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

Posted on January 31, 2019

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.

70.03 Modifiable Risk Factors Associated with Poor Wellness and Suicidal Ideation in Surgical Residents

Posted on January 31, 2019

R. J. Ellis1,2, D. Hewitt3, Y. Hu1, A. D. Yang1, J. T. Moskowitz4, E. O. Cheung4, D. B. Hoyt2, J. Buyske5, T. J. Nasca6, J. R. Potts6, K. Y. Bilimoria1,2  1Northwestern University,Department Of Surgery, Surgical Outcomes And Quality Improvement Center,Chicago, IL, USA 2American College of Surgeons,Chicago, IL, USA 3Thomas Jefferson University,Department Of Surgery,Philadelphia, PA, USA 4Northwestern University,Department Of Medical Social Sciences,Chicago, IL, USA 5American Board of Surgery,Philadelphia, PA, USA 6Accreditation Council for Graduate Medical Education,Chicago, IL, USA

Introduction:  Poor physician wellness often manifests as burnout and may lead to thoughts of attrition and suicidal ideation, with suicide a leading cause of physician mortality. Surgical residents may be particularly at risk for these issues. Objectives of this study were (1) to examine the frequency of burnout, thoughts of attrition, and suicidal ideation in general surgery residents and (2) to characterize individual and environmental factors associated with poor wellness outcomes.

Methods: Cross-sectional national study of clinically active general surgery residents administered in conjunction with the 2018 American Board of Surgery In-Training Examination. Outcomes of interest were burnout, thoughts of attrition, and suicidal ideation. Individual resident and environmental factors associated with resident wellness included resident grit, stress, duty hour violations, discrimination, abuse, and sexual harassment. Associations between exposures and outcomes were assessed using multivariable logistic regression models.

Results: Among 7,413 residents (99.3% response rate) from 262 general surgery programs, 12.9% of residents reported at least weekly symptoms on both burnout subscales (emotional exhaustion and depersonalization). Burnout was more likely in residents with low grit scores (OR 2.27 [95%CI 1.95-2.63]), frequent duty hour violations (OR 1.46 [95%CI 1.22-1.74]), and in those reporting discrimination (OR 1.23 [95%CI 1.02-1.49]), verbal/physical abuse (OR 1.78 [95%CI 1.47-2.15]), or sexual harassment (OR 1.28 [95%CI 1.00-1.63]). Thoughts of attrition were reported by 12.6% of residents and were more likely in female residents (OR 1.32 [95%CI 1.09-1.60]), those with lower grit scores (OR 1.26 [95%CI 1.06-1.50]), frequent duty hour violations (OR 1.68 [95%CI 1.38-2.04]), or in those reporting severe stress (OR 2.47 [95%CI 2.04-2.99]), frequent burnout symptoms (OR 2.35 [95%CI 1.92-2.87]), discrimination (OR 1.27 [95%CI 1.06-1.51]), or verbal/physical abuse (OR 2.16 [95%CI 1.81-2.57]). Suicidal ideation was reported by 4.5% of residents and was more likely in those with lower grit scores (OR 1.43 [95%CI 1.10-1.84]), or in those who reported severe stress (OR 2.61 [95%CI 1.99-3.42]), frequent burnout symptoms (OR 1.94 [95%CI 1.43-2.63]), verbal/physical abuse (OR 1.80 [95%CI 1.39-2.33]), or sexual harassment (OR 1.58 [95%CI 1.13-2.21]).

Conclusion: Burnout symptoms, thoughts of attrition, and suicidal ideation were reported at lower rates in this comprehensive national survey than in previous studies, but remain an important problem among general surgery residents. Resident grit and environmental factors such as duty hour violations, discrimination, abuse, and harassment are associated with burnout. Burnout and negative environmental factors are further associated with thoughts of attrition and suicidal ideation. Targeted interventions aimed at minimizing inappropriate behaviors and improving the learning environment may improve trainee wellness.