Residents, medical students often report mistreatment
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Emergency medicine residents frequently experienced mistreatment in the workplace, including gender and racial discrimination, physical abuse and sexual harassment, according to findings published in JAMA Network Open.
Researchers reported that the source of workplace mistreatment was often patients or patients’ family members.
In a separate study published in JAMA Network Open, data showed that mistreatment is also common among medical students. Both studies highlight the need for interventions to improve medical training, according to researchers.
Mistreatment among residents
Michelle D. Lall, MD, MHS, a physician in the department of emergency medicine at Emory University, and colleagues surveyed 7,680 emergency medicine residents in February 2020 about their experiences during residency training. The survey, which consisted of 35 multiple-choice questions, was administered after residents completed the 2020 American Board of Emergency Medicine computer-based In-training Examination. Among the study cohort, 62.1% were men, 64% were non-Hispanic white, and 6.3% identified as being part of the LGBTQ+ community.
The data revealed that 45.1% of respondents had experienced some type of workplace mistreatment during the most recent academic year. Respondents frequently attributed the mistreatment to patients or the patients’ families, according to Lall and colleagues. The most common form of mistreatment from patients or their family members was physical abuse (85.2%), followed by sexual harassment (69.1%), racial discrimination (67.5%) and gender discrimination (58.7%).
The survey responses also revealed that 2.5% of participants thought about suicide during the past year. The prevalence of suicidal thoughts was similar across gender, racial and ethnic groups, according to the researchers.
Overall, 18% of the respondents reported racial discrimination, including 7.9% of white residents and 37.6% of residents from other racial and ethnic groups. Three percent of residents reported experiencing discrimination based on their sexual orientation or gender.
Some residents — 5.1% — experienced discrimination based on their pregnancy or childcare status, including 10.8% of women and 1.8% of men. About 15% of respondents were sexually harassed. This was more common among women than men (28.8% vs. 6.5%; P < .001). Verbal or emotional abuse was reported by 29% of respondents, including 32.2% of women and 27% of men.
“Women reported higher levels of nearly all forms of mistreatment compared with men, with most of the reported gender-based mistreatment originating from patients and their families,” Lall and colleagues wrote. “The second-most likely source of gender-based mistreatment was nurses and staff. Gender bias, discrimination and sexual harassment in medicine have deleterious consequences for women physicians’ careers and wellbeing.”
The overall prevalence of mistreatment — 45.1% — was lower than the prevalence of mistreatment in a 1993 survey on workplace abuse, during which 98% of emergency medicine residents reported at least one occurrence of harassment, according to the researchers. Still, Lall and colleagues noted that workplace violence is associated with an increased risk for burnout, depression and PTSD. Therefore, educational interventions are needed “to reduce workplace mistreatment and ensure emergency medicine residents’ wellbeing during training.”
Burnout in medical school
In the second study, Liselotte N. Dyrbye, MD, MHPE, FACP, codirector of the Program of Physician Wellbeing, a professor of medicine and medical education, and a consultant in the division of primary care internal medicine at the Mayo Clinic, and colleagues found that medical students who experienced some type of mistreatment were more likely to develop greater levels of exhaustion, be less engaged, have lower levels of empathy and greater career regret.
“There have been several studies suggesting that mistreatment, poor feedback, high faculty demands and bad role models relate to the risk of burnout among medical trainees,” Dyrbye told Healio Primary Care. “Few of these previous studies, however, have been longitudinal or included large national samples of trainees.”
Dyrbye and colleagues analyzed survey responses from 14,126 medical students (52% women) who participated in the 2014-2016 Association of American Medical Colleges (AAMC) Medical School Year 2 Questionnaire and the 2016-2018 AAMC Graduation Questionnaire. Overall, 22.9% of respondents experienced mistreatment by the beginning of their second year of medical school. Men scored higher than women for exhaustion and disengagement, according to the researchers. They reported that higher scores for exhaustion and disengagement correlated with a greater odds of career regret.
“Among physicians in practice, career regret is associated with reductions in clinical time, turnover, and leaving the practice of medicine all together — all of which negatively impacts access to care for patients,” Dyrbye said.
Medical schools and faculty are in a position to improve students’ experiences, she added.
“Many organizations approach improving medical student and physician wellbeing through the lens of increasing individual’s capacity to manage stress,” she said. “Although individuals certainly have a responsibility for self-care, improving medical student and physician wellbeing is a shared responsibility. Medical schools that effectively upskill their teaching faculty, empower faculty to teach and mentor learners through meaningful recognition, build an inclusive learning environment, and implement meaningful ways to foster social support will have bigger gains in students’ wellbeing than those schools solely focused on resiliency training.”
References:
Dyrbye LN, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.19110.
Lall MD, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.21706.