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Camargo A, Radmard M, Dabiri M, Carson KA, Hsu L, Yousem DM. Discrimination faced by radiology residents: an analysis of experiences and mitigation strategies. Curr Probl Diagn Radiol 2024; 53:600-605. [PMID: 38714392 PMCID: PMC11283936 DOI: 10.1067/j.cpradiol.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 05/02/2024] [Indexed: 05/09/2024]
Abstract
RATIONALE AND OBJECTIVES Literature shows that discrimination has been pervasive in the field of medicine. The aim of this study was to collect experiences related to discrimination among US radiology residents, including type and source, as well as the residents' perception on lectures about discrimination and harassment. We also explored the barriers to reporting, and suggested strategies to overcome them. MATERIAL AND METHODS Following Institutional Review Board (IRB) approval, an online survey was sent to program directors and coordinators across the US, who were asked to forward the link to their radiology residents. A reminder email was sent over a period of 4 months. The participants were reassured the survey was confidential and anonymous. RESULTS Among the respondents, the most reported types of discrimination were based in gender, race and nationality, the majority of which not being reported. The most common perpetrators were attending radiologists, co-residents, technologists, and patients. The main barriers for reporting were fear of retaliation, confidentiality concerns, and skepticism about a positive outcome. CONCLUSION Our study examines some experiences of discrimination shared by residents during their training, with gender and race being the most common causes. This sheds light into a hidden and unspoken issue and highlights the need for more active discussions in radiology on microaggressions and implicit bias. Our data can guide future studies as well as residency programs to build effective strategies to address discrimination, aiming for sustainable changes.
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Affiliation(s)
- Aline Camargo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322 USA.
| | - Mahla Radmard
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, 1800 Orleans Street, Baltimore, MD, 21287 USA
| | - Mona Dabiri
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, 1800 Orleans Street, Baltimore, MD, 21287 USA
| | - Kathryn A Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205 USA
| | - Liangge Hsu
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, 75 Francis Street, Boston, MA, 02115 USA
| | - David M Yousem
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, 1800 Orleans Street, Baltimore, MD, 21287 USA
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Kumaran Y, Bellamy J, Maciejewski R, Tulchin-Francis K, Samora JB. How Much Bullying and Discrimination Are Reported by Sexual and Gender Minorities in Orthopaedics? Clin Orthop Relat Res 2024; 482:1282-1292. [PMID: 38415710 PMCID: PMC11272349 DOI: 10.1097/corr.0000000000003009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/23/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Discriminatory practices against minority populations are prominent, especially in the workplace. In particular, lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) individuals experience several barriers and stressors more often than individuals who do not identify as LGBTQ+. Mistreatment is common among these individuals in their personal and professional lives. However, representation and perceptions of discrimination and bullying among attendings, residents, medical students, and other professionals who identify as LGBTQ+ and are "out" (openly acknowledging and expressing one's sexual orientation or gender identity) is seldom studied in orthopaedic surgery. QUESTIONS/PURPOSES (1) How often are orthopaedic trainees and professionals who identify as LGBTQ+ out in their workplaces? (2) What proportion of these individuals report experiencing discrimination, bullying, or differential treatment? (3) Is there regional variation in these reported experiences of bullying and discriminatory behaviors by orthopaedic trainees and professionals in the LGBTQ+ community? METHODS Individuals registering for Pride Ortho, a community of LGBTQ+ individuals and their allies established in 2021 to provide mentorship, networking, and a sense of community among its members, completed an internet-based survey developed by organization leadership. A total of 156 individuals registering for the Pride Ortho community were eligible to participate in the internet-based survey. In all, 92% (144 of 156) fully completed the survey, 6% (10 of 156) partially completed it, and 1% (2 of 156) did not complete any part of the survey. Most respondents (64% [100 of 156]) identified as being LGBTQ+, with 77 members at the attending level of their careers. More than half of LGBTQ+ members (56% [56 of 100]) identified as cisgender women (individuals who identify as women and who were born female). Demographic information was privately collected and deidentified, and included sex assigned at birth, gender expression or identity (the social constructed role that an individual chooses to inhabit, regardless of that individual's assigned sex at birth), sexual orientation, self-identified race, location, level of training, and orthopaedic subspecialty. RESULTS Ninety-four percent (94 of 100) of LGBTQ+ respondents reported being out at their workplace, with nearly one-third of respondents indicating they were only partially out. Most (74% [74 of 100]) respondents reported either "yes" or "maybe" to perceived experiences of bullying, discrimination, or being treated differently. All individuals who partially completed the survey were straight or heterosexual and did not answer or answered "not applicable" to being out in their workplace. These individuals also all answered "no" to experiencing bullying, discrimination, or being treated differently. There was no geographic variation in reported experiences of bullying and discriminatory behaviors by orthopaedic trainees and professionals. CONCLUSION Most LGBTQ+ orthopaedic trainees and professionals are out in their workplaces, although they report experiencing discrimination and bullying more than do non-LGBTQ+ individuals. Bullying and discrimination can deter individuals from beginning and completing their training in orthopaedic surgery. We recommend that orthopaedic institutions not only enforce existing antidiscrimination legal mandates but also increase the visibility of LGBTQ+ faculty and residents. This effort should include the implementation of diversity and sensitivity training programs, strengthened by a structured process of monitoring, reporting, and integrating feedback from all members in the workplace to continuously refine policy adherence and identify the root cause of the reported perceptions of bullying and discrimination. CLINICAL RELEVANCE To deepen our understanding of the experiences faced by sexual and gender minorities in orthopaedic surgery settings, it is crucial to quantify reports of perceived bullying and discrimination. Addressing these issues is key to creating a more diverse and empathetic workforce within orthopaedic institutions, which in turn can lead to improved patient care and a better work environment. Recognizing and understanding the specific contexts of these experiences is an essential starting point for developing a truly inclusive environment for both trainees and attending physicians.
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Affiliation(s)
- Yogesh Kumaran
- University of Toledo Colleges of Medicine and Engineering, Toledo, OH, USA
| | | | | | | | - Julie Balch Samora
- Nationwide Children’s Hospital, Department of Orthopedic Surgery, Columbus, OH, USA
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Massarweh NN, Ibrahim AM. When Getting Bigger is Too Big: Challenges of Growing Health Care Systems. Ann Surg 2024; 280:190-192. [PMID: 38545774 PMCID: PMC11236516 DOI: 10.1097/sla.0000000000006286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Nearly two hospital mergers occur per week and the majority of hospitals are now part of a larger health system. As health systems continue to grow in size and geographic coverage, these changes could have unintended consequences for many different healthcare stakeholders. This surgical perspective outlines emerging challenges associated with the growth of health systems and potential strategies to monitor and mitigate the potential adverse impact of these ongoing changes.
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Affiliation(s)
- Nader N Massarweh
- Atlanta VA Health Care System, Surgery and Perioperative Care, Decatur, GA
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA
| | - Andrew M Ibrahim
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Institute for Healthcare Policy & Innovation, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
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Nelson S, Ayaz B, Baumann AL, Dozois G. A gender-based review of workplace violence amongst the global health workforce-A scoping review of the literature. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003336. [PMID: 38954697 PMCID: PMC11218983 DOI: 10.1371/journal.pgph.0003336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/20/2024] [Indexed: 07/04/2024]
Abstract
Workplace violence (WPV) impacts all levels of the health workforce, including the individual provider, organization, and society. While there is a substantial body of literature on various aspects of WPV against the health workforce, gender-based WPV (GB-WPV) has received less attention. Violence in both the workplace and broader society is rooted in gendered socio-economic, cultural, and institutional factors. Developing a robust understanding of GB-WPV is crucial to explore the differing experiences, responses, and outcomes of GB-WPV with respect to gender. We conducted a scoping review and report on the prevalence and risk factors of GB-WPV in healthcare settings globally. The review followed the Preferred Reporting Items for Systematic and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We registered the scoping review protocol on the Open Science Framework on January 14, 2022, at https://osf.io/t4pfb/. A systematic search was conducted of empirical literature in five health and social science databases. Of 13667, 226 studies were included in the analysis. Across the studies, more women than men experienced non-physical violence, including verbal abuse, sexual harassment, and bullying. Men experienced more physical violence compared to women. Younger age, less experience, shifting duties, specific clinical settings, lower professional status, organizational hierarchy, and minority status were found to be sensitive to gender, reflecting women's structural disadvantages in the workplace. Given the high prevalence and impact of GB-WPV on women, we provided recommendations to address systemic issues in clinical practice, academia, policy, and research.
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Affiliation(s)
- Sioban Nelson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Basnama Ayaz
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Andrea L. Baumann
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Graham Dozois
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Ebrahim FA, Shah J, Sharma K, Kunyiha N, Korom R, Ali SK. Discrimination and Abuse Among Healthcare Workers from Patients and their Relatives at a Tertiary Hospital in Kenya. Behav Med 2024; 50:242-249. [PMID: 37489805 DOI: 10.1080/08964289.2023.2238104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/23/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
Discrimination and abuse of healthcare workers (HCWs) by patients and their relatives remains a pressing and prevalent problem in various healthcare settings, negatively affecting professional outcomes. Despite this, little has been reported about discrimination and abuse in many low- and middle-income countries such as Kenya. We conducted a cross-sectional survey study between May - August 2021 among healthcare workers at a hospital in Kenya. Email invitations were sent, and the survey was in English, and the data was collected through and online survey. Discrimination based on gender was reported by 24.9% of all HCWs; 39.9% of doctors, 17.2% of nurses, and 10.9% of allied staff whereas racial discrimination was reported by 28.8% of all HCWs; 49.0% of doctors, 18.9% of nurses, and 8.9% of allied staff. Verbal or emotional abuse was the most common form of abuse and was reported by 56.8% of all HCWs while physical abuse was reported by 4.9% of all HCWs. For those that reported discrimination based on gender, 77.4% reported patient and their family members as the main source, whereas 81.2% of those that reported discrimination based on race reported the main source was from patient and their family members. Despite strict laws against discrimination and abuse, a significant portion of healthcare providers suffer from discrimination and abuse primarily from patients and their family members. In addition to education programs and policies to curb such behavior in the work environment, coping mechanisms should be actively sought to help healthcare providers deal with such actions.
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Affiliation(s)
| | - Jasmit Shah
- Department of Medicine, Aga Khan University, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | | | - Nancy Kunyiha
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| | | | - Sayed K Ali
- Department of Medicine, Aga Khan University, Nairobi, Kenya
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Yao L, Wang S. Response to "Sexual Harassment Among Chinese Psychiatrists and Its Impact on Quality of Life: A Cross-Sectional Survey" [Letter]. Risk Manag Healthc Policy 2024; 17:1619-1620. [PMID: 38894818 PMCID: PMC11184167 DOI: 10.2147/rmhp.s481040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Li Yao
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, People’s Republic of China
| | - Song Wang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
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Xiao Y, Liu L, Chen TT, Zhang Z, Wu XH. Sexual Harassment Among Chinese Psychiatrists and Its Impact on Quality of Life: A Cross-Sectional Survey. Risk Manag Healthc Policy 2024; 17:1253-1261. [PMID: 38765780 PMCID: PMC11102279 DOI: 10.2147/rmhp.s463502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024] Open
Abstract
Objectives Sexual harassment (SH) is a prevalent issue in various professional fields worldwide. The current study aims to investigate the incidence of SH targeting psychiatrists in China and explore its impact on quality of life (QOL). Methods A consecutive recruitment of 1093 psychiatrists was conducted from 6 hospitals in China. The recorded data included participants' socio-demographic characteristics, experiences of workplace SH within the previous year, and their QOL. SH comprised verbal harassment, physical harassment, and displaying of sexual organs. The Chinese version of the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) was employed to assess QOL. We compared the demographic characteristics and QOL between the SH group and the non-SH group. Multiple logistic regression analysis was used to identify independent demographic correlates of SH. Results In total, 13.8% (n = 151) of the psychiatrists reported SH, with 5.8% reporting it once, 4.4% reporting it twice, and 3.6% reporting it three times or more. Psychiatrists who had encountered SH exhibited lower QOL across social, psychological, physical, and environmental domains. Multiple logistic regression analysis revealed that young physicians and those with shorter work experience had a higher likelihood of experiencing SH. Conclusion The high prevalence of SH among Chinese psychiatrists is of concern. Given its detrimental effects on the well-being of physicians and the quality of medical care they provide, it is crucial to develop specialized employee training programs for this population to effectively manage workplace SH.
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Affiliation(s)
- Yu Xiao
- Psychosomatic Medical Center, The Fourth People’s Hospital of Chengdu, Chengdu, Sichuan Province, 610036, People’s Republic of China
- Psychosomatic Medical Center, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, 610036, People’s Republic of China
| | - Liang Liu
- Department of Urology, Baoding No.1 Central Hospital, Baoding, Hebei Province, 071030, People’s Republic of China
| | - Ting-ting Chen
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610044, People’s Republic of China
| | - Zhou Zhang
- Department of Gastroenterology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, Hubei Province, 441011, People’s Republic of China
| | - Xiao-hong Wu
- Nursing Department, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliate Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan Province, 610041, People’s Republic of China
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8
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Menousek J, Rezaii EG, Sayles H, Anderson MJ, Strong S, Fornoff LE. Perception and Representation of LGBTQ+ Individuals in U.S. Neurosurgical Training. World Neurosurg 2024; 185:e1169-e1176. [PMID: 38503403 DOI: 10.1016/j.wneu.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE The aim of this study is to gauge the current social climate in neurosurgical residency training and attitudes regarding sexual orientation and gender identity. METHODS We conducted a cross-sectional study through a 35-question questionnaire distributed to roughly 1700 residents at all U.S. neurosurgical residency programs. RESULTS A total of 107 responses were obtained. Seventeen residents (16%) identified as being an LGBTQ+ individual. The majority (76%) of LGBTQ+ residents were concerned about how their sexual orientation would be perceived while applying to programs, and 47% endorsed purposefully concealing sexual orientation at work for fear of rejection or reprisal. More than half (56%) of those surveyed have witnessed homophobic/transphobic remarks by patients. While at work, 29% of LGBTQ+ individuals stated they are uncomfortable being open with their sexual orientation, and 3 LGBTQ+ individuals admitted being the target of direct homophobic/transphobic comments. CONCLUSIONS This is the first study to our knowledge that has been conducted assessing the presence, perception, and treatment of LGBTQ+ trainees in neurosurgical residency. Our study outlines the challenges LGBTQ+ individuals face when applying to neurosurgical programs, which involves the perception of their sexual orientation, their witnessed instances of homophobic and transphobic comments by coworkers and patients, and their hesitation with discussing their social lives compared with their non-LGBTQ+ peers at work for fear of judgment or reprisal. Ongoing research is needed to address these issues to obtain workplace respect and fairness in this population and thus create an accepting atmosphere and achieve social justice in neurosurgery training.
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Affiliation(s)
- Joseph Menousek
- Department of Neurosurgery, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Elhaum G Rezaii
- Department of Neurosurgery, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Harlan Sayles
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Matthew J Anderson
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sheritta Strong
- Department of Psychiatry, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Linden E Fornoff
- Pediatric Neurosurgery, Boys Town National Research Hospital, Boys Town, Nebraska
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Akhavan AR, Zhan T, Lall MD, Barton MA, Reisdorff EJ, Hu Y, Bilimoria KY, Lu DW. Suicidal ideation, perception of personal safety, and career regret among emergency medicine residents during the COVID-19 pandemic. AEM EDUCATION AND TRAINING 2024; 8:e10955. [PMID: 38516253 PMCID: PMC10951625 DOI: 10.1002/aet2.10955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 03/23/2024]
Abstract
Objectives The COVID-19 pandemic was disruptive for trainees and may have affected career decisions for some learners. This study examined the impact of the pandemic on emergency medicine (EM) resident perceptions of their mental health, perceptions of personal safety, and career choice regret. Methods This was a cross-sectional survey study administered following the 2021 American Board of Emergency Medicine In-Training Examination (ITE). Survey measures included suicidal ideation (SI), COVID concerns in terms of infection prevention and control (IPC) training, COVID risk to self and/or COVID risk to family, and COVID-related career regret. COVID concerns were compared by gender and race/ethnicity using Pearson's chi-square tests. Multivariable logistic regression models were used to test the association between SI and COVID concerns, resident characteristics, and program characteristics. Results A total of 6980 out of 8491 EM residents (82.2%) from 244 programs completed the survey. Only 1.1% of participants reported insufficient training in COVID IPC practices. Participants were concerned about COVID risk to themselves (40.3%) and to their families (63.3%) due to their job roles. These concerns were more common among women or nonbinary (vs. men); all other races/ethnicities (vs. non-Hispanic Whites); senior residents (vs. PGY-1, PGY-2 residents); and residents who were married or in relationships (vs. single or divorced). A total of 6.1% of participants reported that COVID made them reconsider choosing EM as their career. Career regret in this cohort was higher than that in the proportion (3.2%) expressing career regret in the 2020 ITE (p < 0.001). Career regret was more common among women or nonbinary (vs. men); all other races/ethnicities (vs. non-Hispanic Whites); and senior residents (vs. PGY-1, PGY-2 residents). The overall SI rate was 2.6%, which did not differ from that of the 2020 sample of EM residents (2.5%, p = 0.88). Conclusions Many EM residents reported concerns about COVID risks to themselves and their families. Although the rate of SI remained unchanged, more EM residents reported career regret during the COVID pandemic.
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Affiliation(s)
- Arvin R. Akhavan
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Tiannan Zhan
- Department of SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Michelle D. Lall
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | | | | | - Yue‐Yung Hu
- Department of SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Karl Y. Bilimoria
- Department of SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Dave W. Lu
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
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Diaz R, Balgord S, Klekowski N, Farthing AS, Escolero SG, DeCloux K, Burkhardt JC, Haggins AN, Hopson LR. Understanding clerkship experiences in emergency medicine and their potential influence on specialty selection: A qualitative study. AEM EDUCATION AND TRAINING 2024; 8:e10932. [PMID: 38343629 PMCID: PMC10858322 DOI: 10.1002/aet2.10932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 02/16/2024]
Abstract
Objectives The specialty of emergency medicine (EM) is experiencing a significant decrease in student interest. In addition, women are historically underrepresented within the specialty at all levels of training and practice. We sought to understand how clinical experiences and perceptions of EM influence specialty selection by medical students, particularly women. Methods Using a constructivist grounded theory approach, we analyzed semistructured interviews with senior medical students who considered EM as a specialty. We used purposive sampling to recruit from diverse learning environments and represent a variety of experiences. Participants reflected on their specialty selection process and experiences in EM including their perceived acceptance in the work environment. Results Twenty-five medical students from 11 geographically diverse schools participated. A total of 68% (17/25) identified as women. The majority (21/25, 84%) planned on applying to EM residency. We identified four major themes: (1) distressing interpersonal interactions with patients and the ED care team negatively affect students; (2) EM culture includes behaviors that are perceived as exclusionary; (3) beliefs about the attributes of an ideal EM physician and the specialty itself have a gendered nature; and (4) ease of access to mentors, representation, and early exposure to EM environment increased interest in specialty. Conclusions Our participants express that EM causes challenges for students to accept the norms of behavior in the field, which is an essential element in joining a group and professional identity formation. In addition, we raise concern that gendered perceptions and language may send exclusionary environmental cues that may negatively impact recruitment of a diverse physician workforce.
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Affiliation(s)
- Rosemarie Diaz
- Department of Emergency MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Sarah Balgord
- Department of Emergency MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Nicole Klekowski
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | | | - Korynne DeCloux
- Department of Internal MedicineYale UniversityNew HavenConnecticutUSA
| | - John C. Burkhardt
- Departments of Emergency Medicine and Learning Health SciencesUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Adrianne N. Haggins
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Laura R. Hopson
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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11
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Danckers M, Nusynowitz J, Jamneshan L, Shalmiyev R, Diaz R, Radix AE. The sexual and gender minority (LGBTQ+) medical trainee: the journey through medical education. BMC MEDICAL EDUCATION 2024; 24:67. [PMID: 38233849 PMCID: PMC10795322 DOI: 10.1186/s12909-024-05047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
In this literature overview, we share with the reader challenges faced by LGBTQ + individuals pursuing medical education, from undergraduate to postgraduate training. The LGBTQ + acronym has evolved to encompass the diverse spectrum of sexual orientation and gender identities. Recently, the term "Sexual and Gender Minority" (SGM) has emerged as an umbrella term to provide consistency in research advancing SGM health. The unique obstacles LGBTQ + trainees encounter are highlighted throughout this article, including external factors influencing career decisions, a lack of LGBTQ + healthcare curricula, discriminatory social interactions, limited mentorship opportunities, and a higher mental health burden. These challenges have the capacity to affect educational experiences, personal well-being, and professional growth. Additionally, we examine the impact of inclusive institutional climates on LGBTQ + trainees' selection of medical schools and residency programs, as they may prioritize inclusiveness and diversity when making their choice. In postgraduate training, LGBTQ + trainees continue to face challenges, exemplified by disparities in placement rates and discriminatory experiences based on sexual orientation and gender identity. We describe the gap in current research and its long-term impact of these challenges on career paths. Hostile environments persist in certain specialties, and the lack of LGBTQ + mentorship and support can hinder academic pursuits. We shed light on the unique and pervasive challenges faced by LGBTQ + trainees throughout their medical education journey, while emphasizing the need for inclusive policies, support systems, and research to address these challenges. With increasing research and studies, we hope to create a medical workforce and community that better represents the diverse communities it serves.
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Affiliation(s)
- Mauricio Danckers
- Division of Pulmonary and Critical Care Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA.
| | - Jake Nusynowitz
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Lily Jamneshan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Richard Shalmiyev
- Division of Pulmonary and Critical Care Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Raiko Diaz
- Division of Pulmonary and Critical Care Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Asa E Radix
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, New York, USA
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Sorgini A, Istl AC, Downie ML, Kirpalani A. Pride & prejudice: A scoping review of LGBTQ + medical trainee experiences. MEDICAL TEACHER 2024; 46:73-81. [PMID: 37418565 DOI: 10.1080/0142159x.2023.2229503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
PURPOSE LGBTQ + medical trainees experience significant discrimination. These individuals are stigmatized within a hetero- and cis-normative system, resulting in poorer outcomes in mental health and increased stress regarding career trajectory compared with their hetero- and cis-identifying counterparts. However, literature on the barriers experienced during medical training in this marginalized group is limited to small heterogeneous studies. This scoping review collates and explores prominent themes in existing literature on the personal and professional outcomes of LGBTQ + medical trainees. METHODS We searched five library databases (SCOPUS, Ovid-Medline, ERIC, PsycINFO and EMBASE) for studies that investigated LGBTQ + medical trainees' academic, personal, or professional outcomes. Screening and full text review were performed in duplicate, and all authors participated in thematic analysis to determine emerging themes, which were iteratively reviewed to consensus. RESULTS From 1809 records, 45 met inclusion criteria (κ = 0.57). Major themes that emerged in the literature included the prevalence of discrimination and mistreatment faced by LGBTQ + medical trainees from colleagues and superiors, concerns regarding disclosure of sexual and/or gender minority identity, and overall negative impacts on mental health including higher rates of depression, substance use, and suicidal ideation. There was a noted lack of inclusivity in medical education and having an LGBTQ + identity had a large impact on career trajectory. Community with peers and mentors was an important determinant of success and belonging. There was a noteworthy lack of research on intersectionality or positive interventions that improved outcomes for this population. CONCLUSION This scoping review highlighted important barriers facing LGBTQ + medical trainees, identifying substantial gaps in the existing literature. Research on supportive interventions and predictors of training success is lacking and will be important to foster an inclusive education system. These findings provide critical insights for education leaders and researchers to help create and evaluate inclusive and empowering environments for trainees.
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Affiliation(s)
- Alana Sorgini
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Alexandra C Istl
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mallory L Downie
- Department of Renal Medicine, University College London, London, UK
- Department of Nephrology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Amrit Kirpalani
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Division of Nephrology, Children's Hospital, London Health Sciences Centre, London, ON, Canada
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Tungsupreechameth A, Tanpowpong P, Puranitee P. Mistreatment in paediatric residency programs in Thailand: a national survey. MEDICAL EDUCATION ONLINE 2023; 28:2220176. [PMID: 37270793 DOI: 10.1080/10872981.2023.2220176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/03/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND AIMS Mistreatment in the learning environment is associated with adverse outcomes for residents. Most studies with that regard have been performed in western countries which may have different socio-cultural background and educational and training systems than the non-Western Asian countries. This study aimed (1) to determine the national prevalence of mistreatment in Thai paediatric residents and a correlation with the risk for burnout and other factors and (2) to launch a mistreatment awareness program (MAP) in our training program. METHODS The study was divided into two phases. Phase 1, an online survey of mistreatment-related questions, was sent to current paediatric residents across the country. Burnout and depression were also self-evaluated by formal screening questions. The results were categorized by the Negative Acts Questionnaire-Revised into five domains of mistreatment: workplace learning-related bullying (WLRB), person-related bullying (PRB), physically intimidating bullying, sexual harassment, and ethnic harassment. Frequent mistreated exposure was defined as if mistreatment occurred >1/week. Phase 2, MAP was conducted by distributing the results of the first phase with some examples of mistreatment events and mistreatment-related videos. After 3 months, at our centre, the survey was resent to evaluate mistreatment. RESULTS The response rate was 27% (n = 140). We found that 91% experienced ≥1 mistreated situation in the prior 6 months. Most mistreatment domains were WLRB and PRB, and residents were commonly instigated by clinical faculty and nurses. Most (84%) mistreated residents did not report the events. An association between frequent mistreated exposure and burnout was also found (P < 0.001). For Phase 2, the mistreated situations especially the WLRB and PRB domains dropped after the launch of MAP. CONCLUSIONS Thai paediatric residents frequently perceive mistreatment in their learning environment. Specific aspects of mistreatment, such as WLRB and PRB, should be carefully explored and managed through particular groups of instigators.
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Affiliation(s)
| | - Pornthep Tanpowpong
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongtong Puranitee
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Richman PB, Callahan J, Seaberg D. Workplace abuse of emergency physicians by patients and consultants. Am J Emerg Med 2023; 73:221-222. [PMID: 37696710 DOI: 10.1016/j.ajem.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/25/2023] [Accepted: 09/02/2023] [Indexed: 09/13/2023] Open
Affiliation(s)
- Peter B Richman
- CHRISTUS Health/Texas A&M Health Science Center, Department of Emergency, Medicine, Corpus Christi, TX, United States of America.
| | - Jacquelyn Callahan
- CHRISTUS Health/Texas A&M Health Science Center, Department of Emergency, Medicine, Corpus Christi, TX, United States of America
| | - David Seaberg
- Summa Health, Department of Emergency Medicine, Akron, OH, United States of America
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Liu J, Qiao X, Xiao Y, Deng Z, Cui J, Wu M, Zhang H, Ran K, Luo H, Tang B. Physical and mental health impairments experienced by operating surgeons and camera-holder assistants during laparoscopic surgery: a cross-sectional survey. Front Public Health 2023; 11:1264642. [PMID: 37744484 PMCID: PMC10512950 DOI: 10.3389/fpubh.2023.1264642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Surgeons may experience physical and mental health problems because of their jobs, which may lead to chronic muscle damage, burnout, or even withdrawal. However, these are often ignored in camera-holder assistants during laparoscopic surgery. We aimed to analyze the differences between operating surgeons and camera-holder assistants. Methods From January 1, 2022, to December 31, 2022, a cross-sectional survey was conducted to evaluate the muscle pain, fatigue, verbal scolding, and task load for operating surgeons and camera-holder assistants. The Nordic Musculoskeletal Questionnaire, the Space Administration Task Load Index, and the Surgical Task Load Index (SURG-TLX) were combined in the questionnaire. Results 2,184 operations were performed by a total of 94 operating surgeons and 220 camera assistants. 81% of operating surgeons and 78% of camera-holder assistants reported muscle pain/discomfort during the procedure. The most affected anatomic region was the shoulders for operating surgeons, and the lower back for camera-holder assistants. Intraoperative fatigue was reported by 41.7% of operating surgeons and 51.7% of camera-holder assistants. 55.2% of camera-holder assistants reported verbal scolding from the operating surgeons, primarily attributed to lapses in laparoscope movement coordination. The SURG-TLX results showed that the distributions of mental, physical, and situational stress for operating surgeons and camera-holder assistants were comparable. Conclusion Like operating surgeons, camera-holder assistants also face similar physical and mental health impairments while performing laparoscopic surgery. Improvements to the working conditions of the camera-holder assistant should not be overlooked.
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Affiliation(s)
- Junjie Liu
- Vascular, Hernia & Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Qiao
- Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Municipality Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Yi Xiao
- Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhuofan Deng
- Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ji Cui
- Obstetrics & Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingdong Wu
- Vascular, Hernia & Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haolong Zhang
- Vascular, Hernia & Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Ran
- Vascular, Hernia & Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hailong Luo
- Vascular, Hernia & Abdominal Wall Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Tang
- Hernia and Abdominal Wall Surgery, The Fourth Clinical College of Chongqing Medical University, Chongqing, China
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Lett E, Tran NK, Nweke N, Nguyen M, Kim JG, Holmboe E, McDade W, Boatright D. Intersectional Disparities in Emergency Medicine Residents' Performance Assessments by Race, Ethnicity, and Sex. JAMA Netw Open 2023; 6:e2330847. [PMID: 37733347 PMCID: PMC10514741 DOI: 10.1001/jamanetworkopen.2023.30847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/19/2023] [Indexed: 09/22/2023] Open
Abstract
Importance Previous studies have demonstrated sex-specific disparities in performance assessments among emergency medicine (EM) residents. However, less work has focused on intersectional disparities by ethnoracial identity and sex in resident performance assessments. Objective To estimate intersectional sex-specific ethnoracial disparities in standardized EM resident assessments. Design, Setting, and Participants This retrospective cohort study used data from the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education Milestones (Milestones) assessments to evaluate ratings for EM residents at 128 EM training programs in the US. Statistical analyses were conducted in June 2020 to January 2023. Exposure Training and assessment environments in EM residency programs across comparison groups defined by ethnoracial identity (Asian, White, or groups underrepresented in medicine [URM], ie, African American/Black, American Indian/Alaska Native, Hispanic/Latine, and Native Hawaiian/Other Pacific Islander) and sex (female/male). Main Outcomes and Measures Mean Milestone scores (scale, 0-9) across 6 core competency domains: interpersonal and communications skills, medical knowledge, patient care, practice-based learning and improvement, professionalism, and system-based practice. Overall assessment scores were calculated as the mean of the 6 competency scores. Results The study sample comprised 128 ACGME-accredited programs and 16 634 assessments for 2708 EM residents of which 1913 (70.6%) were in 3-year and 795 (29.4%) in 4-year programs. Most of the residents were White (n = 2012; 74.3%), followed by Asian (n = 477; 17.6%), Hispanic or Latine (n = 213; 7.9%), African American or Black (n = 160; 5.9%), American Indian or Alaska Native (n = 24; 0.9%), and Native Hawaiian or Other Pacific Islander (n = 4; 0.1%). Approximately 14.3% (n = 386) and 34.6% (n = 936) were of URM groups and female, respectively. Compared with White male residents, URM female residents in 3-year programs were rated increasingly lower in the medical knowledge (URM female score, -0.47; 95% CI, -0.77 to -0.17), patient care (-0.18; 95% CI, -0.35 to -0.01), and practice-based learning and improvement (-0.37; 95% CI, -0.65 to -0.09) domains by postgraduate year 3 year-end assessment; URM female residents in 4-year programs were also rated lower in all 6 competencies over the assessment period. Conclusions and Relevance This retrospective cohort study found that URM female residents were consistently rated lower than White male residents on Milestone assessments, findings that may reflect intersectional discrimination in physician competency evaluation. Eliminating sex-specific ethnoracial disparities in resident assessments may contribute to equitable health care by removing barriers to retention and promotion of underrepresented and minoritized trainees and facilitating diversity and representation among the emergency physician workforce.
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Affiliation(s)
- Elle Lett
- Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Center for Anti-Racism and Community Health, University of Washington School of Public Health, Seattle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Nguyen Khai Tran
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California
| | - Nkemjika Nweke
- St George’s University School of Medicine, St George, Grenada
| | | | - Jung G. Kim
- Department of Health System Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Eric Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - William McDade
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Dowin Boatright
- Ronald O. Perelman Department of Emergency Medicine, New York University, New York
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Luo Z, Wang J, Zhou Y, Mao Q, Lang B, Xu S. Workplace bullying and suicidal ideation and behaviour: a systematic review and meta-analysis. Public Health 2023; 222:166-174. [PMID: 37544128 DOI: 10.1016/j.puhe.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/11/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES Suicidal ideation and behaviour are potential outcomes of workplace bullying. This review aimed to determine the extent of the association between workplace bullying and suicidal ideation and behaviour. STUDY DESIGN The study incorporated a systematic review and meta-analysis. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed to conduct a comprehensive systematic review and meta-analysis. A combination of subject terms and free words was used to search nine electronic databases. Two reviewers independently screened articles and extracted information according to the inclusion criteria. A meta-analysis was performed with averaged weighted correlations across samples using the STATA software (version 16.0) from pooled estimates of the main results from all studies. RESULTS In total, 25 articles of high or medium quality were included in the systematic review; 15 of these were included in the meta-analysis. The prevalence of suicidal ideation and behaviour was 18% and 4%, respectively. Individuals who experienced workplace bullying had 2.03-times and 2.67-times higher odds of reporting suicidal ideation and behaviour, respectively, after adjustment for confounding factors. Moderating and mediating factors may help reduce the risk of suicidal ideation and behaviour for individuals experiencing workplace bullying. CONCLUSION This study indicated that exposure to workplace bullying significantly increased the risk of suicidal ideation and behaviour.
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Affiliation(s)
- Z Luo
- Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (West China Hospital Sichuan University Tibet Chengdu Branch Hospital), No. 20 Ximianqiao Hengjie, Chengdu 610041, China.
| | - J Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 610041, China
| | - Y Zhou
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 610041, China
| | - Q Mao
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu 6100752, China
| | - B Lang
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu 6100752, China
| | - S Xu
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu 6100752, China
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Pillado EB, Li RD, Eng JS, Chia MC, Conway A, DiLosa K, Gomez-Sanchez C, Shaw P, Sheahan MG, Bilimoria KY, Hu YY, Coleman DM. Defining sources and ramifications of mistreatment among female vascular surgery trainees. J Vasc Surg 2023; 78:797-804. [PMID: 37088443 DOI: 10.1016/j.jvs.2023.03.504] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/14/2023] [Accepted: 03/26/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Mistreatment among vascular surgery trainees is a known risk factor for physician burnout. This study aims to characterize forms of and identify sources of mistreatment. METHODS This is a cross-sectional study of United States vascular surgery trainees who voluntarily participated in an anonymous survey administered after the 2021 Vascular Surgery In-Training Examination. The primary outcome measures were self-reported mistreatment and sources of mistreatment between genders. Logistic regression was used for multivariable analysis. RESULTS Representing all 125 vascular surgery training programs, 510 trainees (66.9% male) participated in the survey (83.6% response rate). Mistreatment was reported by 54.8% of trainees, with twice as many women reporting as men (82.3% vs 41.0%; P < .001). Women reported higher rates of being shouted at (44.1% vs 21.1%; P < .001); repeatedly reminded of errors (24.3% vs 16.1%; P = .04); ignored/treated hostilely (28.9% vs 10.5%; P < .001); subjected to crude/sexually demeaning remarks, stories, jokes (19.2% vs 2.1%; P < .001); evaluated by different standards (29.3% vs 2.1%; P < .001); and mistaken for a non-physician (75.2% vs 3.5%; P < .001). Among trainees reporting bullying, attendings were the most common source (68.5%). Patients and their families were the most common source of sexual harassment (66.7%), gender discrimination (90.4%), and racial discrimination (74.4%). Compared with men, women identified more patients and families as the source of bullying (50.0% vs 29.7%; P = .005), gender discrimination (97.2% vs 50.0%; P < .001), and sexual harassment (78.4% vs 27.3%; P = .003). Compared with men, women more frequently felt unprepared to respond to the behavior in the moment (10.4% vs 4.6%; P = .002), did not know how to report mistreatment at their institution (7.6% vs 3.2%; P = .04), and did not believe that their institution would take their mistreatment report seriously (9.0% vs 3.9%; P = .002). On multivariable analysis, female gender was an independent risk factor for both gender discrimination (odds ratio, 56.62; 95% confidence interval, 27.89-115) and sexual harassment (odds ratio, 26.2; 95% confidence interval, 3.34-14.8) when adjusting for children, training year, relationship status, and training program location. CONCLUSIONS A majority of vascular surgery trainees experience mistreatment during training. Sources and forms of abuse are varied. Understanding the sources of mistreatment is critical to guide intervention strategies such as faculty remediation and/or sanctions; allyship training for staff, residents, and faculty; and institutional procedures for patient-initiated abuse.
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Affiliation(s)
- Eric B Pillado
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Ruojia Debbie Li
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Matthew C Chia
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Allan Conway
- Division of Vascular Surgery Lenox Hill Hospital, Department of Surgery, Northwell Health, New York, NY
| | - Kathryn DiLosa
- Division of Vascular Surgery, Department of Surgery, University of California, Davis, Sacramento, CA
| | - Clara Gomez-Sanchez
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Palma Shaw
- Division of Vascular Surgery, Upstate Medical University, Syracuse, NY
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Yue-Yung Hu
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Dawn M Coleman
- Division of the Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC.
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Carrillo T, Rodriguez LM, Landry A, Alvarez A, Ceniza A, Gay R, Green A, Faiz J. A Virtual National Diversity Mentoring Initiative to Promote Inclusion in Emergency Medicine. West J Emerg Med 2023; 24:662-667. [PMID: 37527394 PMCID: PMC10393448 DOI: 10.5811/westjem.59666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/27/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Trainees underrepresented in medicine (URiM) face additional challenges seeking community in predominantly white academic spaces, as they juggle the effects of institutional, interpersonal, and internalized racism while undergoing medical training. To offer support and a space to share these unique experiences, mentorship for URiM trainees is essential. However, URiM trainees have limited access to mentorship from URiM faculty. To address this gap, we developed a national virtual mentoring program that paired URiM trainees interested in emergency medicine (EM) with experienced mentors. METHODS We describe the implementation of a virtual Diversity Mentoring Initiative (DMI) geared toward supporting URiM trainees interested in EM. The program development involved 1) partnering of national EM organizations to obtain funding; (2) identifying a comprehensive platform to facilitate participant communication, artificial intelligence-enabled matching, and ongoing data collection; 3) focusing on targeted recruitment of URiM trainees; and (4) fostering regular leadership meeting cadence to customize the platform and optimize the mentorship experience. CONCLUSION We found that by using a virtual platform, the DMI enhanced the efficiency of mentor-mentee pairing, tailored matches based on participants' interests and the bandwidth of mentors, and successfully established cross-institutional connections to support the mentorship needs of URiM trainees.
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Affiliation(s)
- Tatiana Carrillo
- University of Pennsylvania, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | | | - Adaira Landry
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Al'ai Alvarez
- Stanford University, Department of Emergency Medicine, Stanford, California
| | - Alyssa Ceniza
- American College of Emergency Physicians, Dallas, Texas
| | - Riane Gay
- American College of Emergency Physicians, Dallas, Texas
| | - Andrea Green
- Texas Tech University Health Sciences Center/University Medical Center of El Paso, El Paso, Texas
| | - Jessica Faiz
- National Clinician Scholars Program, VA Greater Los Angeles Healthcare System and UCLA, Los Angeles, California
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Real Delor RE, Ayala Saucedo A. [Mistreatment of Paraguayan medical residents in 2022: a multicenter study]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2023; 80:112-118. [PMID: 37402296 PMCID: PMC10443419 DOI: 10.31053/1853.0605.v80.n2.40440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/07/2023] [Indexed: 07/06/2023] Open
Abstract
Introducción los residentes de postgrado tienden a sufrir maltratos durante sus prácticas hospitalarias y estos comportamientos abusivos no deben considerarse normales. El objetivo fue describir la frecuencia y las características del maltrato en residentes de medicina del Paraguay en 2022. Metodología se aplicó un diseño observacional de corte transversal. Se incluyó a los residentes de hospitales del Paraguay que aceptaban completar una encuesta online difundida por las redes sociales. Se utilizó un cuestionario de 23 preguntas que evalúa el maltrato psicológico, físico, académico y sexual. Adicionalmente se solicitó datos demográficos, académicos y aspectos relacionados a la denuncia del maltrato. Resultados el cuestionario fue llenado por 348 residentes. La edad media fue 28 ± 3 años y hubo predomino del sexo femenino (63,2%). Participaron residentes de 32 hospitales, la mayoría era de 1° año (50,3%) y de especialidades clínicas (60,6%). Acorde al cuestionario, 339 residentes (97,4%) refirieron algún grado de maltrato. Relacionando las especialidades con el maltrato, el mismo fue mayor en las quirúrgicas: RR 1,4 IC 95% 1,0-1,9 (p 0,01). Los principales responsables del maltrato fueron los residentes superiores (55,2%) y los jefes de salas (31,8%). La denuncia fue realizada por 8% de los afectados. El principal motivo para no denunciar fue el temor a que realizarla le traería problemas (67,8%). Conclusiones el maltrato fue referido por 97,4% de los residentes, siendo mayor en las especialidades quirúrgicas. Urge aplicar medidas preventivas para evitar este tipo de abusos durante la residencia.
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O'Connor AB, McGarry K, Kisielewski M, Catalanotti JS, Fletcher KE, Simmons R, Zetkulic M, Finn K. Internal Medicine Residency Program Director Awareness and Mitigation of Residents' Experiences of Bias and Discrimination. Am J Med 2023:S0002-9343(23)00203-6. [PMID: 37004954 DOI: 10.1016/j.amjmed.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/17/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Alec B O'Connor
- Internal Medicine Residency Associate Director and Professor of Medicine, University of Rochester School of Medicine and Dentistry.
| | - Kelly McGarry
- Program Director, General Internal Medicine/Primary Care Residency, Department of Medicine, Alpert Medical School at Brown University, Providence RI
| | - Michael Kisielewski
- Assistant Director of Surveys and Research, Alliance for Academic Internal Medicine, Alexandria, VA
| | - Jillian S Catalanotti
- Vice Chair for Academic Affairs, General Internal Medicine Division Director and Professor of Medicine, The George Washington University School of Medicine and Health Sciences
| | - Kathlyn E Fletcher
- Internal Medicine Residency Director and Professor of Medicine, Department of Internal Medicine and the Robert D. and Patricia E. Kern Institute, Medical College of Wisconsin and the Milwaukee VAMC
| | - Rachel Simmons
- Internal Medicine Residency Director, Department of Medicine, Alpert Medical School at Brown University
| | - Marygrace Zetkulic
- Internal Medicine Residency Director and Associate Professor of Medicine, Hackensack-Meridian School of Medicine
| | - Kathleen Finn
- Internal Medicine Residency Director, Vice Chair of Education, Department of Medicine, Associate Professor, Tufts University School of Medicine
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Lu DW, Zhan T, Bilimoria KY, Reisdorff EJ, Barton MA, Nelson LS, Beeson MS, Lall MD. Workplace Mistreatment, Career Choice Regret, and Burnout in Emergency Medicine Residency Training in the United States. Ann Emerg Med 2023; 81:706-714. [PMID: 36754699 DOI: 10.1016/j.annemergmed.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 02/10/2023]
Abstract
STUDY OBJECTIVE The influence of workplace mistreatment on the well-being and career satisfaction of emergency medicine residents is unknown. This study examined the relationships between burnout, career choice regret, and workplace mistreatment in a national sample of emergency medicine residents. METHODS This was a secondary analysis of a survey study on the prevalence of workplace mistreatment among emergency residents. Residents who reported emotional exhaustion or depersonalization at least once per week were considered to have burnout. Residents who reported dissatisfaction with their decision to become an emergency physician were considered to have career choice regret. Respondents also reported the type (discrimination, abuse, sexual harassment) and frequency of mistreatment over the academic year. Multivariable logistic regression, adjusting for program characteristics, was used to examine resident characteristics associated with burnout and career choice regret, with the frequency of mistreatment as a covariate. RESULTS Of the 8,162 eligible residents, 7,680 (94.1 %) participated. About a third of respondents reported burnout (2,188 of 6,902, 31.7%), whereas a minority (224 of 6,923, 3.2%) reported career choice regret. Of the 7,087 responses on mistreatment frequency, 2,117 (29.9%) reported "a few times per year," and 1,296 (18.3%) reported "a few times per month or more." Compared with residents who never experienced mistreatment, residents who reported increasing frequencies of mistreatment were associated with having burnout-from mistreatment a few times per year (OR [odds ratio],1.6; 99% CI [confidence interval], 1.3 to 1.9) to a few times per month or more (OR, 3.3; 99% CI, 2.7 to 4.1). Compared with residents without burnout, residents who reported burnout were associated with having career choice regret (OR, 11.3; 99% CI, 7.0 to 18.1). After adjusting for burnout, there were no significant relationships between the frequency of mistreatment and career choice regret. CONCLUSIONS Workplace mistreatment is associated with burnout, but not career choice regret, among emergency medicine residents. Efforts to address workplace mistreatment may improve emergency medicine residents' professional well-being.
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Affiliation(s)
- Dave W Lu
- Department of Emergency Medicine, University of Washington, Seattle, WA.
| | - Tiannan Zhan
- Department of Surgery, Northwestern University, Chicago, IL
| | | | | | | | - Lewis S Nelson
- Department of Emergency Medicine, Rutgers University, New Brunswick, NJ
| | | | - Michelle D Lall
- Department of Emergency Medicine, Emory University, Atlanta, GA
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Pillado EB, Li RD, Eng JS, Chia MC, Conway A, Gomez-Sanchez C, Shaw P, Sheahan MG, Bilimoria KY, Hu YY, Coleman DM. Persistent racial discrimination among vascular surgery trainees threatens wellness. J Vasc Surg 2023; 77:262-268. [PMID: 36245144 DOI: 10.1016/j.jvs.2022.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/12/2022] [Accepted: 09/08/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Racial/ethnic discrimination is one form of mistreatment and a known risk factor for physician burnout. In the present study, we aimed to characterize the forms and identify the sources of racial/ethnic discrimination among vascular surgery trainees. METHODS We performed a cross-sectional study of U.S. vascular surgery trainees who had voluntarily participated in an anonymous survey administered after the 2021 Vascular Surgery In-Training Examination. The primary outcome measures were self-reported mistreatment and sources of mistreatment between race and ethnicity groups. We used χ2 tests and logistic regression for bivariate and multivariable analyses, respectively. RESULTS Representing all 123 vascular surgery training programs, 510 trainees (66.9% men) participated in the survey (83.6% response rate). Most of the trainees had self-identified as White (53.1%), followed by Asian (24.4%), Hispanic/Latinx (7.6%), Black (4.2%), and other/prefer not to say (10.8%). No significant differences were found in the self-reported duty hour violations among the groups. Black (56.3%) and Asian (36.3%) trainees reported higher rates of racial/ethnic discrimination compared with the White, Hispanic/Latinx, and other/prefer not to say groups (P < .001). Patients and their families were reported as the most common source (74.7%). Other reported sources of discrimination included nurses or staff (60%), attendings (37.4%), co-residents (31.3%), and administration (16.9%). Regarding specific forms of racial discrimination, Black and Asian trainees reported the highest rates of different standards of evaluation (20% and 5.9%, respectively), being mistaken for a nonphysician (50.0% and 5.9%, respectively), slurs and/or hurtful comments (13.3% and 5.9%, respectively), social isolation (13.0% and 1.0%, respectively), and being mistaken for another trainee of the same race/ethnicity (60.0% and 33.7%, respectively). Only 62.5% of Black trainees reported their program/institution would take their mistreatment report seriously compared with the White (88.9%), Hispanic/Latinx (88.2%), Asian (83.2%), and other/prefer not to say (71.4%) trainees (P = .01). On multivariable analysis, female gender (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.44-4.33), Asian race (OR, 6.9; 95% CI, 3.53-13.3), Black race (OR, 13.6; 95% CI, 4.25-43.4), and training in the Southeastern United States (OR, 3.8; 95% CI, 1.17-12.80) were risk factors for racial/ethnic discrimination. CONCLUSIONS The results from the survey revealed that racial/ethnic discrimination persists in surgical training programs, with Asian and Black trainees reporting higher rates than other racial and ethnic groups. Overall, patients and family members were the most common source of racial/ethnic discrimination. However, faculty, staff, and co-trainees also contributed to racial/ethnic discrimination. Further interventions that optimize diversity, equity, and inclusion strategies and policies to address all forms of racial/ethnic discrimination with faculty, staff, and patients within the hospital are critically needed.
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Affiliation(s)
- Eric B Pillado
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Chicago, IL
| | - Ruojia Debbie Li
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Chicago, IL
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Chicago, IL
| | - Matthew C Chia
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Chicago, IL
| | - Allan Conway
- Division of Vascular Surgery Lenox Hill Hospital, Department of Surgery, Northwell Health, New York, NY
| | - Clara Gomez-Sanchez
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Palma Shaw
- Division of Vascular Surgery, Upstate Medical University, Syracuse, NY
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Chicago, IL
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Chicago, IL
| | - Dawn M Coleman
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
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Kemper KJ, Schwartz A. Update on Mistreatment and Burnout in Pediatric Residents. Acad Pediatr 2022:S1876-2859(22)00630-1. [PMID: 36581102 DOI: 10.1016/j.acap.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/02/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Kathi J Kemper
- Department of Pediatrics, College of Medicine (KJ Kemper), The Ohio State University, Columbus.
| | - Alan Schwartz
- Departments of Medical Education and Pediatrics (A Schwartz), University of Illinois College of Medicine, Chicago
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Joung RH, Amortegui D, Silver CM, Mackiewicz NI, Eng JS, Rosenkranz KM, Johnson J, Bilimoria KY, Hu YY. A National Mixed-Methods Evaluation of General Surgery Residency Program Responsiveness and the Association with Resident Wellness. JOURNAL OF SURGICAL EDUCATION 2022; 79:e1-e11. [PMID: 35660306 DOI: 10.1016/j.jsurg.2022.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Resident burnout is highly prevalent in general surgery. Burnout is increasingly recognized as a symptom of an unsupportive workplace. The objectives of this study were to describe resident perceptions of program responsiveness and to identify associated factors. METHODS We used a convergent mixed-methods design. A cross-sectional survey was administered to all U.S. general surgery residents following the 2020 ABSITE, querying resident perceptions of their learning environment (including program responsiveness), burnout, thoughts of attrition and suicide, and career satisfaction. Multivariable logistic regression models adjusting for program/resident characteristics assessed associations of program responsiveness with aspects of the learning environment and resident wellness. 366 interviews and 27 focus groups with residents and faculty were conducted during in-person visits to 15 residency programs. Transcripts were analyzed thematically using inductive and deductive logics until thematic saturation was achieved. RESULTS Of the 7233 clinically active residents from 323 programs who completed the survey (85.5% response rate), 5256 had data available for all outcomes of interest. 72.1% (n = 3791) reported satisfaction with program responsiveness. These residents were significantly less likely to report 80-hour workweek violations (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.18-0.26), burnout (OR 0.47, 95% CI 0.41-0.53), thoughts of attrition (OR 0.32, 95% CI 0.27-0.38), and suicidality (OR 0.52, 95% CI 0.41-0.65). They were significantly more likely to report satisfaction with career choice, personal life, and work-life balance (all p < 0.001). Factors associated with improved perception of program responsiveness included larger program size (50+ vs. <23 residents; OR 1.48, 95% CI 1.01-2.19), having faculty mentorship (OR 2.64, 95% CI 2.22-3.14), having meaningful input into call and vacation schedules (OR 3.31, 95% CI 2.74-4.00), and feeling comfortable speaking up (OR 4.20, 95% CI 3.47-5.09). We conducted a qualitative analysis to identify the following components of program responsiveness: (1) core values reflecting a shared understanding of the importance of resident voice in shaping the training experience and the program, including mutual trust and respect between residents and faculty, transparency and communication, resident unity, and resident participation in and ownership of program improvement; (2) structural constructs that reflect and support responsiveness; (3) mechanisms for supporting resident agency, including resources and leadership support, faculty advocacy, and resident leadership opportunities. CONCLUSION Program responsiveness in surgical residency is associated with improved resident wellness. Programs should develop formal channels to elicit and concretely address resident concerns, provide opportunities for resident representation, and entrust residents with the flexibility and autonomy to make decisions that support their own education and wellness.
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Affiliation(s)
- Rachel H Joung
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniela Amortegui
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois
| | - Casey M Silver
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois
| | - Natalia I Mackiewicz
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois
| | - Kari M Rosenkranz
- Department of Surgery, Dartmouth University Geisel School of Medicine, New Hampshire, Lebanon
| | - Julie Johnson
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Meeks LM, Conrad SS, Nouri Z, Moreland CJ, Hu X, Dill MJ. Patient And Coworker Mistreatment Of Physicians With Disabilities. Health Aff (Millwood) 2022; 41:1396-1402. [DOI: 10.1377/hlthaff.2022.00502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Lisa M. Meeks
- Lisa M. Meeks, University of Michigan, Ann Arbor, Michigan
| | - Sarah S. Conrad
- Sarah S. Conrad, Association of American Medical Colleges, Washington, D.C
| | - Zakia Nouri
- Zakia Nouri, Association of American Medical Colleges
| | | | - Xiaochu Hu
- Xiaochu Hu, Association of American Medical Colleges
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Barbanti PCM, de Oliveira SRL, de Medeiros AE, Bitencourt MR, Victorino SVZ, Bitencourt MR, Alarcão ACJ, Egger PA, Pelloso FC, Borghesan DHP, de Souza MP, Marques VD, Pelloso SM, Carvalho MDDB. Prevalence and Impact of Academic Violence in Medical Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11519. [PMID: 36141787 PMCID: PMC9517415 DOI: 10.3390/ijerph191811519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
Situations of mistreatment in the academic environment are prevalent worldwide, but research in this area is scarce in middle-low-income countries. This study aimed to estimate the prevalence of mistreatment inflicted against Brazilian medical students. In addition, characterize these situations and analyze their consequences. Cross-sectional study conducted with 831 medical students from public and private institutions. Absolute and relative frequencies of the analyzed variables and possible associations were determined through univariate and multivariate logistic regression. Chi-square test of association with second-order Rao-Scott adjustment was also used. The response rate was 56%. Public institution pointed to a higher prevalence of mistreatment when compared to private (59% versus 43%). Female students were the most affected. Verbal and psychological aggression was more prevalent. The aggressor usually was a faculty member. Mistreatment incidence increased over the years of training, with higher rates in the internship. About 94% of the students felt affected in anyway, with 77% feeling diminished and depressed. More than 50% reported impaired academic performance. Almost 30% sought help from experts. The reporting rate was extremely low. Adequate identification of the situations by the victims, safe reporting mechanisms and, an educational system capable of maintaining an appropriate learning environment are essential to break this destructive cycle.
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Zeidan A, Patel J, Dys G, Dean L, Curt A, Lin MP, Samuels-Kalow M. "Why bother?": Barriers to reporting gender and sexual harassment in emergency medicine. Acad Emerg Med 2022; 29:1067-1077. [PMID: 35791497 DOI: 10.1111/acem.14544] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gender and sexual harassment in emergency medicine (EM) is persistent in the workplace but remains underreported. Barriers to reporting in EM are largely unknown. This study explored barriers to reporting gender and sexual harassment among EM faculty and residents and potential improvements to reporting systems. METHODS We conducted semistructured interviews with EM faculty and residents across the United States, utilizing purposive sampling to ensure diverse representation. All interviews were recorded, transcribed, and coded by two independent investigators. Interviews were conducted until thematic saturation and prominent themes were identified from coded data. RESULTS A total of 32 interviews were completed with women and men faculty and residents. Prominent themes were identified representing compounding barriers to reporting. Participants described confusion over what constitutes a reportable definition of gender and sexual harassment, unfamiliarity with reporting processes, and multiple avenues (both informal and formal through departmental, hospital, and institutional systems) for reporting. Participants expressed limited confidence in formal reporting systems and related several perceived and actual negative outcomes of reporting. A number of improvements were recommended centering around creating reporting systems that supported, empowered, and protected survivors; improving transparency about reporting processes; and ensuring accountability at a departmental and institutional level. CONCLUSIONS Significant barriers to reporting exist and deter individuals from reporting. Given the negative consequences of ongoing gender and sexual harassment, emergency departments and institutions must take responsibility to reduce barriers and support individuals throughout the reporting process.
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Affiliation(s)
- Amy Zeidan
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jasmyne Patel
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gabrielle Dys
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laura Dean
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexa Curt
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle P Lin
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Margaret Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Weinand JD, Kvach EJ, O’Connell R. Experiences of transgender and nonbinary physicians during residency training. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:436-446. [PMID: 37901054 PMCID: PMC10601501 DOI: 10.1080/26895269.2022.2098219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Background: Little is known about the experiences of transgender and gender non-binary (TNB) physicians in medical residency training programs. Aim: To identify the self-reported experiences and needs of TNB individuals during medical residency in United States training programs. Methods: An online, anonymous survey of TNB current residents and recent graduates was designed. Results: A total of 26 respondents completed the survey. The most common reported gender identity was non-binary or gender queer (n = 11, 42.3%) and male or transgender man (n = 7, 26.9%). About half of participants (n = 14, 53.8%) had undergone gender affirming interventions prior to residency. Most participants (n = 19, 73.1%) did not know all the gender affirming healthcare benefits offered by their program. The majority (n = 21, 80.8%) also reported 2 hours or less of transgender-related didactics in residency. Respondents were most likely to disclose their gender identity to other residents (n = 19, 73.1%) and faculty (n = 19, 73.1%) and were least likely to disclose their identity to patients (n = 6, 23.1%). Most respondents (n = 15, 57.7%) stated that program faculty and staff communicated support for their gender identity. Most participants (n = 16, 61.5%) reported that they perceived transgender residents to be treated similarly to their non-transgender peers in their training program, while the remainder (n = 7, 26.9%) disagreed or strongly disagreed. Nevertheless, approximately three-quarters of trainees (n = 22, 84.6%) self-reported microaggressions during their training program and non-binary and transfeminine trainees were more likely to report these experiences than transmasculine people. Nearly a quarter of transfeminine and non-binary participants reported macroaggressions, with none of the transmasculine respondents reporting these negative experiences. Most macroaggressions were from program faculty. Discussion: This study highlights that while most physicians in residency report support from their program for their TNB identity, TNB physicians still experience significant barriers and prejudices throughout training and more action is needed among program faculty for support of TNB trainees.
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Affiliation(s)
| | - Elizabeth J. Kvach
- Denver Health and Hospital Authority, Denver, Colorado, USA
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ryan O’Connell
- University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, Colorado, USA
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Täuber S, Loyens K, Oertelt-Prigione S, Kubbe I. Harassment as a consequence and cause of inequality in academia: A narrative review. EClinicalMedicine 2022; 49:101486. [PMID: 35747190 PMCID: PMC9167878 DOI: 10.1016/j.eclinm.2022.101486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/25/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022] Open
Abstract
UNLABELLED A growing body of literature suggests that over the past 30 years, policies aimed at tackling harassment in academia have had little discernable effect. How can this impasse be overcome to make the higher education sector a safe space for everyone? We combine the areas of harassment and inequality, intersectionality, policy-practice gaps, gender sensitive medicine, as well as corruption and whistleblower processes to identify lacunae and offer recommendations for how to apply our recommendations in practice. We have been searching the most influential, relevant, and recent literature on harassment and inequality in our respective fields of expertise. By studying conceptual overlaps between the different fields, we were able to create insights that go beyond the insights of the most recent reviews. Our synthesis results in three concrete recommendations. First, harassment and inequality are mutually reinforcing. Failure to adequately tackle harassment contributes to perpetuating and reproducing inequality. Further, the intersectional nature of inequality has to be acknowledged and acted upon. Second, enforcing anti-harassment policies should be a top priority for universities, funders, and policymakers. Third, sexual harassment should be treated as institutional-level integrity failure. The higher education sector should now focus on enforcing existing anti-harassment policies by holding universities accountable for their effective implementation - or risk being complicit in maintaining and reproducing inequality. FUNDING We have received no funding for this research.
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Affiliation(s)
- Susanne Täuber
- University of Groningen, Groningen, The Netherlands
- Corresponding author.
| | - Kim Loyens
- Utrecht University, Utrecht, The Netherlands
| | - Sabine Oertelt-Prigione
- Radboud University Medical Center, Nijmegen, The Netherlands
- Bielefeld University, Bielefeld, Germany
| | - Ina Kubbe
- Tel Aviv University, Tel Aviv, Israel
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31
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Westafer LM, Freiermuth CE, Lall MD, Muder SJ, Ragone EL, Jarman AF. Experiences of Transgender and Gender Expansive Physicians. JAMA Netw Open 2022; 5:e2219791. [PMID: 35767255 PMCID: PMC9244607 DOI: 10.1001/jamanetworkopen.2022.19791] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/16/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Although LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority) physicians experience bias in the workplace, there is a paucity of data on the experiences of physicians who identify specifically as transgender and/or gender expansive (TGE; gender expansive is an umbrella term encompassing individuals and gender identities that may exist beyond the binary framework [eg, may include nonbinary, genderqueer, and agender individuals]). Objectives To explore the professional experiences of TGE physicians, identify barriers to inclusion, and highlight stakeholder-derived strategies that promote an inclusive workplace. Design, Setting, and Participants This qualitative study informed by semistructured interviews was conducted among 24 TGE physicians in the US from April 1 to December 31, 2021. The sample of TGE physicians was recruited using convenience and snowball sampling. Interviews were recorded and transcribed. Using thematic analysis, at least 2 members of the research team performed blinded coding of each transcript, in an iterative process. Main Outcomes and Measures Data collection and thematic analysis examining themes of physicians' experiences. Results Among 24 physicians (mean [SD] age, 39 [1.4] years) interviewed, 8 (33%) self-identified as transgender women, 7 (29%) as transgender men, 4 (17%) as nonbinary, 3 (13%) as transgender and nonbinary, and 2 (8%) as genderqueer. Prominent themes of the interviews included emotional distress as a result of transphobia, dominance of a rigid binary gender paradigm, and structural and institutional factors that are associated with psychological and physical safety and feelings of isolation as a TGE physician. Clear steps of affirmation were identified that could mitigate the emotional stressors, including signs of safety, active allyship, and mentorship by other TGE physicians. Conclusions and Relevance In this qualitative study, TGE physicians reported facing both overt and subtle biases associated with their identity and gender presentation. Participants also noted several interpersonal and structural factors that mitigate the effect of these biases.
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Affiliation(s)
- Lauren M. Westafer
- Department for Healthcare Delivery and Population Science, University of Massachusetts Chan Medical School–Baystate, Springfield
- Department of Emergency Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield
| | - Caroline E. Freiermuth
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michelle D. Lall
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah J. Muder
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Eleanor L. Ragone
- Department of Emergency Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield
| | - Angela F. Jarman
- Department of Emergency Medicine, University of California, Davis, Sacramento
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Hsiang E, Ritchie AM, Lall MD, Driver L, Moll J, Sonn B, Totten VY, Williams DB, McGregor AJ, Egan DJ. Emergency care of LGBTQIA+ patients requires more than understanding the acronym. AEM EDUCATION AND TRAINING 2022; 6:S52-S56. [PMID: 35783082 PMCID: PMC9222885 DOI: 10.1002/aet2.10750] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/06/2021] [Accepted: 11/21/2021] [Indexed: 06/15/2023]
Abstract
Emergency physicians (EPs) frequently deliver care to members of the LGBTQIA+ community in the emergency department. This community suffers from many health disparities important to understand as part of comprehensive care, and these disparities are infrequently discussed in emergency medicine education. Previous data also suggest a need for broader education to increase the comfort of EPs caring for LGBTQIA+ patients. A group of content experts identified key disparities, opportunities for expanded education, and strategies for more inclusive care of LGBTQIA+ patients.
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Affiliation(s)
- Elaine Hsiang
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Amanda M. Ritchie
- Departments of Emergency Medicine and Internal MedicineLouisiana State UniversityNew OrleansLouisianaUSA
| | - Michelle D. Lall
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Lachlan Driver
- Department of Emergency MedicineHarvard Affiliated Emergency Medicine ResidencyMass General BrighamBostonMassachusettsUSA
| | - Joel Moll
- Department of Emergency MedicineVCU School of MedicineVCU HealthRichmondVirginiaUSA
| | | | | | - Dustin B. Williams
- Department of Emergency MedicineUT‐Southwestern Medical CenterDallasTexasUSA
| | - Alyson J. McGregor
- Department of Emergency MedicineDivision of Sex and Gender in Emergency MedicineWarren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Daniel J. Egan
- Department of Emergency MedicineHarvard Affiliated Emergency Medicine ResidencyMass General BrighamBostonMassachusettsUSA
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Driver L, Egan DJ, Hsiang E, Lall MD, Moll J, Ritchie AM, Sonn BJ, Totten VY, Williams DB, McGregor AJ. Block by block: Building on our knowledge to better care for LGBTQIA+ patients. AEM EDUCATION AND TRAINING 2022; 6:S57-S63. [PMID: 35783077 PMCID: PMC9222888 DOI: 10.1002/aet2.10755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Emergency physicians need to recognize the diversity of identities held by sexual and gender minorities, as well as the health implications and inequities experienced by these communities. Identities such as lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual, aromantic, and many others fall under the LGBTQIA+ acronym. This wide spectrum is seldom discussed in emergency medicine but nonetheless impacts both patient care and patient experience in acute and critical care settings. AIMS This commentary aims to provide a brief but nonexhaustive review of LGBTQIA+ identities and supply a critical framework for applying this understanding to patient encounters in the emergency department, as well as describe the challenges and educational aims at the level of medical school, residency, and postresidency. MATERIALS AND METHODS The commonly used and widely accepted definitions of LGBTQIA+ terms are described, as well as implications for patient care and emergency physician education. The authors of this writing group represent the Society for Academic Emergency Medicine, LGBTQ Task Force of the Academy of Diversity Inclusion in Medicine. RESULTS LGB terms are addressed, with LGBTQIA+ adding "intersex," "asexual," and "+," to include other gender identities and sexual orientations which are not already included. This paper also addresses the terms "transition," "nonbinary," "polyamorous." "two-spirit," "queer," and others. These acronyms and terms continually expand and evolve in the pursuit of inclusivity. Additionally, with some health issues potentially related to medications, hormones, surgery, or to internal or external genitalia, important EM physician tools include gathering an "organ inventory," asking about sexual history, and conducting a physical exam. DISCUSSION Most persons have congruent biological sex, gender identity, and attraction to the "opposite" gender. However, humans can have every imaginable variation and configuration of chromosomes, genitalia, gender identities, sexual attractions, and sexual behaviors. Terms and definitions are constantly changing and adapting; they may also vary by local culture. Obtaining relevant medical history, conducting an "organ inventory," asking about sexual history in a nonjudgmental way, and conducting a physical exam when warranted can all be important in delivering best possible medical care. Although there has been increased focus on education at the medical school, residency, and faculty level on LGBTQIA+ patient care in the ED, much work remains to be done. CONCLUSION Emergency physicians should feel confident in providing a model of care that affirms the sexual and gender identities of all the patient populations we serve. Optimal patient-centric care requires a deeper understanding of the patient's biology, gender identity, and sexual behavior encapsulated into the ever-growing acronym LGBTQIA+.
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Affiliation(s)
- Lachlan Driver
- Department of Emergency MedicineHarvard Affiliated Emergency Medicine ResidencyMass General BrighamBostonMassachusettsUSA
| | - Daniel J. Egan
- Department of Emergency MedicineHarvard Affiliated Emergency Medicine ResidencyMass General BrighamBostonMassachusettsUSA
| | - Elaine Hsiang
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Michelle D. Lall
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Joel Moll
- Department of Emergency MedicineVCU School of MedicineVCU HealthRichmondVirginiaUSA
| | - Amanda M. Ritchie
- Departments of Emergency Medicine and Internal MedicineLouisiana State UniversityNew OrleansLouisianaUSA
| | - Brandon J. Sonn
- Department of Emergency MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Vicken Y. Totten
- Emergency MedicineKaweah Delta Health SystemsVisaliaCaliforniaUSA
| | - Dustin B. Williams
- Department of Emergency MedicineUT‐Southwestern Medical CenterDallasTexasUSA
| | - Alyson J. McGregor
- Department of Emergency MedicineDivision of Sex and Gender in Emergency MedicineWarren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
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Lu DW, Lee J, Alvarez A, Sakamoto JT, Bird SB, Sundaram V, Lall MD, Nordenholz KE, Manfredi RA, Blomkalns AL. Drivers of professional fulfillment and burnout among emergency medicine faculty: A national wellness survey by the Society for Academic Emergency Medicine. Acad Emerg Med 2022; 29:987-998. [PMID: 35304931 DOI: 10.1111/acem.14487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/03/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Professional fulfillment and the mitigation of burnout can enhance clinician well-being and the resiliency of the health care organization. This study examined the extent to which specific individual and workplace factors are associated with professional fulfillment and burnout among a national sample of academic emergency physicians. METHODS This was a cross-sectional survey of faculty members of the Society for Academic Emergency Medicine. Primary outcomes were professional fulfillment and burnout. The survey also examined individual and workplace factors as well as faculty's thoughts of attrition from academic and clinical medicine. Logistic regression was performed to determine the relationships between each outcome and each factor, respectively. RESULTS A total of 771 of 3130 faculty completed the survey (response rate 24.6%). A total of 38.7% reported professional fulfillment and 39.1% reported burnout. Meaningfulness of work (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.9-2.5), perceived appreciation (OR 1.9, 95% CI 1.7-2.1), and the academic work environment (OR 1.7, 95% CI 1.5-1.9) had the highest odds of being associated with professional fulfillment. In contrast, low score responses for meaningfulness of work (OR 0.6, 95% CI 0.5-0.6), self-compassion (0.6, 95% CI 0.5-0.6), and control over schedule (OR 0.6, 95% CI 0.6-0.7) were most associated with burnout. Faculty with professional fulfillment were less likely to report plans for attrition from academics (OR 0.1, 95% CI 0.1-0.2) and from clinical medicine (OR 0.2, 95% CI 0.1-0.4). Faculty with burnout were more likely to report plans for attrition from academics (OR 7, 95% CI 4.8-10.4) and clinical medicine (OR 5.7, 95% CI 3.9-8.6). CONCLUSIONS Individual and workplace factors that contributed to professional fulfillment and burnout were identified, with meaningfulness of clinical work demonstrating the strongest association with both occupational phenomena. Knowledge of which factors are most impactful in promoting professional fulfillment and mitigating burnout may be useful in guiding efforts to enhance clinician well-being.
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Affiliation(s)
- Dave W. Lu
- Department of Emergency Medicine University of Washington School of Medicine Seattle Washington USA
| | - Justin Lee
- Quantitative Sciences Unit, Department of Medicine Stanford University School of Medicine Stanford California USA
| | - Alai Alvarez
- Department of Emergency Medicine Stanford University School of Medicine Stanford California USA
| | - Jeffrey T. Sakamoto
- Department of Emergency Medicine Stanford University School of Medicine Stanford California USA
| | - Steven B. Bird
- Department of Emergency Medicine UMass Memorial Healthcare and University of Massachusetts Medical School Worcester Massachusetts USA
| | - Vandana Sundaram
- Quantitative Sciences Unit, Department of Medicine Stanford University School of Medicine Stanford California USA
| | - Michelle D. Lall
- Department of Emergency Medicine Emory University Atlanta Georgia USA
| | | | - Rita A. Manfredi
- Department of Emergency Medicine The George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Andra L. Blomkalns
- Department of Emergency Medicine Stanford University School of Medicine Stanford California USA
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Pinkhasov A, Filangieri C, Rzeszut M, Wilkenfeld M, Akerman M, Divers J, Oliveras J, Bostwick JM, Svoronos A, Peltier MR. The Effect of Abuse and Mistreatment on Healthcare Providers (TEAM): A Survey Assessing the Prevalence of Aggression From Patients and Their Families and Its Impact. J Occup Environ Med 2022; 64:e136-e144. [PMID: 34935679 DOI: 10.1097/jom.0000000000002467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Aggression from patients and families on health care providers (HCP) is common yet understudied. We measured its prevalence and impact on HCPs in inpatient and outpatient settings. METHODS Four thousand six hundred seven HCPs employed by a community teaching hospital received an anonymous survey with results analyzed. RESULTS Of 1609 HCPs (35%) completing the survey, 88% of inpatient staff reported experiencing different types of aggression compared to 82% in outpatient setting. Almost half did not report it to their supervisor. Younger staff were more likely to report abuse. Negative impacts on productivity and patient care were reported. A third of all responders' indicated negative effects on mental health. CONCLUSIONS Despite negative impacts on staff wellbeing and productivity, patient/family aggression toward HCPs is highly prevalent and underreported. Our healthcare system needs measures to address staff security and wellness.
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Affiliation(s)
- Aaron Pinkhasov
- Department of Psychiatry, NYU Long Island School of Medicine, Mineola, New York (Dr Pinkhasov, Dr Filangieri, Ms Rzeszut, and Ms Oliveras); Department of Medicine, NYU Long Island School of Medicine, Mineola, New York (Dr Pinkhasov and Dr Svoronos); Division of Occupational Medicine, Department of Medicine, NYU Long Island School of Medicine, Mineola, New York (Dr Wilkenfeld); Division of Health Outcomes Research, Department of Foundations of Medicine, NYU Long Island School of Medicine, Mineola, New York (Ms Akerman and Dr Divers); Department of Psychiatry, Mayo Clinic, Rochester, Minnesota (Dr Bostwick); Department of Psychiatry, Jersey Shore University Medical Center, Neptune, New Jersey (Dr Peltier)
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