Survey Design

A RedCap survey was distributed via Facebook, Instagram and over 6,000 emails to residency and fellowship programs.

  • Survey active December 2019 - March 2020.

  • Target population: ~161,000 residents & fellows in the US

  • Demographic questions and prompts with narrative opportunities

942 individual responses were collected: 758 (80%) residents + 184 (19%) fellows

Narrative responses were analyzed using Dedoose, an online program for analyzing qualitative and mixed methods data.

  • This approach is designed to identify emergent social and structural patterns in human experience and to generate a theory or theories to explain these patterns.

  • Narrative survey responses were read in their entirety and a structured codebook was created. This included predicted themes as well as new and emerging patterns.


Survey tool:

"Thank you for participating in this web-based online survey. This is a research project being conducted by Racquel Carranza-Chahal, MD of Eastern Virginia Medical School. Our target audience is all residents & fellows across all specialties. It should take approximately 5 minutes to complete. We are conducting an IRB-approved study to:

  • Characterize the ways in which trainee mothers experience maternal discrimination.

  • Provide a safe, anonymous space for detailing of personal narratives.

  • Examine structural characteristics of residency and fellowship training that facilitate & perpetuate maternal discrimination.

  • Increase visibility of current physician mothers in residency and fellowship regarding their experience of maternal discrimination by using the study results as a rich platform to advocate for tangible change.

Of note, Maternal discrimination is a form of gender discrimination that is rooted in the perceived threat of fertility and/or established identity or role as a mother. An estimated 80% of women physicians whom are or will become mothers also report experiencing maternal discrimination based specifically on their motherhood status (Stentz 2016)

Your participation in this survey is voluntary. You may refuse to take part in the research or exit the survey at any time without penalty.

Thank you!"

When creating the survey, inclusivity and diversity were key aspects.

All genders were included as not all birthing people identify as women.

Special attention was given to include mothers/birthing people who had lost children or were currently pregnant.

Specifying whether a respondent has children under the age of 5 is important in


The majority of respondents already have children, and most of these have at least one child under the age of 5. This is important as the inflexibility of trainee schedules often severely impact the duties of caring for children in this age range.

In order to meet residency research requirements, a quantitative outcome was included. There was no statistically significant relationship between experience of maternal discrimination and experience of maternal discrimination. This suggests what we already know: moral injury is part of medical training and culture, it is a symptom of a larger disease.

These prompts guided the narrative responses. All narrative responses were optional.