Experiences of Gender Discrimination and Sexual Harassment Among Residents in General Surgery Programs Across the US
Experiences of Gender Discrimination and Sexual Harassment Among Residents in General Surgery Programs Across the US
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DOI：
10.1001/jamasurg.2021.3195
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发表时间：
2021-07-28
期刊：
影响因子：
16.9
通讯作者：
Hu, Yue-Yung
中科院分区：
文献类型：
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作者：
Schlick, Cary Jo R.;Ellis, Ryan J.;Hu, Yue-Yung
重要性：在外科住院医师中，虐待是一种常见的经历，并与职业倦怠有关。研究发现，女性遭受虐待的比例高于男性。进一步描述外科住院医生的性别歧视和性骚扰经历可能会为解决方案提供信息。目的描述(1)基于性别、性别认同或性取向的歧视和(2)美国普外科住院医师所经历的性骚扰的类型、来源和相关因素。本横断面全国调查研究是在2019年美国外科培训委员会考试（ABSITE）后进行的。该调查询问了受访者在2018年7月1日至2019年1月考试期间的性别歧视和性骚扰经历。所有被研究生医学教育认证委员会认可的普通外科项目注册的临床住院医师都符合资格。与性别歧视和性骚扰相关的特定类型、来源和因素。主要结局和测量主要结局是性别歧视和性骚扰的发生率。次要结果包括歧视和骚扰的来源，以及使用性别分层多变量logistic回归模型的相关个人和项目层面因素。结果共调查符合条件的居民8129人；301个普外科项目有6956个回复，回复率为85.6%。其中6764人有性别资料，其中男性3968人（58.7%），女性2796人（41.3%）。总共2352名女性居民中有1878人（79.8%）对3288名男性居民中有562人（17.1%）报告遭受过性别歧视（P < 0.001）， 2415名女性居民中有1026人（42.5%）对3360名男性居民中有721人（21.5%）报告遭受过性骚扰（P < 0.001）。最常见的性别歧视类型是被误认为非医师（总体上5640名居民中有1943名[34.5%]；2352名女性居民中有1813名[77.1%]；3288名男性居民中有130名[4.0%]），患者和/或家庭是最常见的来源。最常见的性骚扰形式是粗鲁、贬低或直白的评论（5775名居民中有1557人[27.0%]，女性居民中有901人[37.3%]，男性居民中有656人[19.5%]）；在女性住院医生中，最常见的骚扰来源是患者和/或家属，而在男性住院医生中，最常见的骚扰来源是同事和/或同事。在女性居民中，性别歧视与怀孕（优势比[OR]， 1.93; 95% CI, 1.03-3.62）和较高的ABSITE评分（最高与最低四分位数：OR， 1.67; 95% CI, 1.14-2.43）相关；在男性居民中，性别歧视与父母身份（OR, 1.72; 95% CI, 1.31-2.27）和较低的ABSITE评分（最高与最低四分位数：OR， 0.57; 95% CI, 0.43-0.76）相关。老年住院医师比实习生更有可能报告遭受性骚扰（研究生4年和5年vs研究生1年：女性住院医师OR值为1.77 [95% CI, 1.40-2.24]；男性住院医师OR值为1.31 [95% CI, 1.01-1.70]）。结论与意义在本研究中，性别歧视和性骚扰是外科住院医师中常见的经历，并且经常被女性报告。这些现象需要针对具体情况采取多方面的改进策略。
IMPORTANCE Mistreatment is a common experience among surgical residents and is associated with burnout. Women have been found to experience mistreatment at higher rates than men. Further characterization of surgical residents' experiences with gender discrimination and sexual harassment may inform solutions.OBJECTIVE To describe the types, sources, and factors associated with (1) discrimination based on gender, gender identity, or sexual orientation and (2) sexual harassment experienced by residents in general surgery programs across the US.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional national survey study was conducted after the 2019 American Board of Surgery In-Training Examination (ABSITE). The survey asked respondents about their experiences with gender discrimination and sexual harassment during the academic year starting July 1, 2018, through the testing date in January 2019. All clinical residents enrolled in general surgery programs accredited by the Accreditation Council for Graduate Medical Education were eligible.EXPOSURES Specific types, sources, and factors associated with gender-based discrimination and sexual harassment.MAIN OUTCOMES AND MEASURES Primary outcome was the prevalence of gender discrimination and sexual harassment. Secondary outcomes included sources of discrimination and harassment and associated individual- and program-level factors using gender-stratified multivariable logistic regression models.RESULTS The survey was administered to 8129 eligible residents; 6956 responded (85.6% response rate)from 301 general surgery programs. Of those, 6764 residents had gender data available (3968 [58.7%] were male and 2796 [41.3%] were female individuals). In total, 1878 of 2352 female residents (79.8%) vs 562 of 3288 male residents (17.1%) reported experiencing gender discrimination (P < .001), and 1026 of 2415 female residents (42.5%) vs 721 of 3360 male residents (21.5%) reported experiencing sexual harassment (P < .001). The most common type of gender discrimination was being mistaken for a nonphysician (1943 of 5640 residents [34.5%] overall; 1813 of 2352 female residents [77.1%]; 130 of 3288 male residents [4.0%]), with patients and/or families as the most frequent source. The most common form of sexual harassment was crude, demeaning, or explicit comments (1557 of 5775 residents [27.0%] overall; 901 of 2415 female residents [37.3%]; 656 of 3360 male residents [19.5%]); among female residents, the most common source of this harassment was patients and/or families, and among male residents, the most common source was coresidents and/or fellows. Among female residents, gender discrimination was associated with pregnancy (odds ratio [OR], 1.93; 95% CI, 1.03-3.62) and higher ABSITE scores (highest vs lowest quartile: OR, 1.67; 95% CI, 1.14-2.43); among male residents, gender discrimination was associated with parenthood (OR, 1.72; 95% CI, 1.31-2.27) and lower ABSITE scores (highest vs lowest quartile: OR, 0.57; 95% CI, 0.43-0.76). Senior residents were more likely to report experiencing sexual harassment than interns (postgraduate years 4 and 5 vs postgraduate year 1: OR, 1.77 [95% CI, 1.40-2.24] among female residents; 1.31 [95% CI, 1.01-1.70] among male residents).CONCLUSIONS AND RELEVANCE In this study, gender discrimination and sexual harassment were common experiences among surgical residents and were frequently reported by women. These phenomena warrant multifaceted context-specific strategies for improvement.