Bullying, harassment and sexual discrimination among ophthalmologists in Australia and New Zealand

Sex-Related Differences in Speaker Introductions at Ophthalmology Grand Rounds

PURPOSE

Sex bias remains a pervasive reality in academic medicine, often reflected in subtle linguistic choices, which can skew perceptions of competence and perpetuate workplace inequity. This study aims to investigate the relationship between host sex, speaker sex, and speaker introduction practices in ophthalmology grand rounds events.

DESIGN

Cross-sectional study.

METHODS

Publicly accessible videos of English-language ophthalmology grand rounds and other teaching events uploaded by academic institutions in the United States and Canada from January 2019 to June 2024 were analyzed by two independent reviewers. The primary outcome was the proportion of male and female speakers introduced with the formal title "Dr." by the event host. Secondary outcomes included the proportion of male and female speakers introduced with their academic degrees, current academic appointments, awards or achievements, and research interests. Univariable and multivariable logistic regressions adjusted for the speaker's degree type(s), academic appointment, and affiliation were performed using Stata v17.0.

RESULTS

Of 1,450 videos screened, 399 speaker introductions across 298 ophthalmology teaching sessions were analyzed. The formal title "Dr." was employed by the event host in 75.2% (n = 300/399) of speaker introductions. In multivariable analysis, female speakers were significantly less likely to be introduced by their formal title (OR = 0.55, 95% CI: 0.25-0.78, P < .001), academic degrees (OR = 0.61, 95% CI: 0.35-0.97, P = .03) and their awards or achievements (OR = 0.62, 95% CI: 0.35-0.95, P = .04) compared to male speakers. Interaction terms between speaker and host sex were significant for formal title use (P = .03) and academic degrees (P = .04), prompting subgroup analyses by host sex. Findings were consistent when stratified by male hosts, while there was no difference in the likelihood of introducing male or female speakers with their formal titles, academic degrees, or awards/achievements when introduced by female hosts. Female speakers were significantly more likely to present on nonclinical topics compared to male speakers (OR = 2.39, 95% CI: 1.36-4.79, P < .001).

CONCLUSIONS

When introduced by male hosts, female speakers were less likely to be addressed using a formal title compared with male speakers, while no significant differences were observed when female hosts introduced speakers of either sex. A standardized approach to introducing speakers may be beneficial in mitigating sex biases during grand rounds and other academic events.

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.

Discrimination Within the US Ophthalmology Workforce

Importance

Discrimination in the workforce is a barrier to achieving diversity, equity, and inclusion. A previous study of ophthalmologists in Australia and New Zealand reported high rates of discrimination, but little is known about discrimination among ophthalmologists in the US.

Objective

To describe the frequency, nature, and outcomes of discrimination experienced by US ophthalmologists and trainees.

Design, Setting, and Participants

This cross-sectional study collected anonymous online survey responses from May 5 to July 22, 2022, from ophthalmologists and ophthalmologists in training from 10 US-based ophthalmology organizations.

Main Outcomes and Measures

Main outcomes included (1) the frequency of discrimination based on gender, race and ethnicity, and LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, and asexual) status; (2) the bases, negative consequences, and sources of discrimination; and (3) the association of discrimination with job satisfaction and achieving career goals.

Results

Of 463 respondents (249 women [53.8%]), 194 (41.9%) reported experiencing discrimination. Women more commonly encountered discrimination based on gender than men (73 of 108 [67.6%] vs 2 of 21 [9.5%]; difference, 58.1 percentage points [95% CI, 42.7-73.4 percentage points]; P < .001). Among women, pregnancy (27 of 108 [25.0%]) and maternity (12 [11.1%)] were the most frequently cited bases of discrimination outside of gender. Women (19 of 108 [17.6%]) reported discrimination due to race or ethnicity less frequently than men (13 of 21 [61.9%]; difference, -44.3 percentage points [95% CI, -66.3 to -22.3 percentage points]; P < .001). Reported negative consequences of discrimination included disrespect or passive aggression (44 of 129 [34.1%]), loss of employment opportunities (24 of 129 [18.6%]), and misrepresentation (eg, mistaken for nurse, janitor, etc; 18 of 129 [14.0%]), with loss of income being reported exclusively by women (25 of 108 [23.1%]). Those who reported at least 1 encounter of discrimination experienced significantly lower job satisfaction than those who did not (3.9 [1.0] vs 4.3 [0.8] on a scale of 1-5, where 1 indicates very dissatisfied and 5 indicates very satisfied; difference, -0.4 [95% CI, -0.7 to -0.2]; P < .001), as well as lower achievement of current career goals (3.9 [1.1] vs 4.3 [0.8] on a scale of 1-5; difference, -0.4 [95% CI, -0.6 to -0.2]; P < .001).

Conclusions and Relevance

This study suggests that discrimination remains prevalent among ophthalmologists in the US, with gender-based discrimination being reported most frequently. Discrimination was negatively associated with income, employment opportunities, job satisfaction, and achievement of career goals for respondents. With increased recognition of the prevalence and outcomes of discrimination in the workplace, ophthalmologists can advocate for policy changes and model appropriate behavior to improve the working environment and promote diversity, equity, and inclusion goals.

PlayDecide teamwork: a discussion game for junior doctors to explore workplace bullying and harassment

BACKGROUND

Workplace bullying and harassment (WBH) in healthcare settings has been widely described in the literature, although a lack of consensus on the definition of behaviours constituting WBH makes findings difficult to interpret. The consequences for those experiencing WBH can be severe, including burnout, stress, and suicidal ideation, yet formal reporting rates are low, in part due to a lack of understanding of WBH and the support services designed to address it. Those who experience WBH are more likely to reproduce the behaviour, creating a self-perpetuating cycle. There is an urgent need to develop educational tools to help trainees identify behaviours that can constitute WBH, and the support services available to address this issue.

METHODS

The study setting was four acute hospital sites in Ireland; participants were interns (junior doctors in their first postgraduate year). A card-based discussion game, PlayDecide: Teamwork was developed with a multidisciplinary team (MDT), piloted, and implemented. Feedback was obtained from participants on the acceptability and educational value of the game via an anonymous online survey. The intervention is presented using the TIDieR framework. Data were analysed and presented using descriptive statistics.

RESULTS

Intern trainers and facilitators expressed satisfaction with the game. Intern attendance at the PlayDecide sessions was estimated at 63.64% (n = 70), with a 57.14% response rate to the survey (n = 40). The majority of interns found the game acceptable, the cards realistic and relevant, and agreed that it was a safe space to discuss workplace issues. Most interns agreed that the learning objectives had been met, although fewer agreed that they had learned about support services.

CONCLUSION

PlayDecide: Teamwork is to the best of our knowledge the first intervention of its kind aimed at addressing WBH, and the first aimed at interns. We have shown it to be effective and acceptable to interns and intern trainers in the acute hospital setting. We hypothesised that strong group identification facilitated the discussion, and further, that the cards created cognitive distance, allowing for free discussion of the issues depicted without needing to divulge personal experiences. Further evaluation at behavioural and organisational levels is needed.

You have to work twice as hard as a woman to show that you are competent. Experiences, opportunities and workplace gender harassment for Sport and Exercise Medicine practitioners working in elite sport in Australia

OBJECTIVE

Our aim was to investigate (1) gender representation, (2) opportunities and training and (3) harassment experiences in Sport and Exercise Medicine (SEM) practitioners working in elite sport in Australia.

METHODS

All titled Australian Physiotherapy Association Sport and Exercise Physiotherapists, SEM Physicians and Registrars and doctors and physiotherapists (SEM practitioners) currently/previously/aspiring to work in Australian elite sport were invited to participate in a bespoke online survey and the Gender Experiences Questionnaire.

RESULTS

For SEM practitioners currently working in elite sport, men worked more paid hours each week (mean difference (MD) 12.2 (95% CI 5.5 to 19.0)) and more paid weeks each year (MD 6.8 (95% CI 1.2 to 12.5)). Women SEM practitioners (both currently and previously) were more likely than men to work with women, rather than men athletes. All women SEM practitioners experienced significantly more gender harassment, infantilisation, work/family policing and gender policing than men. For SEM practitioners (both current and previous), there were no gender differences in how practitioners found out about or were recruited to their elite sports roles. Women were four times more likely than men to report that their gender or sexual orientation influenced their opportunities in elite sport. Most roles were not advertised with direct approach being the most common method of job recruitment.

CONCLUSION

Women SEM practitioners currently working in elite sport worked less paid hours per week and less paid weeks per year. All SEM practitioners were appointed to positions without established procedures, and there were significant challenges for women SEM practitioners in the elite sport workplace with women facing considerably more gender harassment than men.

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.

Perpetrators of gender-based workplace violence amongst nurses and physicians-A scoping review of the literature

In healthcare settings worldwide, workplace violence (WPV) has been extensively studied. However, significantly less is known about gender-based WPV and the characteristics of perpetrators. We conducted a comprehensive scoping review on Type II (directed by consumers) and Type III (perpetuated by healthcare workers) gender based-WPV among nurses and physicians globally. For the review, we followed the Preferred Reporting Items for Systematic and Meta Analyses extension for Scoping Review (PRISMA-ScR). The protocol for the comprehensive review was registered on the Open Science Framework on January 14, 2022, at https://osf.io/t4pfb/. A systematic search in five health and social science databases yielded 178 relevant studies that indicated types of perpetrators, with only 34 providing descriptive data for perpetrators' gender. Across both types of WPV, men (65.1%) were more frequently responsible for perpetuating WPV compared to women (28.2%) and both genders (6.7%). Type II WPV, demonstrated a higher incidence of violence against women; linked to the gendered roles, stereotypes, and societal expectations that allocate specific responsibilities based on gender. Type III WPV was further categorized into Type III-A (horizontal) and Type III-B (vertical). With Type III WPV, gendered power structures and stereotypes contributed to a permissive environment for violence by men and women that victimized more women. These revelations emphasize the pressing need for gender-sensitive strategies for addressing WPV within the healthcare sector. Policymakers must prioritize the security of healthcare workers, especially women, through reforms and zero-tolerance policies. Promoting gender equality and empowerment within the workforce and leadership is pivotal. Additionally, creating a culture of inclusivity, support, and respect, led by senior leadership, acknowledging WPV as a structural issue and enabling an open dialogue across all levels are essential for combating this pervasive problem.

A gender-based review of workplace violence amongst the global health workforce-A scoping review of the literature

Workplace violence (WPV) impacts all levels of the health workforce, including the individual provider, organization, and society. While there is a substantial body of literature on various aspects of WPV against the health workforce, gender-based WPV (GB-WPV) has received less attention. Violence in both the workplace and broader society is rooted in gendered socio-economic, cultural, and institutional factors. Developing a robust understanding of GB-WPV is crucial to explore the differing experiences, responses, and outcomes of GB-WPV with respect to gender. We conducted a scoping review and report on the prevalence and risk factors of GB-WPV in healthcare settings globally. The review followed the Preferred Reporting Items for Systematic and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We registered the scoping review protocol on the Open Science Framework on January 14, 2022, at https://osf.io/t4pfb/. A systematic search was conducted of empirical literature in five health and social science databases. Of 13667, 226 studies were included in the analysis. Across the studies, more women than men experienced non-physical violence, including verbal abuse, sexual harassment, and bullying. Men experienced more physical violence compared to women. Younger age, less experience, shifting duties, specific clinical settings, lower professional status, organizational hierarchy, and minority status were found to be sensitive to gender, reflecting women's structural disadvantages in the workplace. Given the high prevalence and impact of GB-WPV on women, we provided recommendations to address systemic issues in clinical practice, academia, policy, and research.

A new framework for Australian specialty colleges and other healthcare leaders to address bullying, discrimination, and harassment that involves doctors

Bullying, discrimination, and harassment (BDH) within healthcare teams is a global issue that risks healthcare worker wellbeing, patient safety, public health, and industry reputations. Collectively, fragmented regulation, weak detection and correction processes, conflicts of interest, and fear of retribution for complainants create an environment that enables perpetrators. Specialty training Colleges and other stakeholders can collaborate to address this issue more effectively. This paper examines Australian processes and proposes that the existing disparate mechanisms should be replaced with a national BDH framework that is supported by an independent investigation body. The authors seek to stimulate discussion to reform practice in Australia and in other countries with similar health systems.

LGBTQ+ Identity and Ophthalmologist Burnout

PURPOSE

To evaluate lesbian, gay, bisexual, transgender, questioning, and other sexual/gender minority (LGBTQ+) orientation as a burnout risk factor among an international ophthalmologist cohort.

METHODS

An anonymous, cross-sectional electronic survey was distributed via an Internet platform to characterize the relationship among demographic factors, including LGBTQ+ orientation, and burnout as measured by the Copenhagen Burnout Inventory (CBI). Univariable data analysis (linear) by sexual orientation was performed and variables with an association with a P value of <0.15 in univariable analysis were included in the multiple linear regression modeling.

RESULTS

A total of 403 ophthalmologists participated in the survey. The majority self-identified as "White" (69.2%), were from North America (72.0% United States, 18.6% Canada) and were evenly distributed between age of 30 and 65 years. Overall, 13.2% of participants identified as LGBTQ+ and 98.2% as cisgender. Approximately 12% had witnessed or experienced LGBTQ+-related workplace discrimination or harassment. The personal and work-related burnout scores and confidence limits of persons identified as LGBTQ+ were higher and nonoverlapping compared with those reported as non-LGBTQ+. Multivariable analysis identified significant risk factors for higher personal and work-related burnout scores: LGBTQ+ (11.8 and 11.1, P = .0005 and .0023), female gender (5.36 and 4.83, P = .0153 and .0434), older age (19.1 and 19.2, P = .0173 and .0273). and caretaker stress (6.42 and 5.97, P = .0085 and .0239).

CONCLUSIONS

LGBTQ+ orientation is a burnout risk factor among ophthalmologists, and LGBTQ+ workplace discrimination may be a contributing factor. Support from ophthalmology organizations to address LGBTQ+-, gender-, and age-related workplace discrimination may decrease burnout. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Benefits and challenges to ophthalmology training via the Specialist Training Program

INTRODUCTION

The Specialist Training Program (STP) is a commonwealth funding initiative to support specialist medical training positions in regional, rural and remote areas, and in private settings. The program helps to improve the skills and distribution of the specialist medical workforce by providing trainees experience of a broader range of healthcare settings.

OBJECTIVE

To examine the benefits and challenges of ophthalmology training delivered by the STP in regional, rural, remote, and/or private settings across Australia.

DESIGN

Qualitative design involving semi-structured in-depth interviews with thirty-two participants experienced in the delivery of ophthalmology training at STP posts including ophthalmology trainees (n = 8), STP supervisors and clinical tutors (n = 16), and other stakeholders (n = 8).

FINDINGS

Training delivered at STP posts was reportedly beneficial for ophthalmology trainees, their supervisors and the broader community given it enabled exposure to regional, rural, remote and private settings, access to unique learning opportunities, provided workforce support and renewal, and affordable ophthalmic care. However, all participants also reported challenges including difficulties achieving work/life balance, unmet training expectations, a lack of professional support, and financial and administrative burden. Malalignment between trainee preferences for STP posts, low STP literacy and limited regional, rural and remote training experiences were also seen as missed opportunities to foster future rural ophthalmic workforce development.

DISCUSSION

The STP improves access to ophthalmic care in underserved populations while enabling valuable rural and/or private practice exposure for medical specialist trainees and workforce support for supervising ophthalmologists.

CONCLUSION

Efforts are needed to improve the quality of training experiences provided at STP posts and post sustainability. Although research is needed to investigate the longer-term benefits of the STP to rural and/or private workforce recruitment and retention, RANZCO should develop further regional, rural and remote STP posts to help realise future rural practice intention amongst ophthalmology trainees.

[The most serious incident-Experiences of aggression and violence in ophthalmology]

BACKGROUND

Experiences of aggression/violence influence job satisfaction and can have a long-term psychological and physical impact on employees. In the fall of 2018, the Professional Association of Ophthalmologists (BVA) and the German Ophthalmological Society (DOG) conducted a survey on experiences of aggression and violence. The first results were published in 2020. In the survey it was also possible to describe the most serious incident to date using free text fields, among others.

METHOD

All 9411 members of the DOG and BVA were given the opportunity to complete a questionnaire online in 2018 regarding aggression and violence in ophthalmology.

RESULTS

Overall, 253 of 1508 (16.8%) ophthalmologists participating in the survey reported their most serious incident, 46.8% of which were classified as moderate and 34.3% were related to verbal violence such as insults and threats. The most serious incident was experienced by 171 (67.6%) physicians in a practice setting, 71% were specialists at the time of the incident and 74.3% of the incidents occurred during regular working hours. The main causes were intercultural conflicts, long waiting times, problems with the allocation of appointments, excessive expectations, differences in treatment and basic aggressiveness. The offenders were male in 86.3% of cases, 15.8% of the incidents were reported to the police and 21 (8.3%) physicians issued a practice reprimand or house ban.

DISCUSSION

The description of the most serious incidents illustrates situations that are sometimes hard to imagine and also which incidents were considered serious. There are large subjective variations in the assessment of the incidents. Protective measures in practices and clinics are essential.

An Eye on Gender Equality: A Review of the Evolving Role and Representation of Women in Ophthalmology

PURPOSE

In recent decades, women have achieved greater representation in ophthalmology. Globally, women now constitute approximately 25%-30% of ophthalmologists and 35%-45% of trainees. Nevertheless, women remain under-represented in key areas, including positions of professional and academic leadership and ophthalmic surgical subspecialization. Furthermore, there is evidence that women in ophthalmology encounter more bias and discrimination across multiple domains than men, including a gender-pay gap that is wider than in many other surgical subspecialties. Women ophthalmologists and trainees report sharply differing training experiences from male peers, including fewer opportunities to operate, more bullying and harassment, less access to mentorship, and contrasting expectations around contributions to family life.

DESIGN

Perspective.

METHODS

An extensive literature search was undertaken to compile and review papers published with a focus on gender equity across ophthalmology, surgery, and medicine.

RESULTS

We identified 8 broad domains that were widely discussed: leadership, research and academics, income, surgical exposure and subspecialization, harassment, career satisfaction, mentorship, and family and marital differences. We have summarized the current research across each of these areas, and discussed possible solutions to reduce the inequities reported.

CONCLUSIONS

This review draws on current research published around representation and experiences of women in ophthalmology and suggests that there are opportunities to improve gender inequity.