Half of Surgery Residents Report Harassment, Bullying

Residents who experience mistreatment during training have greater risks of burnout and suicidal thoughts.

Half of general surgery residents reported experiencing workplace harassment at least a few times a year, with much of the mistreatment coming from patients and their families, and attending surgeons.

The survey of 7,409 residents in 262 residency training programs across the nation — more than 99% of general surgery residents in the United States — found the most common workplace mistreatment were sex discrimination (32%), verbal abuse/bullying (30%), racial discrimination (16.6%), and sexual harassment (10.3%).

"Exposure to workplace mistreatment was the largest driver of surgical residents' burnout," study principal investigator Karl Y. Bilimoria, MD, said in comments accompanying the report.

"Preventing these types of mistreatment could reduce the huge problem of burnout in the specialty of surgery," said Bilimoria, director of the Surgical Outcomes and Quality Improvement Center at Northwestern University Feinberg School of Medicine, Chicago.

The survey findings presented Monday at the American College of Surgeons Clinical Congress 2019 in San Francisco and published on the New England Journal of Medicine website.

The survey found that:

• Nearly 31% of residents reported the frequency of mistreatment as a few times per year, and 19% reportedly experienced mistreatment a few times or more each month.
   
• Women, who represent less than 40% of the survey respondents, were twice as likely to report mistreatment as their male colleagues: 70.6% versus 36%.
   
• Nearly half (47.4%) of the racial discrimination complaints and 43.6% of sexual harassment complaints were prompted by interactions with patients and their families.
   
• Attending surgeons were the most frequent sources for verbal or physical abuse toward residents (52%) and sexual harassment (27.2%).
   
• Symptoms of burnout—emotional exhaustion and depersonalization—occurred weekly among 38.5$ of residents.
   
• Residents reported a 4.5% rate of suicidal thoughts during the past year.
   

Women were 33% more likely to report burnout symptoms. However, Bilimoria said that when the findings were adjusted for exposure to mistreatment, there was no sex-based difference in burnout frequency, suggesting that more frequent harassment explains women residents' higher incidence of burnout.

The prevalence of surgical residents' mistreatment is concerning, Bilimoria said, but he noted that some residency programs had very low or no rates of mistreatment, which he said shows that improvements are doable.

Bilimoria said he was surprised to learn from the survey that patients and their families accounted for the bulk of racial and sex discrimination for residents.

"It completely changes how we should intervene," he said. "We need to arm residents with the skills and ability to address discrimination from patients and patients' families affecting them and their colleagues."