Both trial arms will receive a Fitbit Luxe that will help them understand their sleep patterns with a newborn.  Because there is currently little data about the effectiveness of any wellness interventions on physician trainee who are new mothers, and many interventions are expensive or time/effort-intensive, the 4th Trimester Initiative has been determined to have equipoise. 

Our method of randomization allows us to analyze differences between institutions, as local culture may influence wellness. It also allows us to evaluate trainees based on whether they are in procedural or non-procedural specialties.

At the conclusion of the trial, metrics on trainee wellbeing (e.g., burnout, postpartum depression, sleep and fatigue) and achievement of breastfeeding goals (if applicable) will be compared between the intervention and control groups to assess the intervention’s effectiveness.  Baseline data will be obtained from the pre-enrollment survey

The 4th Trimester Initiative interventions are based on the fundamental belief that a holistic package of support for trainees addressing multiple challenges for the new mother is needed. There is no “magic bullet” – that is, there is no single intervention that has the power to completely change culture or a trainee’s entire pregnancy and new motherhood journey. The interventions are data-driven choices that reflect support in areas that trainee mothers have reported to be particularly difficult.  

Future larger national studies, funded from data from the current study, will help us better understand which supports are the most impactful, thus helping us support training programs that may have fewer resources.  

We believe that it is just as important to invest in a trainee’s personal success as her professional success. Improving work-family integration is a cornerstone of a long and healthy career.

We recognize there are many paths to parenthood and one journey is no more important than another.  The current study was designed only for birthing mothers because including non-birthing parents would have introduced many confounders that would be difficult to control for. Future studies will assess how we can better support non-birthing parents. 

That is fine! We support any choices you make that are best for you as a new parent. We only ask that you notify us, and the survey has built-in questions to report your purchases of these devices. We plan to analyze groups based on intention-to-treat.

Yes! We understand some call nights are unbearable and you may be too tired to do your survey immediately.  The link will still be available but realize it becomes less usable due to recall bias as time goes on. We tried hard to make the surveys concise and designed them so you can complete them even on your smart phone while waiting for the elevator!  Please try your best – we will email you reminders to fill your survey out if we notice you have not done it. 

Yes, please at least wear it all the time when you get home and go to bed (if you wear it all day long, even better!). It is powerful data for us to understand just how tired you are. We can’t make any conclusions about whether interventions support your sleep if you don’t wear it. We are using the Fitbits in lieu of  sleep logs, which pregnant trainees felt were too hard to remember to complete.

Trial enrollment starts in the spring of 2023. We will continue enrolling until we reach our goal of 152 participants.