Prevalence of Discrimination, Abuse, and Harassment in Emergency Medicine Residency Training in the US

Abstract

IMPORTANCEThe prevalence of workplace mistreatment and its association with the well-being of emergency medicine (EM) residents is unclear. More information about the sources of mistreatment might encourage residency leadership to develop and implement more effective strategies to improve professional well-being not only during residency but also throughout the physician's career. OBJECTIVETo examine the prevalence, types, and sources of perceived workplace mistreatment during training among EM residents in the US and the association between mistreatment and suicidal ideation. DESIGN, SETTING, AND PARTICIPANTS In this survey study conducted from February 25 to 29, 2020, all residents enrolled in EM residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME) who participated in the 2020 American Board of Emergency Medicine computer-based In-training Examination were invited to participate. A multiple-choice, 35-item survey was administered after the examination asking residents to self-report the frequency, sources, and types of mistreatment experienced during residency training and whether they had suicidal thoughts. MAIN OUTCOMES AND MEASURESThe types and frequency of workplace mistreatment and the sources of the mistreatment were identified, and rates of self-reported suicidality were obtained.Multivariable logistic regression models were used to examine resident and program characteristics associated with suicidal thoughts. RESULTSOf 8162 eligible EM residents, 7680 (94.1%) responded to at least 1 question on the survey; 6503 (79.7%) completed the survey in its entirety. A total of 243 ACGME-accredited residency programs participated, and 1 did not. The study cohort included 4768 male residents (62.1%), 2698 female residents (35.1%), 4919 non-Hispanic White residents (64.0%), 2620 residents from other racial/ethnic groups (Alaska Native, American Indian, Asian or Pacific Islander, African American, Mexican American, Native Hawaiian, Puerto Rican, other Hispanic, or mixed or other race) (34.1%), 483 residents who identified as lesbian, gay, bisexual, transgender, queer, or other (LGBTQ+) (6.3%), and 5951 residents who were married or in a relationship (77.5%). Of the total participants, 3463 (45.1%) reported exposure to some type of workplace mistreatment (eg, discrimination, abuse, or harassment) during the most recent academic year. A frequent source of mistreatment was identified as patients and/or patients' families; 1234 respondents (58.7%) reported gender discrimination, 867 (67.5%) racial discrimination, 282 (85.2%) physical abuse, and 723 (69.1%) sexual harassment from patients and/or family members. Suicidal thoughts occurring during the past year were reported by 178 residents (2.5%), with similar prevalence by gender (108 men [2.4%]; 59 women [2.4%]) and race/ethnicity (113 non-Hispanic White residents [2.4%]; 65 residents from other racial/ethnic groups [2.7%]).

Emergency care of LGBTQIA+ patients requires more than understanding the acronym

“…It is also important to note that these experiences are not limited to the patients. Health care practitioners (including medical students, residents, and faculty physicians) have reported higher incidents of workplace bias and discrimination based on their LGBTQIA+ identity 18‐20 …”

“…Health care practitioners (including medical students, residents, and faculty physicians) have reported higher incidents of workplace bias and discrimination based on their LGBTQIA+ identity. [18][19][20] Individual interventions can be powerful in counteracting bias.…”

Block by block: Building on our knowledge to better care for LGBTQIA+ patients

“…9 Additionally, a substantial amount of LGBTQIA+ residents experience discrimination and mistreatment from both patients and other health care providers, highlighting a critical structural need to boost diversity, equity, and inclusion. [31][32][33] Although most program directors desire inclusion of sexual and gender minority-adjacent curricula, few emergency medicine residencies have incorporated LGBTQIA+ health into their conference and didactic curricula. 9…”

“…A 2014 study reported a median of 45 min of LGBTQIA+ content in EM didactics, and a related study in 2018 found that a significant proportion of EM residents felt less comfortable caring for LGBTQIA+ patients when compared to cisgender and heterosexual patients 9 . Additionally, a substantial amount of LGBTQIA+ residents experience discrimination and mistreatment from both patients and other health care providers, highlighting a critical structural need to boost diversity, equity, and inclusion 31‐33 . Although most program directors desire inclusion of sexual and gender minority–adjacent curricula, few emergency medicine residencies have incorporated LGBTQIA+ health into their conference and didactic curricula 9 …”

Harassment as a consequence and cause of inequality in academia: A narrative review

“… 17 Members of underrepresented groups who face intersectional disadvantages, such as women in precarious employment conditions, or foreign female scholars, are targeted by GBV more. 8 , 18 , 19 , 20 …”