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.
N1 - Funding Information:
Supported by the American College of Surgeons, the Accreditation Council for Graduate Medical Education, and the American Board of Surgery. Drs. Ellis and Hewitt were supported by a postdoctoral research fellowship from the Agency for Healthcare Research and Quality (5T32HS000078), and Dr. Yang’s research was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (K08HL145139).
Publisher Copyright:
Copyright © 2019 Massachusetts Medical Society.
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.
UR - http://www.scopus.com/inward/record.url?scp=85074305287&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85074305287&partnerID=8YFLogxK
U2 - 10.1056/NEJMsa1903759
DO - 10.1056/NEJMsa1903759
M3 - Article
C2 - 31657887
AN - SCOPUS:85074305287
SN - 0028-4793
VL - 381
SP - 1741
EP - 1752
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 18
ER -