Bullying, Discrimination, Harassment, Sexual Harassment, and the Fear of Retaliation During Surgical Residency Training: A Systematic Review

Bullying, Harassment, and Undermining Behavior in Cardiothoracic Surgery in the United Kingdom and Ireland

BACKGROUND

Bullying, harassment, and undermining behavior has a profound detrimental effect on the multiprofessional team, patient safety, and clinical outcomes. Bullying creates a poor working and training environment, increasing stress, damaging confidence, and impairing well-being. We sought to characterize the prevalence and nature of bullying, harassment, and undermining within cardiothoracic surgery in the United Kingdom and Republic of Ireland.

METHODS

A 21-question survey was sent to all members of the Society for Cardiothoracic Surgery in Great Britain and Ireland. Participants were asked about baseline demographics and their experience of bullying as victim or witness.

RESULTS

The survey was sent to 1326 Society for Cardiothoracic Surgery members, and there were 278 responses (21.0%). Most respondents were physicians (75.2%; n = 209), and most were male (58.3%; n = 162). Most (79.1%; n = 220) had experienced or witnessed bullying in some form within the last 3 years (or appointment as a professional). This was experienced directly by most respondents (62%; n = 136), and a large minority (23.6%; n = 52) had witnessed it in their workplace.

CONCLUSIONS

Bullying is observed or experienced by a concerning proportion of health care professionals working in cardiothoracic surgery. Ongoing initiatives to reduce this within British and Irish health care need to be strengthened to improve prevention, reporting and investigation, and support for victims and perpetrators to keep workplaces safe for teams and individuals and to facilitate the delivery of the best possible patient care.

Burnout syndrome and psychological workplace violence among Peruvian physicians: a cross-sectional study

BACKGROUND

Physicians face increased emotional weariness as a result of the inherent stress and responsibility of their roles. In addition, they are vulnerable to abuse, coercion, and aggressiveness in their workplace settings. The link between burnout syndrome and psychological workplace violence (WPV) is complex and must be viewed as bidirectional. We assessed the association between the levels of burnout and psychological WPV among their colleagues among Peruvian physicians.

METHODS

We performed a cross-sectional study that surveyed licensed Peruvian physicians actively practicing clinical medicine from April to December 2023. A non-probability convenience sampling via hospital interviews and diffusion through online platforms was carried out. The SPV-Health scale, validated for the Peruvian context, assessed psychological violence, while the MBI-HSS evaluated burnout dimensions. Descriptive statistics and Poisson regression models, adjusting for covariates, were employed for analysis.

RESULTS

We included 384 medical doctors; most participants worked in urban areas, with nearly half being specialists or subspecialists, predominantly in medicine services. Physicians experiencing burnout were 4.04 times more likely to encounter psychological violence compared to those without burnout (95% CI: 2.45-6.57), even after adjusting for age, sex, medical positions and years of medical practice (PR: 3.93; 95% CI: 2.35-6.57). Among the risk factors for psychological violence, being a resident practitioner was the only significant one (PR: 1.79; 95% CI: 1.18-2.73).

CONCLUSION

Our study underscores a significant association between Burnout Syndrome among Peruvian doctors and their experience of psychological WPV from colleagues. Tailored interventions addressing these challenges are imperative, with organizational strategies offering potential while interventions for WPV require further investigation.

Fostering an open surgical culture: strategies to eliminate inappropriate behavior in surgical practice

Surgery is a demanding and stressful profession. Unfortunately, inappropriate behavior is still not banished from the daily surgical practice and we are dealing with the negative consequences (e.g. negative working environments or burn-out). To adequately treat this type of behavior we first have to acknowledge its existence and create a proper path to discuss it inside our own ranks. The only manner to achieve this, is through an open culture. An 'open surgical culture' is the key, as it creates an environment with psychological safety and allows all involved parties to be able to speak up without fear for retaliation. Theoretical models such as Bateson's pyramid, McClelland's iceberg, and Dweck's Growth Mindset Theory can serve as valuable sources of inspiration to addressing cultural change by approaching both individual and organizational levels. Examples of cultural change attempts can be as small as discussing inappropriate behavior through pocket cards with statements of certain behavior or during national conferences, e.g. the annual meeting of the Dutch Surgical Society (Chirurgendagen). Only together we are able to achieve an open surgical culture, in order to ban mistreatment from the surgical profession. Here a roadmap to achieving an open surgical culture is presented and discussed.

Barriers and facilitators for female practitioners in orthopaedic training and practice: a scoping review

BACKGROUND

Despite advances in medical education and professional opportunities, orthopaedic surgery remains the least gender-diverse medical specialty, with women significantly underrepresented globally. This scoping review aims to synthesize existing literature to provide a comprehensive overview of the barriers and facilitators encountered by females in orthopaedic surgery training and practice.

METHODS

A comprehensive search of Medline (OVID), Scopus, Embase, Emcare, and CINAHL was performed from inception to 14 July 2024. Additional sources were identified via citation searching and Google Scholar. Any primary studies employing qualitative, quantitative, or mixed methods approaches to explore barriers and facilitators experienced by female orthopaedic trainees and consultants in high-income countries. Quality analysis of included articles was conducted using the Mixed Methods Appraisal Tool.

RESULTS

Seventy-nine studies met the inclusion criteria, involving over 100 000 participants between 1993 and 2024. Most studies were cross-sectional surveys. Sixty-eight barriers and 38 facilitators were identified. Analysis using the Socio-Ecological Model revealed the complex interplay of factors at the individual, interpersonal, organizational, community, and policy levels. The largest proportion of barriers and facilitators resided at the organizational level.

CONCLUSION

This scoping review provides a comprehensive mapping of current evidence on barriers and facilitators for female practitioners in orthopaedic surgery training and practice. The findings suggest the need for multifaceted interventions to promote gender equity. Future research should evaluate the effectiveness of specific interventions and develop strategies to support women in orthopaedics, ultimately contributing to a more inclusive and diverse workforce.

The Hidden Problem: Verbal Sexual Abuse in Higher Education from a Linguistic Perspective

The present study aims to investigate the prevalence of various forms of verbal sexual abuse among students in higher education. Specifically, the study seeks to explore the linguistic features and types of utterances used in verbal sexual abuse and to examine how male and female students perceive such abuse. A mixed-methods design was employed, incorporating both qualitative and quantitative approaches. The qualitative component involved the use of discourse analysis to analyze texts, pictures, and symbols containing instances of verbal sexual abuse. Meanwhile, the quantitative component employed a survey approach to understand how students in higher education perceive such abuse. Data were collected from 30 students who had experienced verbal sexual abuse through both spoken words and social media. In addition, a survey was conducted among 317 students in Indonesia to collect data on their responses to different forms of verbal sexual abuse. The findings of the study suggest that verbal sexual abuse experienced by students can be classified into three forms: vulgar discussions, sexual gestures, and seductive whistles, with vulgar discussions being the most prevalent form of such abuse. The perpetrators of verbal sexual abuse were found to employ specific linguistic features and symbols. The study also revealed that perpetrators of verbal sexual abuse most frequently used assertive and expressive utterances. In addition, the study highlighted significant differences in the perceptions of male and female students concerning verbal sexual abuse. The study's findings have potential implications, particularly in the development of programs aimed at preventing verbal sexual abuse among students in higher education settings. A deeper understanding of the various forms of verbal sexual abuse can help raise students' awareness and concerns about avoiding such behavior.

Bias Experiences and Burnout: A Multispecialty, Cross-Sectional Survey of Residents and Fellows at a Multisite US Academic Medical Center

OBJECTIVE

To explore associations of bias frequency, sources, and types with burnout in a large, multispecialty sample of residents and fellows and to determine whether and how odds of burnout change after adjustment for bias experiences in multiple demographic subgroups.

METHODS

Trainees in graduate medical education programs at Mayo Clinic sites were surveyed between October 12, 2020, and November 22, 2020. Survey items measured personal experiences with bias (frequency, sources, types), burnout (2 Maslach Burnout Inventory items), and demographic characteristics (age, gender, race/ethnicity, lesbian-gay-bisexual-transgender-queer-nonbinary-other identification, disability, socioeconomic background, year in school, specialty). The χ2 test and logistic regression analyses examined relationships between variables.

RESULTS

Of 1825 trainees surveyed, 942 (52%) from 77 programs responded. Overall, 16% (137/881) of respondents reported 1 or more personal bias experiences. Trainees reporting bias experiences weekly or more often had markedly higher odds of burnout in adjusted analyses (odds ratio [OR], 8.00; 95% CI, 2.68 to 23.89; P<.001). Bias from education leaders/staff, fellow learners, and faculty was independently associated with burnout, whereas bias from patients/companions and other staff/employees was not. Trainees with a disability (OR, 3.16; 95% CI, 1.05 to 9.53; P=.04) and trainees from a low-income background (OR, 1.53; 95% CI, 1.03 to 2.26; P=.03) had higher odds of burnout in unadjusted analyses, but these associations were no longer statistically significant after adjustment for bias frequency.

CONCLUSION

Self-reported bias experiences relate strongly to trainee burnout. Some bias sources may be more strongly associated with burnout than others. More frequent bias experiences could account, at least in part, for higher odds of burnout in some demographic subgroups.

Considerations to Optimize Structurally Responsive Work Environments for U.S. Military Specialty Physicians

INTRODUCTION

Recruitment, training, and retention of wartime critical specialty physicians may be stymied by discrimination and abuse. It is unclear to what extent the US combat specialty physicians witness or experience discrimination and abuse, whether they or others intervene, and if they would subsequently discourage people from entering their field.

MATERIALS AND METHODS

The present study surveyed US active duty anesthesiologists, emergency medicine physicians, and orthopedic surgeons (N = 243; 21% response rate). A generalized linear model evaluated the extent to which gender, specialty, service, and number of witnessed/experienced negative/stigmatizing comment/event types were associated with burnout. A bootstrapped mediation analysis evaluated whether gender and burnout were mediated by the number of comment/event types.

RESULTS

The sample was majority non-Latine White (87%) and men (66%) with tri-service and specialty representation. The most commonly reported negative/stigmatizing comment/event types were related to pregnancy (62%) and parental leave (61%), followed by gender and assigned sex (42%), lactation (37%), and sexual harassment (35%). Of the respondents who witnessed/experienced such comments/events, self-intervention was reported after comments regarding lactation (43%), assigned sex and gender (42%), race and ethnicity (41%), pregnancy (41%), parental leave (37%), and sexual harassment (24%). Witnessing another person intervene was reported after sexual harassment (25%) and comments/events regarding race and ethnicity (24%), pregnancy (20%), assigned sex and gender (19%), lactation (19%), and parental leave (18%). Nonintervention was reported after comments/events related to parental leave (42%), pregnancy (38%), sexual harassment (26%), lactation (26%), assigned sex and gender (26%), and race and ethnicity (22%). Respondents reported moderate-to-high intervening likelihood, importance, and confidence. Respondents reporting neutral to extremely agree on prompts indicating that pregnant active duty physicians are trying to avoid deployment (P = .002) and expect special treatment that burdens the department (P = .007) were disproportionately men (36% and 38%, respectively) compared to women (14% and 18%, respectively). The highest proportion of neutral to extremely agree responses regarding discouraging specialty selection were reported in relation to transgender and gender diverse students (21%), followed by cisgender female students (18%); gay, lesbian, or bisexual+ students (17%); cisgender male students (13%); and racial and ethnic minoritized students (12%). In the primary model, the number of witnessed/experienced comment/event types was associated with greater burnout (0.13, 95% CI 0.06-0.20, P = .001), but women did not report significantly different levels of burnout than men (0.20, 95% CI -0.10 to 0.51, P = 0.20). The number of comment/event types mediated the relationship between gender and burnout (0.18, 95% CI 0.06, 0.34; P < .001).

CONCLUSIONS

Although reported intervening confidence, likelihood, and importance were high, it is unclear whether perceptions correspond to awareness of intervention need and behaviors. Bivariate differences in burnout levels between men and women were fully explained by the number of comment types in the mediation model. Annual trainings may not effectively address workplace climate optimization; institutions should consider targeted policy and programmatic efforts to ensure effective, structurally responsive approaches.

Resident encounters with disruptive workplace behaviours in Japan: findings from a national cross-sectional study

IMPORTANCE

Disruptive workplace behaviours (DWBs) between healthcare professionals compromise patient care quality and organisational culture, impacting staff morale, communication and teamwork. Residents are particularly vulnerable to it from nurses and supervisors.

OBJECTIVE

Elucidate factors associated with DWBs experienced by residents.

DESIGN

Nationwide cross-sectional study using a web-based survey.

SETTING

Japanese postgraduate clinical training hospitals.

PARTICIPANTS

First- and second-year postgraduate residents were surveyed between 15 and 31 January 2023, immediately after participating in the nationally administered computer-based residency exam.

EXPOSURE

None.

MAIN OUTCOMES AND MEASURES

Primary outcomes include previously published eight types of DWBs experienced by residents. Resident characteristics at the time of the study were used. Hospital data (location of the training hospital, number of beds, number of emergency transports, average length of hospital stays, number of outpatients per day and the actual number of residents, full-time physicians and nurses) were obtained from Japan's largest hospital information database.

RESULTS

Of 5403 residents analysed, 68.3% were males, and 84.9% were under 28 years of age. Residents reported encountering DWBs from physicians and nurses approximately 35% of the time, a roughly equivalent percentage from both groups. After multivariate logistic regression analysis, the likelihood of encountering DWBs from nurses increased with hospital size (>700 beds; adjusted OR (aOR) 2.19; 501-700 beds; aOR 1.45 and 301-500 beds; aOR 1.26, all statistically significant). Furthermore, DWBs from nurses were significantly more prevalent in settings with higher admissions per nurse (aOR 1.70). DWBs from physicians were significantly more prevalent towards male (vs female) residents (aOR 1.60) and less likely among the second-year postgraduate (vs first-year postgraduate) residents (aOR 0.87).

CONCLUSIONS

DWBs from nurses are significantly more common with increasing hospital bed numbers and increase with the number of admissions per nurse. No such correlation was observed with DWBs from physicians. Male residents experience more DWBs than female residents.

Prevalence of workplace bullying among medical students: A meta-analysis and systematic review protocol

Workplace bullying is a significant issue impacting various professions, including the healthcare sector. This study presents a meta-analysis aimed at assessing the global prevalence of workplace bullying among medical students and identifying potential influencing factors. Previous research suggests that medical students experience higher rates of bullying compared to senior doctors. However, no worldwide meta-analysis has been conducted on this topic. By utilizing a reliable measurement tool, this study will offer a comprehensive analysis of the prevalence of workplace bullying among medical students. The findings are intended to inform the development of strategies to address this issue and enhance the well-being and professional development of medical students worldwide.

Perceived sexual harassment and gender differences in anesthesiology: a cross-sectional survey

Background

In 2017, the hashtags #MeToo and #MeTooMedicine went viral and raised awareness of sexual harassment (SH) and sexual violence affecting all ages, genders, races, sexualities, and careers. Most studies investigating SH have found that women report higher rates of SH experiences compared to men, with documented incidences reaching as high as 81%. Notably, 47% of these incidents go unreported. A study from the Association of Anesthesiologists found that female victims of sexual assault often do not speak up due to the myth that harassment is rare, which further silences women and stigmatizes this issue, leading them to be discouraged from participating in academic anesthesia. Due to the outdated data examining the incidence of SH in the field of anesthesiology, an anonymous 20 item survey was administered to physician attendings and trainees to assess the incidence of SH perceiving SH within the field.

Methods

An anonymous questionnaire-based cross-sectional study, adapted from a validated survey tool on SH and burnout, was administered to a sample of registered members of the American Society of Anesthesiologists (ASA) to evaluate physicians' perceptions related to SH and burnout in their workplace.

Results

The email survey was sent to 30,765 registered ASA members; a total of 2,830 (9.2%) members responded to the 20-item survey for this quantitative analysis. 53.4% (n = 1,511) and 44.2% (n = 1,251) identified themselves as men and women, respectively. Among all the respondents, 57.6% perceived some form of SH (75.5% women and 44.2% men, p-value:<0.0001). Around 40.1% of respondents indicated that they did not react to or report SH events, with a significantly higher incidence among women when compared to men (46.3% vs. 35.5%; p-value:<0.0001). Respondents who perceived SH were more likely to agree with the 5-point Likert-scale questions related to experiencing burnout, facing declining job opportunities or leaving a job, and becoming more emotionally detached from others.

Conclusion

SH has been reported by both male and female anesthesiologists, with female physicians perceiving significantly higher rates of SH compared to their male counterparts. Most respondents who experienced SH in their workplaces expressed agreement with statements related to "burnout feelings" and/or "declining a job opportunity or leaving the workplace." This study contributes to the current literature that SH is prevalent within the field of anesthesiology. Furthermore, our study demonstrates that SH has a positive correlation to feelings of burnout. This study demonstrates the critical importance of instituting policies regarding reporting SH events. Additionally, implementing bystander training can empower individuals to report witnessed SH events. Lastly, safeguards should be implemented to protect those who report witnessing or experiencing SH events.

Attitudes of medical students in Croatia toward rural medicine education and practice

Introduction

Recruiting and retaining doctors in rural areas is challenging. In Croatia, medical school curricula lack content on rural medicine and specialized training for rural practice. This study explores the opinions and attitudes of first- and sixth-year medical students in all four medical schools in Croatia regarding working in rural areas.

Methods

An online questionnaire was administered to Croatian medical students in their first and final years between January 2022 and February 2023. Responses were obtained from 690 participants from the Universities of Osijek, Rijeka, Split, and Zagreb. The cross-sectional study included 13 questions, with 5 on socio-demographic data. Data were analyzed using descriptive statistics and non-parametric tests (chi-square) to assess group differences.

Results

Compared to first-year students, final-year students feel less prepared by their education for rural practice (χ2 = 84.287; P = 0.000) but are more interested in working in rural areas (χ2 = 26.810; P = 0.000). Most students believe rural doctors need additional financial incentives, with this belief significantly stronger among final-year students (χ2 = 14.192; P = 0.000). Both groups agree that rural doctors face poor working conditions (χ2 = 1.524; P = 0.217). No statistically significant differences were found regarding job interest outside city centers (χ2 = 2.041; P = 0.564) or choosing rural medical practice (χ2 = 4.795; P = 0.187) among medical students from the Universities of Osijek, Rijeka, Split, and Zagreb. Students from rural settlements were more often interested in jobs outside the city center (72.1%) compared to those from smaller towns (60.6%), [χ2(1) = 5.142, p = 0.023] and larger cities (44.1%), [χ2(1) = 28.978, p = 0.000].

Conclusion

Although Croatian medical students show interest in working in rural areas, their education lacks sufficient preparation for the unique challenges of rural practice. They view the current conditions for rural doctors as inadequate and believe that additional financial incentives are necessary. Interest in rural practice is consistent across medical faculties in Croatia, with students living in rural areas showing a higher interest in working there.

Education and training interventions for healthcare workers to prevent sexual harassment

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness of education and training interventions on improving knowledge and skills for managing sexual harassment, and to assess their impact on the incidence of sexual harassment towards healthcare workers in healthcare settings. We will include all forms of sexual harassment committed by patients, visitors, and co-workers.

Current status of the surgical training system in Japan: results of a nationwide questionnaire survey of graduating surgical trainees

PURPOSE

To identify the problems trainees face during surgical training in Japan.

METHODS

A nationwide online questionnaire survey was conducted targeting newly certified surgical trainees.

RESULTS

The response rate was 53.8% (758/1410). Among those respondents, 25.6% were women, 71.4% were either married or had a partner, 41.3% had children, 72.7% had performed over 200 surgeries under general anesthesia, and 54.1% had chosen, before graduating from medical school, to become a surgeon. While 88.8% were interested in learning surgical techniques, 63.8% were hesitant to become a surgeon for fear of a compromised quality of private life (QOL). Conversely, only 1.4% chose their surgical training programs based on QOL. Overall, 84.6% of the trainees were satisfied with their training and this correlated with the number of surgeries performed. Only 29.9% received non-technical skill training. The average number of night shifts per month was 5.6, and 10.6% worked over 80 h per week. Harassment was reported by 41.5% of the respondents. Moreover, 33.0% had considered dropping out at some time, primarily because of their QOL (51.1%) or the harassment they had encountered (50.4%).

CONCLUSION

This survey revealed that while trainees were satisfied with the overall training system, issues such as long working hours and harassment are prevalent. Working to improve these issues could make surgery more attractive for young trainees.

"Someone to talk to": A qualitative study of oncology trainees' experience of mentorship around moral distress

BACKGROUND

Moral distress is an intrinsic part of healthcare, particularly prevalent in oncology practitioners. Previous studies have suggested mentorship may play a role in combatting moral distress; however, there is a lack of good evidence aimed at understanding trainees' experience with either mentorship or moral distress, including the intersection between the two.

METHODS

We conducted a single-centre study in the hermeneutic phenomenological approach at a Canadian academic cancer centre. Six semi-structured interviews with senior oncology trainees were conducted and analysed according to the interpretive profiles hermeneutic phenomenological approach.

FINDINGS/RESULTS

Key findings include the idea that trainees do find mentorship valuable and helpful in navigating moral distress, which is described as common and inevitable, with a number of triggers and factors identified. However, a mentorship relationship must involve mutual respect, understanding, and honesty in order to be valuable. Additionally, engaging in open, honest discussions with mentors, particularly more senior individuals, is seen as a risk-benefit balance by trainees; vertical mentors bring more wisdom and experience, but may also have a greater impact on a trainee's future.

CONCLUSION

This thought-provoking study highlights mentorship as a potential method to combat the troubling phenomenon of moral distress in oncology trainees.

Prevalence of depression and anxiety in orthopedic residents: a systematic review and meta-analysis

BACKGROUND

Orthopedics is one of the specialized fields of medicine and its residency has always been of interest. This systematic review and meta-analysis aim to evaluate the prevalence of depression and anxiety among orthopedic residents.

METHODS

Digital databases such as PubMed, Scopus and Web of Science were systematically searched until July 27, 2024.

RESULTS

The analysis included a total of 10 studies for anxiety (1,758 cases, 374 anxiety cases) and depression (2,389 cases, 381 depression cases). The pooled prevalence of anxiety was 31.6% [95% CI: 18.04-45.26%] with significant publication bias (Egger's test p = 0.0257). After removing a potential outlier, the prevalence of anxiety was recalculated as 25% [95% CI: 16.61-34.01%]. The pooled prevalence of depression was 22.2% [95% CI: 12.08-32.51%] with significant publication bias (Egger's test p = 0.0434). After removing a potential outlier, the prevalence of depression was recalculated as 18.6% [95% CI: 10.27-26.92%], showing no significant publication bias (Egger's test p = 0.1229).

CONCLUSION

Depression and anxiety are highly prevalent among orthopedic residents, with significant levels of psychological distress affecting nearly one-third of this population.

Bullying within specialist medical training in Australia: Analysis of the medical training survey, 2020-2023

OBJECTIVE

Bullying is common in medical specialist training in Australia. To understand bullying rates across medical specialist training programs, we analyse the recent Medical Training Survey, administered by the Medical Board of Australia to all registered medical practitioners.

METHODS

Medical Training Survey data were extracted and averaged from 2020 to 2023.

RESULTS

Many speciality trainees reported personally experiencing or witnessing bullying. This was lowest in general practice (13% personally experienced and 15% witnessed) and highest in obstetrics and gynaecology (27% and 41%). The highest rate of bullying by supervisors was in surgery: 60% of surgical trainees stated that when they were bullied it was by their supervisor. Within psychiatry, 22% of trainees had personally experienced bullying and 32% of trainees had witnessed bullying. When they were bullied, the perpetrator was less commonly a supervisor (40%). In all specialities, there was a very low percentage of bullying which was reported, and was identified as having a satisfactory outcome: the most satisfactory outcomes (13%) were in general practice.

CONCLUSION

Current rates of bullying for medical specialist trainees, the reluctance to report, as well as the lack of satisfactory outcomes, is of grave concern for Australian healthcare. This requires urgent attention at a systems level.

Relationship between forensic medicine education, stress factors, and mobbing perception from the perspective of specialists in Turkey's universities

INTRODUCTION

The current situation needs to be presented with scientific data to ensure and improve the quality of specialist training. This study examined the quality of education, instructor competence, stress factors, mobbing, and their interconnections in the domain of forensic medicine specialty education in Turkey.

MATERIALS AND METHODS

This cross-sectional study was conducted through an anonymous, web-based survey targeting forensic medicine specialists who have completed their specialist training in university forensic medicine departments within the last three years. The survey consisted of questions regarding issues included in the core education curriculum, educator characteristics, and perceptions of stress and mobbing. Based on the responses provided, the relationships between these factors were statistically analysed.

RESULTS

72.7 % of the study population completed the survey. Nearly half of the participants (46.3 %) did not consider the number of instructors adequate. The quality of instructors (scientific competence, educational and teaching skills, interpersonal relations, accessibility, management, and problem-solving abilities) was determined to be partially sufficient (mean = 3.36). Approximately one-third of the respondents indicated that instructors made the greatest contribution to their specialist training, whereas the proportion of those who said otherwise was much higher. Education received for topics included in the core curriculum was partially sufficient level (mean = 3.04). It was observed that there was a significant relationship between the instructor characteristics, sufficiency score of the taught topics, and perception of mobbing (p < 0.01). The sufficiency scores of instructor characteristics had a 1.02-fold impact on sufficiency ratings of the topics covered in residency training. Among the respondents, 76.9 % reported encountering stress factors during their specialty training, with the most frequently exposed stress factor (52.2 %) being disorganisation within the training program. Among the participants, 22.8 % reported experiencing mobbing.

CONCLUSIONS

Education and instructor qualifications were correlated; however, stress factors and mobbing adversely affected education. A close association was observed between education, instructors, stressors, and mobbing. Thus independent and objective auditors tasked with verifying whether institutions meet the established educational standards need to be established.

Abuse, Bullying, Harassment, Discrimination, and Allyship in Cardiothoracic Surgery

Abuse, bullying, harassment, and discrimination are prominent workplace occurrences within cardiothoracic (CT) surgery that cause burnout and threaten the well-being of surgeons. Under-represented and marginalized groups experience higher incidences of these negative events, and CT surgery is one of the least diverse specialties. The CT surgery workforce and institutional leadership must prioritize mentorship, sponsorship, and allyship to promote a diverse and healthy specialty for surgeon recruitment, growth, and job satisfaction.

Do Women and Minority Orthopaedic Residents Report Experiencing Worse Well-being and More Mistreatment Than Their Peers?

BACKGROUND

Despite the increased risk of attrition for women and minority residents during orthopaedic residency, there is currently a paucity of research examining the training environment of these residents. To address this, we examined how well-being constructs may differ for women or minority residents compared with their peers, and whether these residents report experiencing more mistreatment during residency.

QUESTIONS/PURPOSES

(1) How does the psychologic wellbeing of women and minority residents compare with that of their peers regarding the constructs of burnout, lifestyle satisfaction, social belonging, and stereotype threat? (2) Do reported mistreatment experiences during residency differ among women and minority residents compared with their peers? (3) Is there a difference in the proportion of women and minority orthopaedic residents with thoughts of leaving residency compared with their peers?

METHODS

Seventeen orthopaedic residency programs in the 91 programs comprising the Collaborative Orthopaedic Educational Research Group agreed to participate in the study. Program directors sent an anonymous one-time survey with two reminders to all orthopaedic residents at their respective institutions. The survey instrument comprised validated and previously used instruments with face validity designed to measure burnout, satisfaction, duty-hour violations, belonging, stereotype threat, mistreatment, and thoughts of leaving residency, in addition to demographic information. Forty-three percent (211 of 491) of residents responded to the survey. Race or ethnicity data were combined into "White" and "underrepresented in orthopaedics" (URiO), which included residents who self-identified as Asian, African American, Hispanic or Latino, Native American, or other, given that these groups are all underrepresented racial and ethnic groups in orthopaedics. The demographic makeup of our study, 81% men and 75% White, is roughly comparable to the current demographic makeup of orthopaedic residency programs, which is 82% men and 74% White. Data were analyzed using chi-square tests, Fisher exact tests, and t-tests as appropriate. For comparisons of Likert scale measures, we used an anchor-based approach to determining the minimum detectable change (MDC) and set the MDC as a 1-point difference on a 5-point scale and a 1.5-point difference on a 7-point scale. Stereotype threat is reported as the mean ▵ from the neutral response, and ▵ of 1.5 or greater was considered significant.

RESULTS

Women residents were more likely than men to report experiencing emotional exhaustion (odds ratio 2.18 [95% confidence interval 1.1 to 4.5]; p = 0.03). Women reported experiencing stereotype threat regarding their identity as women surgeons (mean ▵ 1.5 ± 1.0). We did not identify a difference in men's and women's overall burnout (OR 1.4 [95% CI 0.7 to 3.0]; p = 0.3), lifestyle satisfaction across multiple domains, or sense of social belonging (men: 4.3, women 3.6; mean difference 0.7 [95% CI 0.4 to 0.9]; p < 0.001). We did not identify differences in overall burnout (OR 1.5 [95% CI 0.8 to 3.0]; p = 0.2), lifestyle satisfaction across multiple domains, sense of social belonging (White: 4.2, URiO: 3.9; mean difference 0.3 [95% CI 0.17 to 0.61]; p < 0.001), or stereotype threat (mean ▵ 0.8 ± 0.9) between White and URiO surgeons. Women were more likely than men to report experiencing mistreatment, with 84% (32 of 38) of women and 43% (70 of 164) of men reporting mistreatment at least a few times per year (OR 7.2 [95% CI 2.8 to 18.1]; p < 0.001). URiO residents were more likely than White residents to report experiencing mistreatment overall, with 65% (32 of 49) of URiO residents and 45% (66 of 148) of White residents reporting occurrences at least a few times per year (OR 2.3 [95% CI 1.2 to 4.6]; p = 0.01). Women were more likely than men to report experiencing gender discrimination (OR 52.6 [95% CI 18.9 to 146.1]; p < 0.001), discrimination based on pregnancy or childcare status (OR 4.3 [95% CI 1.4 to 12.8]; p = 0.005), and sexual harassment (OR 11.8 [95% CI 4.1 to 34.3]; p < 0.001). URiO residents were more likely than White residents to report experiencing racial discrimination (OR 7.8 [95% CI 3.4 to 18.2]; p < 0.001). More women than men had thoughts of leaving residency (OR 4.5 [95% CI 1.5 to 13.5]; p = 0.003), whereas URiO residents were not more likely to have thoughts of leaving than White residents (OR 2.2 [95% CI 0.7 to 6.6]; p = 0.1).

CONCLUSION

Although we did not detect meaningful differences in some measures of well-being, we identified that women report experiencing more emotional exhaustion and report stereotype threat regarding their identity as women surgeons. Women and URiO residents report more mistreatment than their peers, and women have more thoughts of leaving residency than men. These findings raise concern about some aspects of the training environment for women and URiO residents that could contribute to attrition during training.

CLINICAL RELEVANCE

Understanding how well-being and mistreatment affect underrepresented residents helps in developing strategies to better support women and URiO residents during training. We recommend that orthopaedic governing bodies consider gathering national data on resident well-being and mistreatment to identify specific issues and track data over time. Additionally, departments should examine their internal practices and organizational culture to address specific gaps in inclusivity, well-being, and mechanisms for resident support.

A Canadian National Survey Study of Harassment in Surgery-Still a Long Way to Go

OBJECTIVES

Previous literature has consistently documented harassment and discrimination in surgery. These experiences may contribute to the continuing gender inequity in surgical fields. The objective of our study was to survey Canadian surgeons and surgical trainees to gain a greater understanding of the experience of harassment across genders, career stage, and specialty.

METHODS

A cross-sectional, online survey was distributed to Canadian residents, fellows, and practicing surgeons in general surgery, plastic surgery, and neurosurgery through their national society email lists and via social media posts.

RESULTS

There were 194 included survey respondents (60 residents, 11 fellows, and 123 staff) from general surgery (44.8%), plastic surgery (42.7%), and neurosurgery (12.5%). 59.8% of women reported having experienced harassment compared to only 26.0% of men. Women were significantly more likely to be harassed by colleagues and patients/families compared to men. Residents (62.5%) were two times more likely to report being harassed compared to fellows/staff (38.3%). Residents were significantly more likely to be harassed by patients/families while fellows/staff were more likely to be harassed by colleagues. There were no significant differences in self-reported harassment across the three surgical specialties. There was no significant difference in rates of reported harassment between current residents (62.5%), and fellow/staff recollections of their experiences of harassment during residency (59.2%).

CONCLUSIONS

The prevalence of gender-based discrimination remains high and harassment prevalence remains largely unchanged from when current staff were in residency. Our findings highlight a need to implement systemic changes to support the increasing number of women entering surgery, and to improve surgical culture to continue to attract the best and brightest to the field.

A Shadow of Doubt: Is There Implicit Bias Among Orthopaedic Surgery Faculty and Residents Regarding Race and Gender?

BACKGROUND

Orthopaedic surgery continues to be one of the least diverse medical specialties. Recently, increasing emphasis has been placed on improving diversity in the medical field, which includes the need to better understand existing biases. Despite this, only about 6% of orthopaedic surgeons are women and 0.3% are Black. Addressing diversity, in part, requires a better understanding of existing biases. Most universities and residency programs have statements and policies against discrimination that seek to eliminate explicit biases. However, unconscious biases might negatively impact the selection, training, and career advancement of women and minorities who are underrepresented in orthopaedic surgery. Although this is difficult to measure, the Implicit Association Test (IAT) by Project Implicit might be useful to identify and measure levels of unconscious bias among orthopaedic surgeons, providing opportunities for additional interventions to improve diversity in this field.

QUESTIONS/PURPOSES

(1) Do orthopaedic surgeons demonstrate implicit biases related to race and gender roles? (2) Are certain demographic characteristics (age, gender, race or ethnicity, or geographic location) or program characteristics (geographic location or size of program) associated with the presence of implicit biases? (3) Do the implicit biases of orthopaedic surgeons differ from those of other healthcare providers or the general population?

METHODS

A cross-sectional study of implicit bias among orthopaedic surgeons was performed using the IAT from Project Implicit. The IAT is a computerized test that measures the time required to associate words or pictures with attributes, with faster or slower response times suggesting the ease or difficulty of associating the items. Although concerns have been raised recently about the validity and utility of the IAT, we believed it was the right study instrument to help identify the slight hesitation that can imply differences between inclusion and exclusion of a person. We used two IATs, one for Black and White race and one for gender, career, and family roles. We invited a consortium of researchers from United States and Canadian orthopaedic residency programs. Researchers at 34 programs agreed to distribute the invitation via email to their faculty, residents, and fellows for a total of 1484 invitees. Twenty-eight percent (419) of orthopaedic surgeons and trainees completed the survey. The respondents were 45% (186) residents, 55% (228) faculty, and one fellow. To evaluate response biases, the respondent population was compared with that of the American Academy of Orthopaedic Surgeons census. Responses were reported as D-scores based on response times for associations. D-scores were categorized as showing strong (≥ 0.65), moderate (≥ 0.35 to < 0.65), or slight (≥ 0.15 to < 0.35) associations. For a frame of reference, orthopaedic surgeons' mean IAT scores were compared with historical scores of other self-identified healthcare providers and that of the general population. Mean D-scores were analyzed with the Kruskal-Wallis test to determine whether demographic characteristics were associated with differences in D-scores. Bonferroni correction was applied, and p values less than 0.0056 were considered statistically significant.

RESULTS

Overall, the mean IAT D-scores of orthopaedic surgeons indicated a slight preference for White people (0.29 ± 0.4) and a slight association of men with career (0.24 ± 0.3), with a normal distribution. Hence, most respondents' scores indicated slight preferences, but strong preferences for White race were noted in 27% (112 of 419) of respondents. There was a strong association of women with family and home and an association of men with work or career in 14% (60 of 419). These preferences generally did not correlate with the demographic, geographic, and program variables that were analyzed, except for a stronger association of women with family and home among women respondents. There were no differences in race IAT D-scores between orthopaedic surgeons and other healthcare providers and the general population. Gender-career IAT D-scores associating women with family and home were slightly lower among orthopaedic surgeons (0.24 ± 0.3) than among the general population (0.32 ± 0.4; p < 0.001) and other healthcare professionals (0.34 ± 0.4; p < 0.001). All of these values are in the slight preference range.

CONCLUSION

Orthopaedic surgeons demonstrated slight preferences for White people, and there was a tendency to associate women with career and family on IATs, regardless of demographic and program characteristics, similar to others in healthcare and the general population. Given the similarity of scores with those in other, more diverse areas of medicine, unconscious biases alone do not explain the relative lack of diversity in orthopaedic surgery.

CLINICAL RELEVANCE

Implicit biases only explain a small portion of the lack of progress in improving diversity, equity, inclusion, and belonging in our workforce and resolving healthcare disparities. Other causes including explicit biases, an unwelcoming culture, and perceptions of our specialty should be examined. Remedies including engagement of students and mentorship throughout training and early career should be sought.

To the bone: Prevalence and correlates of depression and anxiety among orthopedic residents in Mexico

OBJECTIVE

Examining orthopedic residents in Mexico, researchers explore the relationship between the presence of depressive or anxious symptoms and the degree of perfectionism, perceived work-related distress, and involvement in the care of patient(s) who died.

METHODS

This was a cross-sectional online survey of 642 orthopedic residents from October 2019 to April 2021.

RESULTS

Of orthopedic residents contacted, 50.6% responded rate (70.9% male, average age 29.8 years). A total of 12.5% reported significant depressive symptoms and 18.4% reported significant anxious symptoms. On a scale from 0-100, the mean score of perceived work-related distress was 51.9. One-third (33.6%) reported being involved in the care of patient(s) who had died. Higher levels of work-related distress and higher scores on perfectionism were associated with depressive and anxiety symptoms. In particular, being involved in the care of patient(s) who had died was associated with anxious symptoms (OR = 1.79; 95%CI = 1.18-2.72).

CONCLUSIONS

These results highlight the need for systematic monitoring of the mental health of orthopedic residents in Mexico, particularly those who report a high level of work-related distress or perfectionism or who have recently experienced the death of a patient.

Sexual Harassment, Abuse, and Discrimination in Obstetrics and Gynecology: A Systematic Review

Importance

Unlike other surgical specialties, obstetrics and gynecology (OB-GYN) has been predominantly female for the last decade. The association of this with gender bias and sexual harassment is not known.

Objective

To systematically review the prevalence of sexual harassment, bullying, abuse, and discrimination among OB-GYN clinicians and trainees and interventions aimed at reducing harassment in OB-GYN and other surgical specialties.

Evidence Review

A systematic search of PubMed, Embase, and ClinicalTrials.gov was conducted to identify studies published from inception through June 13, 2023.: For the prevalence of harassment, OB-GYN clinicians and trainees on OB-GYN rotations in all subspecialties in the US or Canada were included. Personal experiences of harassment (sexual harassment, bullying, abuse, and discrimination) by other health care personnel, event reporting, burnout and exit from medicine, fear of retaliation, and related outcomes were included. Interventions across all surgical specialties in any country to decrease incidence of harassment were also evaluated. Abstracts and potentially relevant full-text articles were double screened.: Eligible studies were extracted into standard forms. Risk of bias and certainty of evidence of included research were assessed. A meta-analysis was not performed owing to heterogeneity of outcomes.

Findings

A total of 10 eligible studies among 5852 participants addressed prevalence and 12 eligible studies among 2906 participants addressed interventions. The prevalence of sexual harassment (range, 250 of 907 physicians [27.6%] to 181 of 255 female gynecologic oncologists [70.9%]), workplace discrimination (range, 142 of 249 gynecologic oncologists [57.0%] to 354 of 527 gynecologic oncologists [67.2%] among women; 138 of 358 gynecologic oncologists among males [38.5%]), and bullying (131 of 248 female gynecologic oncologists [52.8%]) was frequent among OB-GYN respondents. OB-GYN trainees commonly experienced sexual harassment (253 of 366 respondents [69.1%]), which included gender harassment, unwanted sexual attention, and sexual coercion. The proportion of OB-GYN clinicians who reported their sexual harassment to anyone ranged from 21 of 250 AAGL (formerly, the American Association of Gynecologic Laparoscopists) members (8.4%) to 32 of 256 gynecologic oncologists (12.5%) compared with 32.6% of OB-GYN trainees. Mistreatment during their OB-GYN rotation was indicated by 168 of 668 medical students surveyed (25.1%). Perpetrators of harassment included physicians (30.1%), other trainees (13.1%), and operating room staff (7.7%). Various interventions were used and studied, which were associated with improved recognition of bias and reporting (eg, implementation of a video- and discussion-based mistreatment program during a surgery clerkship was associated with a decrease in medical student mistreatment reports from 14 reports in previous year to 9 reports in the first year and 4 in the second year after implementation). However, no significant decrease in the frequency of sexual harassment was found with any intervention.

Conclusions and Relevance

This study found high rates of harassment behaviors within OB-GYN. Interventions to limit these behaviors were not adequately studied, were limited mostly to medical students, and typically did not specifically address sexual or other forms of harassment.

Sexual Harassment at Work: Scoping Review of Reviews

Background

This article presents a scoping review of reviews on the topic of Sexual Harassment (SH) in the workplace, a subject that has garnered significant global attention. The phenomenon of SH poses a critical challenge to equal opportunity and gender equity in the workplace.

Aim

The review aims to synthesize existing research, focusing on the antecedents, consequences, and interventions related to SH.

Methods

The inclusion and exclusion criteria were established based on the research question, which was adapted from the PICO strategy. A protocol was devised following the "DS-CPC" format, which encompasses considerations related to Documents, Studies, Construct, Participants, and Contexts. The search was carried utilizing several automated databases, specifically focusing on the fields of Psychology, Behavioral Sciences, and Health. Preliminary search yielded a total of 468 articles, and the review ultimately encompassed a total of 22 articles.

Results

This review critically examines the complexity of SH, including the role of bystanders, the perpetuation of myths and misconceptions, and the exploitation of power imbalances by harassers. It also explores the manifestation of SH in male-dominated workplaces and the varying levels of organizational awareness and response to such incidents. The review highlights the importance of fostering an organizational culture that not only acknowledges and protects victims but also implements effective measures to penalize perpetrators.

Implications

It aims to elucidate the intricacies of SH and advocate for a workplace environment characterized by respect and accountability. Through this comprehensive analysis, the article seeks to inform and guide future research, policy development, and organizational practices concerning SH.

What is the nature, extent and impact of bullying in surgical settings? Insights of surgeons in Australia and Aotearoa New Zealand

BACKGROUND

A significant body of literature has examined the impact of verbal and non-verbal bullying in surgical settings, where a central focus has been on the experiences of trainee and junior members of the surgical team, women in surgery and other health professionals, such as nurses. Research on how surgeons' perceive or experience bullying is more limited. Therefore, this study aims to investigate the views of surgeons on negative and disrespectful verbal and non-verbal behaviour and bullying in surgical settings, including its impact on surgeons themselves and the surgical staff they oversee.

METHODS

Semi-structured interviews were undertaken with surgeons between February and November 2019. Questions explored surgeons' perceptions of interpersonal communication and behaviour in their surgical workplaces in the preceding 6-months. A narrative analysis approach was used to code, interpret, and report the interview data.

RESULTS

Thirty-one interviews were conducted with surgeons (19 male and 12 female), from Australia (26) and Aotearoa New Zealand (5) from 10 surgical specialties. Three themes were identified with associated subthemes: bullying (five subthemes), non-verbal bullying (seven subthemes), and impact and outcomes of bullying (six subthemes).

CONCLUSION

This study revealed a notable shift in the reported verbal and non-verbal bullying behaviour among surgeons, demonstrating a decrease in intensity, physicality and violence for the 6-months prior to interviews conducted in 2019, when compared with surgeons' historic experiences. Despite reported behaviour being more subtle and indirect, it nonetheless continues to have a marked impact on many surgeons as well as the staff they oversee.

Implementation of Well-Being for Cardiothoracic Surgeons

Well-being is a quality of positive physical, mental, social, and environmental experiences. Well-being enables thoracic surgeons to achieve their full potential across personal and work domains. Evidence-based guidelines to promote individual well-being include (1) progress toward a goal; (2) actions commensurate with experience, interest, mission; (3) interconnectivity with others; (4) social relatedness of the work one does; (5) safety; and (6) autonomy. Successful pursuit of well-being includes the development of individual skills of mindfulness, resilience, and connection with others. However, well-being among individuals cannot be achieved without support of workplace leaders and durable institutional infrastructure.

Sex Disparities in Ophthalmology From Training Through Practice: A Systematic Review

Importance

Sex-based research in medicine has revealed inequities against females on almost every metric at almost every career stage; ophthalmology is no exception.

Objective

To systematically review the experiences of females in ophthalmology (FiO) from training through practice in high-income countries (HICs).

Evidence Review

A systematic review of English-language studies, published between January 1990 and May 2022, relating to FiO in HICs was performed. PubMed, MEDLINE, and Embase electronic databases were searched, as well as the Journal of Academic Ophthalmology as it was not indexed in the searched databases. Studies were organized by theme at each career stage, starting in medical school when an interest in ophthalmology is expressed, and extending up to retirement.

Findings

A total of 91 studies, 87 cross-sectional and 4 cohort, were included. In medical school, mentorship and recruitment of female students into ophthalmology was influenced by sex bias, with fewer females identifying with ophthalmologist mentors and gender stereotypes perpetuated in reference letters written by both male and female referees. In residency, females had unequal learning opportunities, with lower surgical case volumes than male trainees and fewer females pursued fellowships in lucrative subspecialties. In practice, female ophthalmologists had lower incomes, less academic success, and poorer representation in leadership roles. Female ophthalmologists had a greater scholarly impact factor than their male counterparts, but this was only after approximately 30 years of publication experience. Pervasive throughout all stages of training and practice was the experience of greater sexual harassment among females from both patients and colleagues. Despite these disparities, some studies found that females reported equal overall career satisfaction rating with males in ophthalmology, whereas others suggested higher burnout rates.

Conclusions and Relevance

Ophthalmology is approaching sex parity, however, the increase in the proportion of females in ophthalmology had not translated to an increase in female representation in leadership positions. Sex disparities persisted across many domains including recruitment, training, practice patterns, academic productivity, and income. Interventions may improve sex equity in the field.

Health Considerations for Female Orthopaedic Surgeons

The number of female orthopaedic surgeons is increasing. They face unique health concerns, which include cancer risk, pregnancy and fertility problems, musculoskeletal issues, and mental health disorders. In 2010, a survey study showed a 2.9-fold increased prevalence of breast cancer in female orthopaedic surgeons, compared with women in the general US population. A follow-up study 13 years later showed a 3.97-fold higher prevalence of breast cancer in female orthopaedic surgeons compared with matched women in the US general population. Surveys on fertility have also reported that orthopaedic surgery is one of three surgical subspecialty fields with the highest rates of fertility difficulty. In addition, the rate of pregnancy loss in female surgeons was twice the rate compared with that of the general population. There is an increased risk of preterm delivery in female orthopaedic surgeons. Awareness, education, and preventive measures may help reduce these issues and thereby promote the recruitment, retainment, and success of female surgeons in orthopaedic surgery.

Self-reported Patient-perpetrated Sexual Harassment and Subsequent Reporting Among Health Care Clinicians in Urology and Obstetrics-Gynecology: A Cohort Survey

OBJECTIVE

To understand the experiences of urologists and obstetricians-gynecologists (obgyns) with patient-perpetrated sexual harassment (PPSH) since the clinical focus of these specialists may make them particularly vulnerable to PPSH.

METHODS

A multiple-choice anonymous online survey was administered in the Departments of Urology and Obgyn at a single institution from 22 September, 2022-18 October, 2022. The survey assessed if clinicians had experienced PPSH, including gender harassment, unwanted sexual attention, and/or sexual coercion from patients, where PPSH was witnessed or experienced, and whether implementation of chaperones impacted their experiences with PPSH. We conducted descriptive analysis by clinician sex, department, and form of PPSH experienced. We also performed logistic regression analysis to identify clinician factors associated with experiencing PPSH.

RESULTS

Majority of respondents reported that they experienced or witnessed PPSH (78%, N = 100). Gender harassment was the most common form of PPSH experienced by clinicians (53%, N = 68). PPSH was most often experienced or witnessed in clinic (74%, N = 70) and inpatient wards (66%, N = 62). Of those who utilized chaperones, 80% (N = 57) of clinicians reported they either did not reduce or were unsure if they reduced PPSH. When adjusting for clinician factors, being a female clinician (adjusted odd ratio [aOR] = 5.1, 95% confidence interval (CI) 1.5-17.3), trainee (aOR = 6.9, 95% CI 1.1-44.6), or a urologist (aOR = 18.1, 95% CI 2.0-166.1) were associated with experiencing PPSH.

CONCLUSION

Our study highlights the pervasiveness of PPSH among urologists and obgyns. Future studies should elucidate what policy changes can be effective in protecting clinicians from PPSH.

The role of gender as a barrier to the professional development of psychiatrists

BACKGROUND

Despite efforts toward greater gender equality in clinical and academic psychiatry in recent years, more information is needed about the challenges in professional development within psychiatry, and how these may vary with gender.

METHODS

A cross-sectional 27-item online survey was conducted with psychiatrists and psychiatric trainee members of the European Psychiatric Association.

RESULTS

A total of 561 psychiatrists and psychiatric trainees from 35 European countries participated representing a response rate of 52.8% for women and 17.7% for men from a total sample of 1,580. The specific challenges that women face in their professional development fall into two categories. One comprised women's negative attitudes concerning their abilities in self-promotion and networking. The other identified environmental barriers related to lack of opportunity and support and gender discrimination. Compared to men, women reported higher rates of gender discrimination in terms of professional advancement. Women were less likely to agree that their institutions had regular activities promoting inclusion, diversity, and training to address implicit gender bias. Working in high-income countries compared to middle-income countries relates to reporting institutional support for career progression.

CONCLUSIONS

These findings are an open call to hospital leaders, deans of medical schools, and department chairs to increase efforts to eradicate bias against women and create safer, inclusive, and respectful environments for all psychiatrists, a special call to women psychiatrists to be aware of inner tendencies to avoid self-promotion and networking and to think positively and confidently about themselves and their abilities.

Workplace violence against healthcare workers: an umbrella review of systematic reviews and meta-analyses

OBJECTIVES

The aim of this umbrella review of systematic reviews and meta-analyses was to address workplace violence (WPV) against healthcare workers (HCWs). Several systematic reviews exist in the literature, but the diversity of settings, population considered, and type of violence investigated make it difficult to gain insight and use the vast amount of available data to implement policies to tackle WPV. With this in mind, we conducted an umbrella review of systematic reviews and meta-analyses on WPV against HCWs to examine the global prevalence of the phenomena and its features.

STUDY DESIGN AND METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Scopus, and ISI Web of Science were searched for relevant systematic reviews and meta-analyses published in English up to November 2022. Data on authors, year, country, violence type, prevalence (pooled and not), setting, population, and specific considerations were extracted.

RESULTS

A total of 32 systematic reviews were included, 19 of which performed a meta-analysis, investigating overall, physical, and non-physical violence. Even considering the variability of the data, the COVID-19 pandemic has exacerbated the scale of the problem. From our review, we found that overall violence prevalence among HCWs was reported to be as high as 78.9%, and nurses working in psychiatric wards were the professionals most impacted.

CONCLUSION

In conclusion, this umbrella review revealed a high prevalence of WPV among HCWs, which varies between countries, population subgroups, and detection methods. Strengthening recognition of the problem could lead to appropriate local and international strategies to address it.

Workplace Bias Affecting Applicants to Independent Plastic Surgery Residencies

Background

This study explores factors that encourage residents to apply to independent plastic surgery residencies to gain insight into whether they faced bias as a result of this decision.

Methods

Resident applicants who applied to two academic independent plastic surgery residencies in 2021 and 2022 were emailed a survey consisting of 25 questions. Responses were collected anonymously and analyzed. Descriptive statistics were performed, and subgroup analyses were conducted with Fisher exact and Pearson χ2 testing.

Results

Thirty-nine complete responses were included for analysis (response rate 22.7%). Participants were asked what encouraged them to go into plastic surgery during residency. The most common reasons were scrubbing in on plastic surgery cases and interactions with plastic surgery faculty/residents, with each reason cited by 30 respondents (76.8%). Further, 20.5% of residents agreed or strongly agreed that they felt unsupported by their program director in their decision to apply into plastic surgery. Likewise, 64.1% of respondents agreed or strongly agreed to having experienced demeaning comments or jokes by faculty about their choice of plastic surgery. Consequently, 17.9% agreed or strongly agreed that they developed stress or anxiety due to how co-residents and/or faculty treated them regarding their decision to pursue plastic surgery.

Conclusions

General surgery residents planning to apply to independent plastic surgery residency may experience workplace biases related to their career decision. An important opportunity exists to support independent applicants and to provide mentorship.

Workplace bullying and sexual harassment among general surgery residents in Colombia

INTRODUCTION

Workplace bullying and sexual harassment are concerns among general surgery residents in Colombia.

OBJETIVE

To explore the prevalence and impact of workplace bullying and sexual harassment incidents among general surgery residents in Colombia.

MATERIALS AND METHODS

This nationwide study was conducted in 2020. Residents selfrated their exposure to workplace bullying and to sexual harassment in the forms of gender harassment, unwanted sexual attention, and sexual coercion. We analyzed demographic variables, perpetrator’s characteristics, and differences between victims and non-victims.

RESULTS

The study included 302 residents. It found that 49% of general surgery residents in Colombia suffered from workplace bullying and 14.9% experienced sexual harassment. The main forms of sexual harassment were gender harassment (47%) and unwanted sexual attention (47%). Women reported significantly higher rates of being sexually harassed. Surgeons were the main perpetrators of sexual harassment.

CONCLUSIONS

Workplace bullying and sexual harassment are frequent events in general surgery residency in Colombia. These findings suggest the need for interventions to improve the educational culture of surgical departments and decrease the prevalence of these behaviors.

Reactions and perspectives of medical students on workplace violence during clinical training in Ardabil, Iran, 2020

BACKGROUND

Workplace violence continues among medical students in training. This study aimed to determine the reactions and perspectives of medical students against workplace violence during clinical training in Ardabil University of Medical Sciences in Iran, 2020.

MATERIALS

This descriptive cross-sectional study was conducted on 300 medical students from April to March 2020, in the Ardabil university hospitals. Students with at least one year training in the university hospitals were eligible to participate. Data was collected via questionnaires administered in the health ward. Data was analyzed through SPSS 23 software.

RESULTS

Most respondents had experienced workplace violence in the form of verbal (63%), physical (25.7%), racial (23%) and sexual (3%) violence during clinical training. Men were the aggressors during violence of a physical (80.5%), verbal (69.8%), racial (76.8%) and sexual (100%) nature (p < 0.001). When encountered with violence, 36% of the respondents did not take any action and 82.7% of respondents failed to report the incident. For 67.8% of respondents that did not report of violence incident, this procedure was deemed pointless, while 27% of respondents considered the violent incident insignificant. The main reason for workplace violence was perceived to be a lack of awareness of people about staff duties (67.3% of respondents). According to 92.7% of respondents personnel training was the most important factor in preventing workplace violence.

CONCLUSIONS

The findings suggest that the majority of medical students during clinical training in Ardabil Iran (2020) have been exposed to workplace violence. However, most students did not take any action or report the incident. Targeted personnel training, increase awareness of workplace violence, and encouragement of reporting these incidents should be promoted to reduce violence to medical students.

Gender Differences in Professional Adversities and Mental Health Among Surgical and Nonsurgical Medical Trainees: An Internet-Based Survey

BACKGROUND

Physicians in training face a variety of stressors throughout their professional development and according to their gender. Among them, surgical trainees appear to be especially at risk for mental health problems.

OBJECTIVE

The aim of the present study was to compare demographic features, professional activities and adversities, depression, anxiety, and distress among men and women trainees of surgical and nonsurgical medical specialties.

DESIGN AND PARTICIPANTS

A cross-sectional, retrospective, comparative study was conducted on a total of 12,424 trainees (68.7% nonsurgical and 31.3% surgical) from Mexico through an online survey. Demographic features, variables related to professional activities and adversities, depression, anxiety, and distress were evaluated through self-administered measures. Comparative analyses using the Cochran-Mantel-Haenszel test for categorical variables and multivariate analysis of variance including medical residency program and gender as fixed factors to test their interaction effect for continuous variables were used.

RESULTS

An important interaction between medical specialty and gender was found. Women trainees from surgical specialties report more frequent psychological and physical aggressions. Women from both specialties had higher distress, significant anxiety, and depression than men. Men from surgical specialties worked more hours per day.

CONCLUSIONS

Gender differences are evident in trainees for medical specialties, with a larger impact in surgical fields. Mistreatment of students is a pervasive behavior that affects society as a whole, and actions to improve learning and working environments in all medical specialties, but mostly in surgical fields, are urgently needed.

Bullying in Orthopaedic Surgery: A Survey of US Orthopaedic Trainees and Attending Surgeons

INTRODUCTION

Bullying is a notable problem in surgery, creating a hostile environment for surgeons and trainees, and may negatively affect patient care. However, specific details regarding bullying in orthopaedic surgery are lacking. The primary aim of this study was to determine the prevalence and nature of bullying within orthopaedic surgery in the United States.

METHODS

A deidentified survey was developed using the survey created by the Royal College of Australasian Surgeons and the validated Negative Acts Questionnaire-Revised survey tool. This survey was distributed to orthopaedic trainees and attending surgeons in April 2021.

RESULTS

Of the 105 survey respondents, 60 (60.6%) were trainees and 39 (39.4%) were attending surgeons. Although 21 respondents (24.7%) stated they had been bullied, 16 victims (28.1%) did not seek to address this behavior. Perpetrators of bullying were most commonly male (49/71, 67.2%) and the victims' superior (36/82, 43.9%). Five bullying victims (8.8%) reported the behavior, despite 46 respondents (92.0%) stating that their institution has a specific policy against bullying.

CONCLUSION

Bullying behavior occurs in orthopaedic surgery, with perpetrators being most commonly male and the victims' superiors. Despite the fact that an overwhelming majority of institutions have policies against bullying, the reporting of such behavior is lacking.

Patient Safety/Quality Improvement Primer, Part IV: Psychological Safety-Drivers to Outcomes and Well-being

Psychological safety is the concept that an individual feels comfortable asking questions, voicing ideas or concerns, and taking risks without undue fear of humiliation or criticism. In health care, psychological safety is associated with improved patient safety outcomes, increased clinician engagement, and greater creativity. A culture of psychological safety is imperative for physician well-being and satisfaction, which in turn directly affect delivery of care. For health care professionals, psychological safety creates an environment conducive to trust and openness, enabling the team to focus on high-quality care. In contrast, unprofessional behavior reduces psychological safety and threatens the culture of the organization. This patient safety/quality improvement primer considers the barriers and facilitators to psychological safety in health care; outlines principles for creating a psychologically safe environment; and presents strategies for managing conflict, microaggressions, and lapses in professionalism. Individuals and organizations share the responsibility of promoting psychological safety through proactive policies, conflict management, interventions for microaggressions, and cultivation of emotional intelligence.

Prevalence and associated factors of bullying in medical residents: A systematic review and meta-analysis

OBJECTIVE

To assess the prevalence of bullying in medical residents and its associated factors.

METHODS

In this systematic review and meta-analysis, articles from MEDLINE, EMBASE, Scopus, PsycInfo, Cochrane databases, and Web of Science were searched. Published and unpublished cross-sectional studies were included. Cochrane's Q test and I2 statistics were used to assess the existence of heterogeneity. Subgroup analysis and sensitivity analysis were performed on evidence of heterogeneity. Egger's test and funnel plots were performed to investigate publication bias.

RESULTS

A total of 13 cross-sectional studies with a total of 44 566 study participants from different medical residencies were analyzed. The overall prevalence of bullying was 51% (95% CI 36-66). Furthermore, female residents and residents that belong to a minority group had higher odds of experiencing bullying compared to their peers.

CONCLUSION

A high prevalence of bullying in medical residents exists around the world. There is a need for education, dissemination, and more effective interventions among the residents and authorities about bullying to build and promote adequate behaviors and diminish bullying prevalence.