Almost half report mistreatment
The survey was sent to 8,162 eligible residents in EM. Of those, 6,503 (79.7%) completed the entire survey. Respondents were primarily male (62.1%) and non-Hispanic White (64.0%); 2,620 residents (34.1%) were from other racial/ethnic groups. Of the respondents, 483 residents (6.6%) identified as lesbian, gay, bisexual, transgender, queer, or other (LGBTQ+); 5,951 residents (77.5%) were married or in a relationship.
It was found that 3,463 (45.1%) of participants reported having been exposed to some sort of workplace mistreatment during the most recent academic year. A common source of mistreatment was patients and/or their families. These caused a total of 1,234 events.
Gender discrimination was reported by 2,104 residents (29.5%), 1,635 of whom were women. The most common source of such discrimination was patients or patients’ family members (1,027 women; 184 men). Other sources included nurses or staff (331 women; 59 men).
Racial discrimination was common. It was reported by 1,284 residents; 907 residents were from racial/ethnic groups other than White. Among non-White racial/ethnic groups, 248 residents reported being exposed to racial discrimination at least a few times per month. The most common source of racial discrimination was patients or their family members.
Discrimination based on sexual orientation or gender identity was reported by 220 residents. Once again, the majority of LGBTQ+ residents indicated that patients or their families were the primary source. More than 1,000 residents (n = 1047) reported sexual harassment; among these residents, 721 were women. Patients and/or patients’ family members were the most common source of such discrimination, followed by nurses and staff.
A total of 2,069 residents reported verbal or emotional abuse, including 806 women and 1,212 men. Patients/patients’ family members were the most common source, followed by attending physicians. Physical abuse was reported by 331 respondents. Physical abuse was primarily attributed to patients/patients’ families.
Suicidal thoughts were reported by 178 residents; the prevalence was comparable with respect to gender (2.4% men; 2.4% women) and race/ethnicity (2.4% non-Hispanic White; 2.7% other racial/ethnic groups). Adjusted models revealed that the prevalence for suicidal thoughts was greater among residents who identified as LGBTQ+ (odds ratio [OR], 2.04; 99% confidence interval, 1.04-3.99). An association was found between suicidal thoughts and having experienced mistreatment at least a few times each month (OR, 5.83; 99% CI, 3.70-9.20).
Identifying sources key to stemming mistreatment
These findings, the researchers say, demonstrate the alarming frequency with which workplace mistreatment occurs for EM residents. The survey also found that such mistreatment was more common among residents from racial/ethnic minority populations, women, and residents who identify as LGBTQ+. Perhaps most disturbingly, the occurrence of workplace mistreatment was found to be associated with suicidal thoughts.
The researchers say that although it is likely that residents in many medical specialties experience similar mistreatment to some degree, such treatment should never be considered acceptable. Indeed, Dr. Lall said that identifying sources of mistreatment may help both institutions and individuals determine interventions necessary for improving the well-being of EM residents.
“The first step is recognizing, based on our data, that mistreatment is experienced frequently in EM training in the United States,” she said. “Future qualitative studies of residents and program leaders may help identify which systems, programs, or cultural factors were associated with lower rates of mistreatment in some institutions and higher rates in others.
“Identifying these factors and developing and promoting best practices to minimize workplace mistreatment during residency may help optimize the professional career experience and improve the personal and professional well-being of physicians throughout their lives,” Dr. Lall added.
Commenting on the findings for this article, Karl Y. Bilimoria, MD, of Northwestern University, Chicago, noted that these surveys clearly lay out actionable opportunities to improve trainee mistreatment. “Given that much of the mistreatment of EM residents comes from patients and families, the solutions must be appropriately tailored to address those sources,” Dr. Bilimoria noted.
“Programs need to actively work even more to protect their trainees and faculty from this mistreatment, as it has severe effects and often leads to, or worsens, burnout,” he added.
Funding for statistical analysis was provided by the American Board of Emergency Medicine. Dr. Lall and Dr. Bilimoria reported no relevant financial relationships.
A version of this article first appeared on Medscape.com.