 63.7% overall) when compared to the national average. This is also supported by the pronounced gender distribution in the absence of a delay (Male: 84.6% MFT, 78.4 overall; Female 15.4% MFT, 21.6% overall). Another contributing factor to study delays in Tübingen could be the heavily used option of individualised timetables with a spread of compulsory courses and examinations over a longer period of time. This individualised timetabling has a positive effect on the compatibility of work and family compared to the national average (“Have you had problems in the last semester combining studies and family” No: MFT 43.3%, 39.4% overall, “Combining it at university is easier than when working as a doctor” MFT 72.9%, 66.7% overall), but one runs the risk of holding back students from the workplace who are studying for a second degree (MFT 57.1%). The key is to balance the capacities and productivity of individuals and the rights and needs of society.

Organisation, counselling and structural challenges

When looking more closely at study progression, a number of areas can be found where students with children should be given more support in future. These are divided into two groups:

The Dean’s Office as an organizational helper:

Individual support allows students to be timetabled early on, increasing their planning security and thus facilitating their daily routines. The advice services offered by the Dean’s Office is still significantly underused (MFT 24.7%, 25.1% overall). A more proactive approach towards the students by the Dean’s Office and Student Services (“I would take up the offer of individual advice on organizing studies with child” 62.5%, “I didn’t know that the Dean’s Office offered that” 42%) should be implemented for additional support. Cross-semester advice services (“I’m in regular contact with academic advice services,” “does not apply” MFT 68.3%, 73.5% overall; “I think a cross-semester agreement with the Dean’s Office would make sense” 78%) can facilitate long-term planning.

The Dean’s Office as an advocate:

Compulsory attendance, especially in the mornings, often presents these students with a challenge. As compulsory courses are concernecd, special arrangements for any missed dates caused by organizational bottlenecks or absence due to sick children could be supportive. It is the responsibility of the Dean’s Office as an advocate to raise awareness amongst the disciplines and to inform about such opportunities. Together it becomes possible to find alternatives (blended learning, etc.) which continue to ensure the quality of course content (“The following offer would have eased my studies: more flexibility regarding compulsory attendance” 83.3%, “Being able to catch up on missed events” 65.2%). A separate arrangement must absolutely be found to address missed events caused by sick children (“In case of missed events due to illness of a child, there should be a special arrangement” MFT 92.9%). In order to facilitate the students’ direct contact with the faculty for immediate problems, we will introduce a student parent pass based on the model used in Ulm [4]. It aims to raise awareness of the special situation amongst the faculty and administrative staff through visualization and to free the students from the position of being a petitioner.

In addition, there are some points where basic rules, which do not fall under the control of the Dean’s Office, can cause problems for student parents. A national campaign would be the best way to draw attention to these (for example increased absences during the Internship Year through a sick child (Contact LPA) or obtaining copies of maternity leave provisions while at university in federal or state law) and possibly work towards a change in the regulations.

Infrastructure:

In terms of the infrastructure, additional resources must also be made available, with the support of the Dean’s Office, (“The following services are sufficiently on offer: Not true”: Changing rooms MFT 94.5%, 83.8% overall; parking MFT 57.1%, 73.6% overall). A special role is played by childcare (“Disadvantages of starting a family while at university: Childcare impossible to plan MFT 62.3%”; “Problems reconciling both: Lack of childcare” MFT 54.1%; “Would you use hourly short-term childcare offered by the university” MFT Yes 74%). Flexible care times in this area would offer students more leeway to successfully complete their studies.

Outlook

Open questions

We will further pursue certain aspects which have emerged in this study in subsequent interviews and surveys. For example, it remains to be investigated why problems with the reconciliation of work and family occur more frequently in the pre-clinical period than the clinical period (69.2% pre-clinical, clinical 53.7%). It is also not clear why significantly more fathers study human medicine as a second degree than mothers (MFT 53.6% mothers, 85.7% fathers). Finding answers to these questions may show more options for potential support.

We are particularly pleased by the desire of student parents at Tübingen for more children (MFT 64.3%, 57% overall). Through close cooperation with the University Hospital Tübingen we intend to help these parents with their start into their working life with children while at the same time preserving their valuable work contribution. By doing so, we wish to live up to the contribute the new challenges facing our students, the teaching staff and ultimately society as a whole which were described at the beginning.

Note

1 University Student Statistics Summer Semester 2010

2 University Fee Waivers for the purposes of child rearing during Summer Semester 2010

3 Return rate: 55.9% of students with child

Competing interests

The authors declare that they have no competing interests.