Discrimination, abuse, harassment, and burnout in surgical residency training

Yue Yung Hu, Ryan J. Ellis, D. Brock Hewitt, Anthony D. Yang, Elaine Ooi Cheung, Judith T. Moskowitz, John R. Potts, Jo Buyske, David B. Hoyt, Thomas J. Nasca, Karl Y. Bilimoria*

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts. METHODS A cross-sectional national survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination assessed mistreatment, burnout (evaluated with the use of the modified Maslach Burnout Inventory), and suicidal thoughts during the past year. We used multivariable logistic-regression models to assess the association of mistreatment with burnout and suicidal thoughts. The survey asked residents to report their gender. RESULTS Among 7409 residents (99.3% of the eligible residents) from all 262 surgical residency programs, 31.9% reported discrimination based on their self-identified gender, 16.6% reported racial discrimination, 30.3% reported verbal or physical abuse (or both), and 10.3% reported sexual harassment. Rates of all mistreatment measures were higher among women; 65.1% of the women reported gender discrimination and 19.9% reported sexual harassment. Patients and patients’ families were the most frequent sources of gender discrimination (as reported by 43.6% of residents) and racial discrimination (47.4%), whereas attending surgeons were the most frequent sources of sexual harassment (27.2%) and abuse (51.9%). Proportion of residents reporting mistreatment varied considerably among residency programs (e.g., ranging from 0 to 66.7% for verbal abuse). Weekly burnout symptoms were reported by 38.5% of residents, and 4.5% reported having had suicidal thoughts during the past year. Residents who reported exposure to discrimination, abuse, or harassment at least a few times per month were more likely than residents with no reported mistreatment exposures to have symptoms of burnout (odds ratio, 2.94; 95% confidence interval [CI], 2.58 to 3.36) and suicidal thoughts (odds ratio, 3.07; 95% CI, 2.25 to 4.19). Although models that were not adjusted for mistreatment showed that women were more likely than men to report burnout symptoms (42.4% vs. 35.9%; odds ratio, 1.33; 95% CI, 1.20 to 1.48), the difference was no longer evident after the models were adjusted for mistreatment (odds ratio, 0.90; 95% CI, 0.80 to 1.00). CONCLUSIONS Mistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.

Original languageEnglish (US)
Pages (from-to)1741-1752
Number of pages12
JournalNew England Journal of Medicine
Volume381
Issue number18
DOIs
StatePublished - Oct 31 2019

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Sexual Harassment
Internship and Residency
Odds Ratio
Confidence Intervals
Racism
Logistic Models
Sex Offenses
Cross-Sectional Studies
Physicians
Equipment and Supplies
Physical Abuse

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Hu, Yue Yung ; Ellis, Ryan J. ; Hewitt, D. Brock ; Yang, Anthony D. ; Cheung, Elaine Ooi ; Moskowitz, Judith T. ; Potts, John R. ; Buyske, Jo ; Hoyt, David B. ; Nasca, Thomas J. ; Bilimoria, Karl Y. / Discrimination, abuse, harassment, and burnout in surgical residency training. In: New England Journal of Medicine. 2019 ; Vol. 381, No. 18. pp. 1741-1752.
@article{278771a019a04ffdae62e434ffaa3ac9,
title = "Discrimination, abuse, harassment, and burnout in surgical residency training",
abstract = "BACKGROUND Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts. METHODS A cross-sectional national survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination assessed mistreatment, burnout (evaluated with the use of the modified Maslach Burnout Inventory), and suicidal thoughts during the past year. We used multivariable logistic-regression models to assess the association of mistreatment with burnout and suicidal thoughts. The survey asked residents to report their gender. RESULTS Among 7409 residents (99.3{\%} of the eligible residents) from all 262 surgical residency programs, 31.9{\%} reported discrimination based on their self-identified gender, 16.6{\%} reported racial discrimination, 30.3{\%} reported verbal or physical abuse (or both), and 10.3{\%} reported sexual harassment. Rates of all mistreatment measures were higher among women; 65.1{\%} of the women reported gender discrimination and 19.9{\%} reported sexual harassment. Patients and patients’ families were the most frequent sources of gender discrimination (as reported by 43.6{\%} of residents) and racial discrimination (47.4{\%}), whereas attending surgeons were the most frequent sources of sexual harassment (27.2{\%}) and abuse (51.9{\%}). Proportion of residents reporting mistreatment varied considerably among residency programs (e.g., ranging from 0 to 66.7{\%} for verbal abuse). Weekly burnout symptoms were reported by 38.5{\%} of residents, and 4.5{\%} reported having had suicidal thoughts during the past year. Residents who reported exposure to discrimination, abuse, or harassment at least a few times per month were more likely than residents with no reported mistreatment exposures to have symptoms of burnout (odds ratio, 2.94; 95{\%} confidence interval [CI], 2.58 to 3.36) and suicidal thoughts (odds ratio, 3.07; 95{\%} CI, 2.25 to 4.19). Although models that were not adjusted for mistreatment showed that women were more likely than men to report burnout symptoms (42.4{\%} vs. 35.9{\%}; odds ratio, 1.33; 95{\%} CI, 1.20 to 1.48), the difference was no longer evident after the models were adjusted for mistreatment (odds ratio, 0.90; 95{\%} CI, 0.80 to 1.00). CONCLUSIONS Mistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.",
author = "Hu, {Yue Yung} and Ellis, {Ryan J.} and Hewitt, {D. Brock} and Yang, {Anthony D.} and Cheung, {Elaine Ooi} and Moskowitz, {Judith T.} and Potts, {John R.} and Jo Buyske and Hoyt, {David B.} and Nasca, {Thomas J.} and Bilimoria, {Karl Y.}",
year = "2019",
month = "10",
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doi = "10.1056/NEJMsa1903759",
language = "English (US)",
volume = "381",
pages = "1741--1752",
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Discrimination, abuse, harassment, and burnout in surgical residency training. / Hu, Yue Yung; Ellis, Ryan J.; Hewitt, D. Brock; Yang, Anthony D.; Cheung, Elaine Ooi; Moskowitz, Judith T.; Potts, John R.; Buyske, Jo; Hoyt, David B.; Nasca, Thomas J.; Bilimoria, Karl Y.

In: New England Journal of Medicine, Vol. 381, No. 18, 31.10.2019, p. 1741-1752.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Discrimination, abuse, harassment, and burnout in surgical residency training

AU - Hu, Yue Yung

AU - Ellis, Ryan J.

AU - Hewitt, D. Brock

AU - Yang, Anthony D.

AU - Cheung, Elaine Ooi

AU - Moskowitz, Judith T.

AU - Potts, John R.

AU - Buyske, Jo

AU - Hoyt, David B.

AU - Nasca, Thomas J.

AU - Bilimoria, Karl Y.

PY - 2019/10/31

Y1 - 2019/10/31

N2 - BACKGROUND Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts. METHODS A cross-sectional national survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination assessed mistreatment, burnout (evaluated with the use of the modified Maslach Burnout Inventory), and suicidal thoughts during the past year. We used multivariable logistic-regression models to assess the association of mistreatment with burnout and suicidal thoughts. The survey asked residents to report their gender. RESULTS Among 7409 residents (99.3% of the eligible residents) from all 262 surgical residency programs, 31.9% reported discrimination based on their self-identified gender, 16.6% reported racial discrimination, 30.3% reported verbal or physical abuse (or both), and 10.3% reported sexual harassment. Rates of all mistreatment measures were higher among women; 65.1% of the women reported gender discrimination and 19.9% reported sexual harassment. Patients and patients’ families were the most frequent sources of gender discrimination (as reported by 43.6% of residents) and racial discrimination (47.4%), whereas attending surgeons were the most frequent sources of sexual harassment (27.2%) and abuse (51.9%). Proportion of residents reporting mistreatment varied considerably among residency programs (e.g., ranging from 0 to 66.7% for verbal abuse). Weekly burnout symptoms were reported by 38.5% of residents, and 4.5% reported having had suicidal thoughts during the past year. Residents who reported exposure to discrimination, abuse, or harassment at least a few times per month were more likely than residents with no reported mistreatment exposures to have symptoms of burnout (odds ratio, 2.94; 95% confidence interval [CI], 2.58 to 3.36) and suicidal thoughts (odds ratio, 3.07; 95% CI, 2.25 to 4.19). Although models that were not adjusted for mistreatment showed that women were more likely than men to report burnout symptoms (42.4% vs. 35.9%; odds ratio, 1.33; 95% CI, 1.20 to 1.48), the difference was no longer evident after the models were adjusted for mistreatment (odds ratio, 0.90; 95% CI, 0.80 to 1.00). CONCLUSIONS Mistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.

AB - BACKGROUND Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts. METHODS A cross-sectional national survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination assessed mistreatment, burnout (evaluated with the use of the modified Maslach Burnout Inventory), and suicidal thoughts during the past year. We used multivariable logistic-regression models to assess the association of mistreatment with burnout and suicidal thoughts. The survey asked residents to report their gender. RESULTS Among 7409 residents (99.3% of the eligible residents) from all 262 surgical residency programs, 31.9% reported discrimination based on their self-identified gender, 16.6% reported racial discrimination, 30.3% reported verbal or physical abuse (or both), and 10.3% reported sexual harassment. Rates of all mistreatment measures were higher among women; 65.1% of the women reported gender discrimination and 19.9% reported sexual harassment. Patients and patients’ families were the most frequent sources of gender discrimination (as reported by 43.6% of residents) and racial discrimination (47.4%), whereas attending surgeons were the most frequent sources of sexual harassment (27.2%) and abuse (51.9%). Proportion of residents reporting mistreatment varied considerably among residency programs (e.g., ranging from 0 to 66.7% for verbal abuse). Weekly burnout symptoms were reported by 38.5% of residents, and 4.5% reported having had suicidal thoughts during the past year. Residents who reported exposure to discrimination, abuse, or harassment at least a few times per month were more likely than residents with no reported mistreatment exposures to have symptoms of burnout (odds ratio, 2.94; 95% confidence interval [CI], 2.58 to 3.36) and suicidal thoughts (odds ratio, 3.07; 95% CI, 2.25 to 4.19). Although models that were not adjusted for mistreatment showed that women were more likely than men to report burnout symptoms (42.4% vs. 35.9%; odds ratio, 1.33; 95% CI, 1.20 to 1.48), the difference was no longer evident after the models were adjusted for mistreatment (odds ratio, 0.90; 95% CI, 0.80 to 1.00). CONCLUSIONS Mistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.

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