Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training
Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training
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DOI：
10.1056/nejmsa1903759
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发表时间：
2019-10-31
影响因子：
158.5
通讯作者：
Bilimoria, Karl Y.
中科院分区：
文献类型：
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作者：
Hu, Yue-Yung;Ellis, Ryan J.;Bilimoria, Karl Y.
医生，特别是实习医生和外科专科医生，有倦怠的风险。虐待（即，方法2018年美国外科培训考试委员会对普外科住院医师进行的全国横断面调查评估了过去一年中的虐待、倦怠（使用改良Maslach倦怠量表进行评估）和自杀想法。我们使用多变量逻辑回归模型来评估虐待与倦怠和自杀想法的关联。调查要求住院医师报告他们的性别。在所有262个外科住院医师项目的7409名住院医师中，31.9%的人报告了基于自我认定的性别的歧视，16.6%的人报告了种族歧视，30.3%的人报告了口头或身体虐待（或两者兼而有之），10.3%的人报告了性骚扰。所有虐待措施在妇女中的发生率更高; 65.1%的妇女报告受到性别歧视，19.9%报告受到性骚扰。患者和患者家属是性别歧视（43.6%的居民报告）和种族歧视（47.4%）的最常见来源，而主治外科医生是性骚扰（27.2%）和虐待（51.9%）的最常见来源。报告虐待的居民比例在不同的居住方案中差异很大（例如，口头虐待的比例从0到66.7%不等）。38.5%的居民报告了每周的倦怠症状，4.5%的居民报告说在过去一年中有自杀念头。每月至少报告遭受歧视、虐待或骚扰几次的居民比没有报告遭受虐待的居民更有可能出现倦怠症状（优势比，2.94; 95%置信区间[CI]，2.58至3.36）和自杀念头（优势比，3.07; 95%CI，2.25至4.19）。虽然没有调整虐待的模型显示，女性比男性更容易报告倦怠症状，（42.4% vs. 35.9%;比值比，1.33; 95%CI，1.20 - 1.48），在模型校正治疗后，差异不再明显结论：普外科住院医师，尤其是女性，常发生治疗不当，且与倦怠和自杀念头有关。
BACKGROUNDPhysicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts.METHODSA cross-sectional national survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination assessed mistreatment, burnout (evaluated with the use of the modified Maslach Burnout Inventory), and suicidal thoughts during the past year. We used multivariable logistic-regression models to assess the association of mistreatment with burnout and suicidal thoughts. The survey asked residents to report their gender.RESULTSAmong 7409 residents (99.3% of the eligible residents) from all 262 surgical residency programs, 31.9% reported discrimination based on their self-identified gender, 16.6% reported racial discrimination, 30.3% reported verbal or physical abuse (or both), and 10.3% reported sexual harassment. Rates of all mistreatment measures were higher among women; 65.1% of the women reported gender discrimination and 19.9% reported sexual harassment. Patients and patients' families were the most frequent sources of gender discrimination (as reported by 43.6% of residents) and racial discrimination (47.4%), whereas attending surgeons were the most frequent sources of sexual harassment (27.2%) and abuse (51.9%). Proportion of residents reporting mistreatment varied considerably among residency programs (e.g., ranging from 0 to 66.7% for verbal abuse). Weekly burnout symptoms were reported by 38.5% of residents, and 4.5% reported having had suicidal thoughts during the past year. Residents who reported exposure to discrimination, abuse, or harassment at least a few times per month were more likely than residents with no reported mistreatment exposures to have symptoms of burnout (odds ratio, 2.94; 95% confidence interval [CI], 2.58 to 3.36) and suicidal thoughts (odds ratio, 3.07; 95% CI, 2.25 to 4.19). Although models that were not adjusted for mistreatment showed that women were more likely than men to report burnout symptoms (42.4% vs. 35.9%; odds ratio, 1.33; 95% CI, 1.20 to 1.48), the difference was no longer evident after the models were adjusted for mistreatment (odds ratio, 0.90; 95% CI, 0.80 to 1.00).CONCLUSIONSMistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.