Bullying, Undermining, and Harassment in Vascular Surgical Training in the UK: How Can it be Confronted?

#SpeakUpOrtho: Narratives of Women in Orthopaedic Surgery-Invited Manuscript

Microaggressions, bullying, harassment, sexual harassment, and discrimination continue to be experienced by orthopaedic physicians in the workplace. Oftentimes, these behaviors go unreported because of fear of retaliation, and many perpetrators are not held accountable. This article provides examples of stories anonymously submitted to #SpeakUpOrtho on the topics of microaggressions, bullying/harassment, sexual harassment, discrimination, and retaliation by orthopaedic surgery residents, fellows, and attending surgeons. Commentary by experts in the field is also included to provide ways to manage and prevent the perpetuation of these behaviors.

Bullying in Vascular Surgery Trainees

OBJECTIVES

Bullying is defined as the perception of negative actions in which the target has difficulty in defending themself. This may include verbal, physical, or psychological force used to influence behavior. We sought to understand factors associated with bullying identified in vascular surgery trainees as well as barriers to reporting.

METHODS

An anonymous electronic survey consisting of demographic information and validated scales for bullying (NAQ-R), social support, and grit was sent to vascular surgery trainees in the United States. Respondents who reported bullying were compared to those who were not bullied.

RESULTS

Of the 516 invitations sent, 132 (26%) completed the survey. 63/132 (48%) reported being bullied or witnessed a fellow trainee being bullied in the past 6 months, with 42 (32%) reporting being bullied. Gender, marital status, paradigm of vascular training, grit level, and social support did not predict reception of bullying, although those in the highest quartile of grit showed a trend towards lower NAQ-R scores (p=0.06). As expected, trainees that reported receiving bullying had a higher NAQ-R (p<0.0001). No trainee reported daily bullying but 52% reported bullying "now and then" or several times a week. The most common perpetrator was their direct superior surgeon, although 12 (29%) reported bullying from co-residents and 6 (14%) reported bullying from patients. 15/42 (36%) did not address the bullying behavior, and the most common barriers to reporting bullying identified were fear of loss of support from supervisor (48%), loss of reputation (45%), and effect on career choices (43%). Of those who reported addressing the behavior, 56% reported the behavior continued. 70/132 (53%) reported no knowledge of institution-specific policies to address bullying in their program. The most common reasons identified for why bullying may occur in vascular training programs are "high stress environments" and "learned behavior" from others.

CONCLUSIONS

Bullying occurs in a significant amount of vascular trainees, but there are no clearly identified factors predictive of who will receive bullying. Trainees with higher grit may experience less bullying or more likely have a lower perception of bullying behavior. Further research is needed to determine the effects of bullying on vascular trainees.

A cross-sectional national study of burnout and psychosocial work environment in vascular surgery in Denmark

OBJECTIVE

Little is known about burnout among European vascular surgeons. In this study, the prevalence of burnout and its associated risk factors were investigated among all vascular surgeons (VS) and vascular surgeons in training (VST) in Denmark.

METHODS

An anonymous electronic survey was distributed to all clinical active VS and VST on the 1st of January 2020. Validated assessment tools were used to measure burnout and aspects of the psychosocial work environment.

RESULTS

104 VSs and VSTs were invited to participate, and 82% (n=85) completed the survey. The majority of the respondents were male (60%, n=50) and VSs (67%, n=61). Of the respondents, 82% (n=70) reported either light (54%, n=46), moderate (22%, n=19) or severe (6%, n=5) personal burnout. More than 50% (n=47) reported work-related burnout, respectively light (39%, n=33), moderate (9%, n=8) and severe (7%, n=6), while 35% (n=30) reported patient-related burnout, respectively light (31%n=26), moderate (2%, n=2) and severe (2%, n=2). Respondents with more than four 24-hour-on-call shifts/month had significantly higher work-related burnout scores, while respondents with home-living children and those aged 45-59 years respectively showed significantly higher personal and patient-related burnout. There were strong associations between personal and work-related burnout and the psychosocial work environment, especially work organisation and interpersonal relations, but not job demands. The prevalence of burnout was unevenly distributed across departments, with the most affected department having a burnout occurrence twice the least affected department.

CONCLUSIONS

Based on a national survey conducted among all clinical active VSs and VSTs in Denmark, more than 80% (n=70) suffered from burnout, of which 28% (n=24) suffered from moderate to severe personal burnout. The strong association with the psychosocial work environment, and the significant differences between departments, suggest that burnout is modifiable through changes in the work environment.

A Report of Gender Bias and Sexual Harassment in Current Plastic Surgery Training: A National Survey

BACKGROUND

Gender bias and sexual misconduct continue to pervade medicine. The authors hypothesize that gender bias and sexual misconduct disproportionately and negatively affect female plastic surgery trainees.

METHODS

A national survey of plastic surgery trainees (2018 to 2019) was conducted using previously validated sexual harassment surveys adapted for relevance to plastic surgery. Respondents were queried about experiences with workplace gender bias and harassment; personal and professional impact; and reporting practices. Analyses included chi-square, logistic regression, and analysis of variance. Significance was accepted for values of p < 0.05.

RESULTS

There were 236 responses (115 female respondents; 20.1 percent response rate). Most respondents were Caucasian (Asian/Pacific Islander, n = 34) residents (n = 123). The feeling of hindrance to career advancement was greater for women, by 10-fold (p < 0.001), and increased with age (p = 0.046). Women felt uncomfortable challenging attitudes regarding gender inequality (p < 0.001), regardless of training levels (p = 0.670) or race (p = 0.300). Gender bias diminished female trainees' career goals/ambition (p < 0.001). Women were more likely to experience sexual harassment, in the form of jokes (p = 0.003) and comments about their body or sexuality (p = 0.014). Respondents reported the majority of perpetrators of harassment to be attending physicians (30 percent) and other trainees (37 percent). Most common reasons to not report incidents included "futility" (29 percent) and "fear" (20 percent). Women experienced at least three symptoms of depression/anxiety, significantly higher than men (p = 0.001).

CONCLUSIONS

Gender bias and sexual misconduct negatively affect female trainees' attitudes toward their career. Two-thirds of cases of sexual harassment originate from other physicians. Minority trainees are less prepared to address transgressions and more likely to experience sexual coercion. Trainees perceive a culture nonconducive to reporting. These findings can guide changes and discussions surrounding workplace culture in plastic surgery training.