Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical Students.
Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical Students.
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美国医学生之间的性取向，虐待和倦怠之间的联系。
DOI：
10.1001/jamanetworkopen.2020.36136
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发表时间：
2021-02-01
影响因子：
13.8
通讯作者：
Gross CP
中科院分区：
文献类型：
--
作者：
Samuels EA;Boatright DH;Wong AH;Cramer LD;Desai MM;Solotke MT;Latimore D;Gross CP
在美国医学生中，性取向和职业倦怠之间是否存在关联？这种关联是否由虐待经历介导？对2016年和2017年毕业的美国医学生进行的横断面调查显示，与异性恋学生相比，女同性恋、男同性恋或双性恋（LGB）医学生的虐待和倦怠症状发生率明显更高。感知虐待的经验介导的LGB性取向和倦怠之间的关联，但并没有完全解释过度倦怠的LGB学生报告。这项研究的结果表明，医学生在性少数群体的报告增加倦怠的症状，无论他们认为的虐待经验。医疗实习生职业倦怠与护理质量差和自然减员有关。性少数群体中的医学生报告害怕歧视和虐待增加，但性取向，倦怠和虐待之间的关联尚不清楚。评估医学生倦怠是否因性取向而异，以及这种关联是否由虐待经历介导。这项横断面研究调查了从美国医学院协会（AAMC）认证的美国对抗疗法医学院毕业的美国医学生，他们在2016年和2017年回答了AAMC毕业问卷。于2019年3月15日至2020年7月2日和2020年11月20日至12月9日进行统计分析。职业倦怠是用奥尔登堡医学生职业倦怠量表测量的，性取向被分为异性恋或女同性恋、男同性恋或双性恋（LGB）。建立Logistic回归模型，以评估性取向和经历倦怠（定义为在疲惫和脱离倦怠维度的前四分位数）之间的关联，并测试中介协会的虐待。从2016年到2017年，30 651名学生完成了AAMC毕业问卷，并对26 123份回复进行了分析。大多数受访者年龄在30岁以下（82.9%）和白色（60.3%）。共有13 470名受访者（51.6%）是男性，5.4%被认为是LGB。与异性恋学生相比，更大比例的LGB学生报告说经历过所有类别的虐待，包括羞辱（27.0%的LGB学生vs 20.7%的异性恋学生; P < .001），虐待不特定于身份（17.0%对10.3%; P < .001），以及性别特异性虐待（27.3%对17.9%; P < .001），种族/民族（11.9%对8.6%; P < .001）和性取向（23.3%对1.0%; P < .001）。LGB与倦怠的几率增加相关（调整后的比值比，1.63 [95%CI，1.41-1.89]）;这种关联持续存在，但在调整治疗后减弱（比值比，1.36 [95%CI，1.16-1.60]）。倦怠的几率增加了剂量反应的方式与虐待强度。与异性恋学生相比，女同性恋、男同性恋或双性恋学生报告更高的性取向虐待的倦怠预测概率高8倍（19.8% [95%CI，8.3%-31.4%] vs 2.3% [95%CI，0.2%-4.5%]; P <0.001）。中介分析显示，虐待占LGB性取向与总体倦怠总关联的31%（P < .001）。这项研究表明，LGB医学生比他们的异性恋同龄人更有可能经历倦怠，这种关联部分是由虐待介导的。需要进一步开展工作，以确保医学院为男女同性恋、双性恋和变性医学生提供安全和包容性的学习环境。这项横断面研究评估医学生倦怠是否因性取向而异，以及这种关联是否由虐待经历介导。
Is there an association between sexual orientation and burnout among US medical students, and is this association mediated by experiences of mistreatment? Cross-sectional surveys of 2016 and 2017 graduating US medical students showed significantly higher rates of perceived mistreatment and burnout symptoms among lesbian, gay, or bisexual (LGB) medical students compared with heterosexual students. Perceived experiences of mistreatment mediated the association between LGB sexual orientation and burnout but did not completely account for excess burnout reported by LGB students. The findings of this study suggest that medical students in sexual minority groups report increased symptoms of burnout regardless of their perceived experiences of mistreatment. Medical trainee burnout is associated with poor quality care and attrition. Medical students in sexual minority groups report fear of discrimination and increased mistreatment, but the association between sexual orientation, burnout, and mistreatment is unknown. To evaluate whether medical student burnout differs by sexual orientation and whether this association is mediated by experiences of mistreatment. This cross-sectional study surveyed US medical students graduating from Association of American Medical Colleges (AAMC)–accredited US allopathic medical schools who responded to the AAMC graduation questionnaire in 2016 and 2017. Statistical analyses were performed from March 15, 2019, to July 2, 2020, and from November 20 to December 9, 2020. Burnout was measured using the Oldenburg Burnout Inventory for Medical Students, and sexual orientation was categorized as either heterosexual or lesbian, gay, or bisexual (LGB). Logistic regression models were constructed to evaluate the association between sexual orientation and experiencing burnout (defined as being in the top quartile of exhaustion and disengagement burnout dimensions) and to test the mediating association of mistreatment. From 2016 to 2017, 30 651 students completed the AAMC Graduation Questionnaire, and 26 123 responses were analyzed. Most respondents were younger than 30 years (82.9%) and White (60.3%). A total of 13 470 respondents (51.6%) were male, and 5.4% identified as LGB. Compared with heterosexual students, a greater proportion of LGB students reported experiencing mistreatment in all categories, including humiliation (27.0% LGB students vs 20.7% heterosexual students; P < .001), mistreatment not specific to identity (17.0% vs 10.3%; P < .001), and mistreatment specific to gender (27.3% vs 17.9%; P < .001), race/ethnicity (11.9% vs 8.6%; P < .001), and sexual orientation (23.3% vs 1.0%; P < .001). Being LGB was associated with increased odds of burnout (adjusted odds ratio, 1.63 [95% CI, 1.41-1.89]); this association persisted but was attenuated after adjusting for mistreatment (odds ratio, 1.36 [95% CI, 1.16-1.60]). The odds of burnout increased in a dose-response manner with mistreatment intensity. Lesbian, gay, or bisexual students reporting higher mistreatment specific to sexual orientation had and 8-fold higher predicted probability of burnout compared with heterosexual students (19.8% [95% CI, 8.3%-31.4%] vs 2.3% [95% CI, 0.2%-4.5%]; P < .001). Mediation analysis showed that mistreatment accounts for 31% of the total association of LGB sexual orientation with overall burnout (P < .001). This study suggests that LGB medical students are more likely than their heterosexual peers to experience burnout, an association that is partly mediated by mistreatment. Further work is needed to ensure that medical schools offer safe and inclusive learning environments for LGB medical students. This cross-sectional study evaluates whether medical student burnout differs by sexual orientation and whether this association is mediated by experiences of mistreatment.
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