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N Engl J Med. 2019 Oct 31;381(18):1741-1752. doi: 10.1056/NEJMsa1903759. Epub 2019 Oct 28.

Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training.

Author information

1
From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia.

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.

PMID:
31657887
PMCID:
PMC6907686
[Available on 2020-10-31]
DOI:
10.1056/NEJMsa1903759
[Indexed for MEDLINE]

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