85.01 National Evaluation of Gender Discrimination and Sexual Harassment in U.S. General Surgery Residency Programs

Y. Hu1,3, R. Ellis1, D. B. Hewitt1,6, A. D. Yang1, J. Buyske7, D. B. Hoyt8, T. Nasca9, K. Y. Bilimoria1  1Feinberg School Of Medicine – Northwestern University,Chicago, IL, USA 3Ann & Robert H. Lurie Children’s Hospital,Pediatric Surgery,Chicago, IL, USA 6Thomas Jefferson University,Philadelphia, PA, USA 7American Board Of Surgery Inc,Philadelphia, PA, USA 8American College Of Surgeons,Chicago, IL, USA 9Accreditation Council for Graduate Medical Education,Chicago, IL, USA

Introduction: Discrimination and harassment create a hostile work environment that adversely affects morale, productivity, and patient care. However, national prevalence estimates of discrimination and harassment, sources of mistreatment, and associated factors are unknown.

Methods: Residents training in all Accreditation Council for Graduate Medical Education (ACGME)-accredited general surgery programs were administered a survey immediately following the 2018 American Board of Surgery In-Training Examination (ABSITE). The survey queried experiences with gender discrimination, pregnancy/childcare discrimination, and sexual harassment. Program-level proportions of female residents and faculty were obtained from the Association of American Medical Colleges. Gender-stratified multivariable regression models, adjusted for resident clustering within programs, were developed to examine associations with resident and program characteristics.

Results: Among 7,409 respondents (99.3% response rate), 31.9% reported gender discrimination, 7.2% pregnancy/childcare discrimination, and 10.3% sexual harassment. Gender discrimination was reported by 65.1% of female residents, most commonly from patients/families (49.2%), nurses/staff (23.6%), and attendings (17.6%). Gender discrimination was more likely to be reported by senior residents, women training in the Northeast, and men in programs with the highest proportions of female residents (all p<0.05). Pregnancy/childcare discrimination was experienced by 13.1% of women, mostly from other surgeons (attendings 43.9%, co-residents 23.5%). Pregnancy/childcare discrimination was more likely in female senior residents, married residents, divorcées/widows, women training in the largest programs, women in non-military programs, and women in the Northeast and Midwest (all p<0.05).  Sexual harassment was reported by 19.9% of female residents, most frequently from patients/families (31.2%), attendings (30.9%), and co-residents (15.4%).  Sexual harassment was more likely in senior residents, unmarried residents, women in non-military programs, women training in the Northeast, women in programs with lower proportions of female residents, and women in programs with the highest proportion of female faculty (all p<0.05). There was wide variation in program-level rates of (proportion of residents reporting) gender discrimination (0% to 66.7%) and sexual harassment (0% to 37.5%).

Conclusion: Gender discrimination, pregnancy/childcare discrimination, and sexual harassment are frequent experiences in general surgery residency, particularly for women. Programmatic variation indicates that low mistreatment rates are feasible. The sources (patient/families vs. attendings/co-residents) vary and must be considered when developing potential mitigation strategies.  These results begin to provide insight on how to build safer, more equitable, and more effective educational environments.