Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training
2019/10/28 by Yue-Yung Hu, Ryan J. Ellis, D. Brock Hewitt +9 · 907 citations
Health Professions · Medicine · Psychology · Social Sciences · #Burnout #Clinical psychology #Diversity and Career in Medicine #Harassment #Healthcare professionals’ stress and burnout #Medical Education and Admissions #Medical education #Medical emergency #Medicine #Poison control #Psychology #Sexual abuse #Social psychology #Suicide prevention #Verbal abuse
paper · pdf · doi:10.1056/nejmsa1903759
published in New England Journal of Medicine 381(18), 1741-1752 (Massachusetts Medical Society)
openalex publication_date 2019/10/28 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/04
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.
Citations
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- Assessment of the Prevalence of Medical Student Mistreatment by Sex, Race/Ethnicity, and Sexual Orientation. [europepmc]
- National Evaluation of Racial/Ethnic Discrimination in US Surgical Residency Programs. [europepmc]
- Prevalence, Types, and Sources of Bullying Reported by US General Surgery Residents in 2019. [europepmc]
- Enhanced Stress Resilience Training in Surgeons: Iterative Adaptation and Biopsychosocial Effects in 2 Small Randomized Trials. [europepmc]
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- COVID-19 Pandemic and the Lived Experience of Surgical Residents, Fellows, and Early-Career Surgeons in the American College of Surgeons. [europepmc]
- Resident Physician Experiences With and Responses to Biased Patients. [europepmc]
- An Approach to Diversity and Inclusion in Cardiothoracic Surgery. [europepmc]
- The unspoken reality of gender bias in surgery: A qualitative systematic review. [europepmc]
- Assessment of the Association of Leadership Behaviors of Supervising Physicians With Personal-Organizational Values Alignment Among Staff Physicians. [europepmc]
- Professionalism: microaggression in the healthcare setting. [europepmc]
- Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression. [europepmc]
- Prevalence and Nature of Sexist and Racial/Ethnic Microaggressions Against Surgeons and Anesthesiologists. [europepmc]
- Long working hours and burnout in health care workers: Non-linear dose-response relationship and the effect mediated by sleeping hours-A cross-sectional study. [europepmc]
- Systematic review of academic bullying in medical settings: dynamics and consequences. [europepmc]
- Experiences of Gender Discrimination and Sexual Harassment Among Residents in General Surgery Programs Across the US. [europepmc]
- Association of Characteristics of the Learning Environment and US Medical Student Burnout, Empathy, and Career Regret. [europepmc]
- Prevalence of Discrimination, Abuse, and Harassment in Emergency Medicine Residency Training in the US. [europepmc]
- Experiences of LGBTQ+ Residents in US General Surgery Training Programs. [europepmc]
- Marginalized identities, mistreatment, discrimination, and burnout among US medical students: cross sectional survey and retrospective cohort study. [europepmc]
- Mistreatment Experiences, Protective Workplace Systems, and Occupational Distress in Physicians. [europepmc]
- Physicians' Experiences With Mistreatment and Discrimination by Patients, Families, and Visitors and Association With Burnout. [europepmc]
- Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights. [europepmc]
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