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 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 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.

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.

Racial discrimination in surgery: A systematic review

INTRODUCTION

Racial/ethnic discrimination indicates the stereotyped or unkind conduct of superiority towards other persons based on their race or skin color. The UK General Medical Council published a statement supporting zero-tolerance approach to racism in the workplace. We aimed to systematically review racial discrimination in surgery and answer the following questions: (1) Does racial/ethnic discrimination in surgery exist in citations from the last 5 years. (2) If yes, are ways suggested to reduce racial/ethnic discrimination in surgery?

METHODS

The systematic review was performed in compliance with the PRISMA guidelines along AMSTAR 2. A 5-year literature search was carried out on PubMed for articles published from 1/1/2017 to 01/11/2022. Search terms were 'racial discrimination and surgery', 'racism OR discrimination AND surgery', 'racism OR discrimination AND surgical education'. The retrieved citations were quality assessed by MERSQI and evidence graded by GRADE.

RESULTS

A total of 9116 participants responded with a mean of 1013 (SD = 2408) responses per citations reported in 9 studies from a final list of 10 included citations. Nine studies were from USA and 1 from South Africa. There was evidence of racial discrimination in the last 5 years and the results were justified on strong scientific evidence constituting the basis for evidence grade I. The second question's answer was 'yes' which was defendable on moderate scientific recommendation and thereby establishing the basis for evidence grade II.

CONCLUSION

There was sufficient evidence for the presence of racial discrimination in surgical practice in the last 5 years. Ways to decrease racial discrimination in surgery exist. Healthcare and training systems must increase the awareness of these issues to eliminate the harmful effect on the individual as well as on the level of the surgical team performance. The existence of the discussed problems must be managed in more countries with diverse healthcare systems.

Incivility in medical education: a scoping review

Incivility in the workplace, school and political system in the United States has permeated mass and social media in recent years and has also been recognized as a detrimental factor in medical education. In this scoping review, we use the term incivility to encompass a spectrum of behaviors that occur across the continuum of medical education, and which include verbal abuse including rude or dismissive conduct, sexual and racial harassment and discrimination, and sexual and physical assault. We identified research on incivility involving medical students, residents and fellows, and faculty in North America to describe multiple aspects of incivility in medical education settings published since 2000. Our results reinforce that incivility is likely under-reported across the continuum of medical education and also confirmed incidences of incivility involving nursing personnel and patients, not emphasized in previous reviews. The authors suggest a zero-tolerance national policy if this problem is to be resolved.

Sexual Harassment and Mental Health of Female Healthcare Workers in a Tertiary Care Hospital in Riyadh, Saudi Arabia

Background In this study, we aimed to estimate the prevalence and identify the correlates of sexual harassment among female healthcare workers in a tertiary care hospital in Riyadh, Saudi Arabia. Methodology A cross-sectional study was conducted among 432 female healthcare workers in both Arabic and English languages. The questionnaire consisted of five sections which included the sociodemographic characteristics, a sexual harassment survey, the Kessler distress scale, social support, and the Rosenberg self-esteem scale. Unadjusted odds ratios with 95% confidence intervals were calculated to identify the significant factors associated with harassment. Results Sexual harassment was reported by 15.5% of the participants, with verbal harassment being the most commonly reported (66%), followed by physical harassment (34%). Around three-fourths of harassment acts took place during the daytime, and 18% of the participants preferred to keep quiet about it. Moderate distress [2.38 (1.17, 4.84)] and severe distress [2.31 (1.09, 4.90)], feeling hopeless [2.86 (1.47, 5.57)] and feeling depressed [3.70 (1.62, 8.48)] were significantly associated with sexual harassment. Low self-esteem items, such as "I don't have good qualities" [4.78 (2.0, 11.43)], "don't have much to be proud of" [2.10 (1.22, 3.63)], "wish that I have more respect for myself" [2.30 (1.36, 3.90)], and "inclined to feel that I am a failure" [2.27 (1.24, 4.16)] were significantly associated with sexual harassment. Conclusions It is important for all employees to know about their rights and report all types of harassment acts. Counseling sexually harassed victims should focus on improving the self-esteem and mental distress of these women. Prevention of harassment against female healthcare workers can improve their mental health as well as their quality of work.

Hospital medicine team perception of diversity and inclusion at work

BACKGROUND

: Diversity and Inclusion concepts are crucial in healthcare as the patient population we encounter as hospitalist medicine team is diverse. A diverse and inclusive environment for healthcare employees can lead to improved job satisfaction and high-quality medical care of patients. However, hospitalist perspectives on diversity and inclusion in their work environment are not well studied and noted in literature. Understanding hospitalist perspectives of diversity and inclusion is important in promoting organizational culture.

METHODS

We conducted an online survey of a large hospitalist group at Mayo Clinic, Rochester, from October-December 2019, as part of Hospital Internal Medicine (HIM) Diversity Council (HIM-DC) inception, to understand the perceptions of its staff about diversity and inclusion at work and facilitate the next best steps for the team. The responses to the survey questions were graded on a likert scale. Descriptive statistics were used to analyze and interpret the data.

RESULTS

: Of the 135 team members, 78 responded (58%). Of the respondents, more than 80% never witnessed or experienced discrimination from a colleague, while more than 50% did witness or experience discrimination from a patient/visitor. More than 70% did not report this discrimination. Nearly 90% felt that it was an inclusive environment at work, across different personal attributes. Most of the respondents requested additional cultural education and social events.

CONCLUSION

Unfortunately, a higher percentage of discrimination is perceived from patients/visitors. This highlights the need for institutional policies about visitor conduct. A high proportion of HIM staff felt inclusive at workplace. Committees such as HIM-DC can augment cultural education and social events to improve team's perception.

Perception of Harrasment or Discrimination during Urology Residency in Colombia

Purpose Workplace bullying (harassment, abuse, or discrimination), practiced persistently against an individual, can generate a hostile workplace environment, consequently leading to exhaustion, with poor psychological outcomes, and the onset of symptoms such as loss of confidence, fatigue, depressive thoughts, desertion, and suicidal thoughts. There are no publications regarding this issue in Colombia.

Our objective is to describe the residents' perception of gender and workplace discrimination and verbal/sexual harassment during their urological training.

Methods Observational, descriptive, cross-sectional study with anonymous surveys. We evaluated the demographic characteristics and the residents' perception of harassment, the type of harassment, how it affected their performance during residency, and from whom it was perceived.

Results We were able to obtain answers from 82/115 residents (71.3%), most of them men (45 [56%]). In total, 66% (54) reported workplace harassment; and 35.4% (29) felt gender discrimination, most of them women (17; 58.6%). Verbal abuse was reported by 64.6% (53), and it affected the work of 92.5%. The parception of workplace harassment was similar among both men and women (32 [69.5%] men and 21 [61.1%] women). A total of 7(19%) women reported sexual abuse. Regarding the source of the abuse, 39 (65.8%) was by professors, 26 (45%), by other residents, and 17 (35.4%), by patients.

Conclusion The perception of harassment during urology residency in Colombia is real, and it affects the work of residents. This abuse is greater on the part of men, and is mainly perpetrated by professors. We consider our work the starting point to continue researching a topic of national and international importance.

Percepción de acoso o discriminación durante la residencia de urología en Colombia

Objetivos El maltrato laboral (acoso, abuso o discriminación) ejercido de manera persistente contra un individuo genera un ambiente de trabajo hostil y lleva a agotamiento, con un impacto psicológico importante y la posibilidad de aparición de síntomas depresivos. En Colombia, no contamos con publicaciones al respecto.

El objetivo de nuestro trabajo es conocer la percepción de los residentes de urología en cuanto a discriminación de género y acoso laboral, verbal y sexual durante su formación.

Metodos Estudio observacional, descriptivo, de corte transversal, por medio de encuestas anónimas. Evaluamos las características demográficas, la percepción de acoso, el tipo de acoso, si éste afectó el rendimiento laboral del residente, y por parte de quién lo percibió.

Resultados Obtuvimos respuestas de 82/115 (71,3%) residentes, en su mayoría hombres (45 [56%]). En total, 66% (54) reportaron haber experimentado acoso laboral; y 35,4% (29) reportaron haber experimentado discriminación de género, siendo más frecuente en las mujeres (17; 58,6%). El acoso verbal fue reportado por un 64,6% (53), y afectó el trabajo de un 92,5%. La percepción de acoso laboral fue similar entre hombres y mujeres (32 [69.5%] hombres y 21 [61.1%] de mujeres). En total, 7 (19%) mujeres reportaron acoso sexual. Con respecto a la fuente de acoso, 39 (65,8%) fue por profesores, 26 (45%), por otros residentes, y 17 (35.4%), por pacientes.

Conclusión La percepción de acoso durante la residencia de urología en Colombia es real, y afecta el trabajo de los residentes. Este acoso es mayor por parte de los hombres, y es principalmente generado por profesores. Consideramos nuestro trabajo el punto de partida para continuar investigando un tema de importancia a nivel nacional y internacional.

Where Are the Women: Evolution of Women's Specialty Organizations

Women emerged against significant obstacles in the nineteenth century to claim a right to participate in the health professions. Women were excluded from many areas of medical and dental practice until well after the 1964 Civil Rights Act forbade discrimination on the basis of sex. Their entry has been, and continues to be, blocked by discrimination, misogyny, and harassment both personal and institutional. The formation of women-specific surgical subspecialty organizations has improved access to mentoring, sponsorship, and acceptance. This article reviews the history of some of the older organizations with recommendations for OMFS women's action.

Toward an understanding of sexual harassment in neurosurgery

OBJECTIVE

The goal of this study was the creation and administration of a survey to assess the depth and breadth of sexual harassment across neurosurgery.

METHODS

A survey was created to 1) assess perceived attitudes toward systemic issues that might be permissive of sexual harassment; 2) measure the reported prevalence and severity of sexual harassment; and 3) determine the populations at highest risk and those most likely to perpetrate sexual harassment. Demographic information was also included to facilitate further analysis. The SurveyMonkey platform was used, and a request to complete the survey was sent to all Society of Neurological Surgeons and Congress of Neurological Surgeons (CNS) active and resident members as well as CNS transitional, emeritus, and inactive members. Data were analyzed using RStudio version 1.2.5019.

RESULTS

Nearly two-thirds of responders indicated having witnessed sexual harassment in some form (62%, n = 382). Males were overwhelmingly identified as the offenders in allegations of sexual harassment (72%), with individuals in a "superior position" identified as offenders in 86%. Less than one-third of responders addressed the incidents of sexual harassment when they happened (yes 31%, no 62%, unsure 7%). Of those who did report, most felt there was either no impact or a negative one (negative: 34%, no impact: 38%). Almost all (85%) cited barriers to taking action about sexual harassment, including retaliation/retribution (87%), impact on future career (85%), reputation concerns (72%), and associated stress (50%). Female neurosurgeons were statistically more likely than male neurosurgeons to report witnessing or experiencing sexual harassment, as well as assessing it as a problem.

CONCLUSIONS

This study demonstrates that neurosurgeons report significant sexual harassment across all ages and practice settings. Sexual harassment impacts both men and women, with more than half personally subjected to this behavior and two-thirds having witnessed it. Male dominance, a hierarchical environment, and a permissive environment remain prevalent within the neurosurgical community. This is not just a historical problem, but it continues today. A change of culture will be required for neurosurgery to shed this mantle, which must include zero tolerance of this behavior, new policies, awareness of unconscious bias, and commitment to best practices to enhance diversity. Above all, it will require that all neurosurgeons and neurosurgical leaders develop an awareness of sexual harassment in the workplace and establish consistent mechanisms to mitigate against its highly deleterious effects in the specialty.

A Report of Gender Bias and Sexual Harassment in Current Plastic Surgery Training: A National Survey

BACKGROUND

Gender bias and sexual misconduct continue to pervade medicine. The authors hypothesize that gender bias and sexual misconduct disproportionately and negatively affect female plastic surgery trainees.

METHODS

A national survey of plastic surgery trainees (2018 to 2019) was conducted using previously validated sexual harassment surveys adapted for relevance to plastic surgery. Respondents were queried about experiences with workplace gender bias and harassment; personal and professional impact; and reporting practices. Analyses included chi-square, logistic regression, and analysis of variance. Significance was accepted for values of p < 0.05.

RESULTS

There were 236 responses (115 female respondents; 20.1 percent response rate). Most respondents were Caucasian (Asian/Pacific Islander, n = 34) residents (n = 123). The feeling of hindrance to career advancement was greater for women, by 10-fold (p < 0.001), and increased with age (p = 0.046). Women felt uncomfortable challenging attitudes regarding gender inequality (p < 0.001), regardless of training levels (p = 0.670) or race (p = 0.300). Gender bias diminished female trainees' career goals/ambition (p < 0.001). Women were more likely to experience sexual harassment, in the form of jokes (p = 0.003) and comments about their body or sexuality (p = 0.014). Respondents reported the majority of perpetrators of harassment to be attending physicians (30 percent) and other trainees (37 percent). Most common reasons to not report incidents included "futility" (29 percent) and "fear" (20 percent). Women experienced at least three symptoms of depression/anxiety, significantly higher than men (p = 0.001).

CONCLUSIONS

Gender bias and sexual misconduct negatively affect female trainees' attitudes toward their career. Two-thirds of cases of sexual harassment originate from other physicians. Minority trainees are less prepared to address transgressions and more likely to experience sexual coercion. Trainees perceive a culture nonconducive to reporting. These findings can guide changes and discussions surrounding workplace culture in plastic surgery training.

Gender dynamics in education and practice of gastroenterology

BACKGROUND AND AIMS

With an increasing number of women joining procedural fields, including gastroenterology, optimizing the work environment for learning, teaching, and clinical practice is essential to the well-being of both physicians and their patients. We queried female and male gastroenterologists on their beliefs toward the endoscopy suite environment, as well as their experiences in learning and teaching endoscopic skills.

METHODS

We distributed a web-based survey to 403 gastroenterology fellows and practicing gastroenterologists at 12 academic institutions and 3 large private practices. We used univariate and multivariate analysis to compare the responses of female and male gastroenterologists.

RESULTS

The overall response rate was 32% (n = 130); 54 women and 61 men completed the survey in its entirety and were included in the analysis (15 respondents did not meet the inclusion criteria). Baseline demographics were comparable between the groups. Overall, fewer women than men were trained using tactile instruction (41% vs 67%; P = .004). Of those trained using tactile instruction, 60.3%, with no gender differences, felt it was also important for endoscopic learning. More women reported experiencing gender bias toward themselves during training (57.4% vs 13.1%; P = .001) as well as in their current careers (50.0% vs 9.8%; P = .001). When queried on treatment of gastroenterologists by endoscopy staff, 75.9% of women reported that men were treated more favorably, whereas 70.5% of men felt that both male and female gastroenterologists were treated equally.

CONCLUSIONS

Inequities exist with regard to the experience of men and women in gastroenterology, and specific challenges for women may have an impact on their career choices and ability to safely and effectively learn, teach, and practice endoscopy.

El estado de la investigación en educación en cirugía general en Colombia (2000-2020): un análisis bibliométrico

Introducción. Se desconoce el estado de la investigación en educación médica en cirugía general (IEMC) en Colombia en el siglo XXI. El objetivo de esta revisión bibliométrica de la literatura es realizar un análisis de las publicaciones relacionadas con la IEMC en Colombia a partir del año 2000. Métodos. Se incluyeron artículos originales, escritos en español o inglés, publicados por grupos de investigación que cuentan al menos con un investigador colombiano como autor principal o coautor. Se definieron variables demográficas e indicadores bibliométricos para cada estudio y autor. Resultados. Un total de 63 estudios fueron incluidos. Estas publicaciones se enfocaron predominantemente en investigación sobre bienestar, enseñanza clínica y simulación a nivel de postgrado. El 36 % de los artículos sobre IEMC fueron publicados en revistas sin indexación (ISI/SCOPUS); 13 artículos (20,6 %) fueron publicados en revistas en el cuartil 1 (Q1). El promedio de citas por artículo fue 9,3. Discusión. La producción intelectual en educación en cirugía en Colombia tiene bajo impacto a nivel internacional. Los hallazgos encontrados pueden ser utilizados para organizar y priorizar la investigación en educación quirúrgica en el país.

Gender-Specific Factors Influencing Gastroenterologists to Pursue Careers in Advanced Endoscopy: Perceptions vs Reality

INTRODUCTION

In 2020, only 19% of 63 matched advanced endoscopy (AE) fellows were women. This study evaluates the gender-specific factors that influence gastroenterologists to pursue careers in AE.

METHODS

An anonymous survey was distributed to gastroenterology fellows and attendings through various gastroenterology society online forums. Data were collected on demographics, training, mentorship, current practice, family planning, and career satisfaction.

RESULTS

Women comprised 71.1% of the 332 respondents. 24.7% of female fellows plan to pursue an AE career compared with 37.5% of male fellows (P = 0.195). The main motivating factor for both genders was interest in the subject area. Interest in another subspecialty was the main deterring factor for both genders. Women were more deterred by absence of same-sex mentors (P < 0.001), perception of gender-based bias in the workplace (P = 0.009), family planning (P = 0.018), fertility/pregnancy risks from radiation (P < 0.001), and lack of ergonomic equipment (P = 0.003). AE gastroenterologists of both genders were satisfied with their career decision and would recommend the field to any fellow. Most respondents (64%) believed that more female role models/mentors would improve representation of women in AE.

DISCUSSION

There are multiple gender-specific factors that deter women from pursuing AE. Increasing the number of female role models is strongly perceived to improve representation of women in AE. Most AE attendings are satisfied with their career and would recommend it to fellows of any gender. Thus, early targeted mentorship of female trainees has potential to improve recruitment of women to the field.

Gender Disparity Among American Medicine and Surgery Physicians: A Systematic Review

BACKGROUND

Disparity exists between men and women physicians. We aimed to examine changes in gender disparity in the medical profession over the last two decades. The study reviewed publications on gender differences and the measures which have been implemented or suggested to rectify these disparities.

METHODS

Pubmed, Embase, Scopus, and The Cochrane Library were searched in December 2019 using ("gender disparity" OR "gender gap" OR "pay gap" OR "gender discrimination") from 1998-2019. The sources list of reviewed articles was also used to retrieve more relevant articles. Articles about physicians in the United States were included, and Critical Appraisal Skills Programme (CASP) was used to evaluate the quality of the articles.

RESULTS

In this systematic review that includes 49 studies, there is still disparity and discrimination in research, leadership, and pay between male and female physicians. Women have less leadership roles and progress at a slower rate to associate and full professor. Women publish less articles and have a lower h-index than men. Men earn $20,000 more a year after salary adjustment. More women than men experience negative comments about their gender (36% vs 4%), experience gender discrimination (65% vs 10%) and sexual harassment (30% vs 6%).

CONCLUSIONS

Although substantial research exists on this topic, there remains significant room for improvement to achieve gender equality. Institutions and individuals should implement interventions to rectify this disparity .

Leading from Behind: Paucity of gender equity statements and policies among professional surgical societies

BACKGROUND

The availability and utility of public statements and policies on gender equity from professional surgical societies has not been studied.

METHODS

Professional surgical society websites were searched for publicly available statements and policies related to gender equity. These were compiled and assessed for critical components.

RESULTS

Publicly available statements/policies were published in every surgical society, though few pertained specifically to gender. Nearly all were recently written or revised. The most common statement/policy addressed discrimination and harassment. The only policies/statements that reliably contained all four key components pertained to professional conduct at national meetings. All policies that provided consequences also contained specific reporting processes.

CONCLUSIONS

Gender equity statements and policies are deficient among professional surgical societies. Prioritization of publicizing statements/policies that describe the challenges and provide potential solutions to well-documented gender inequities within surgical fields allows professional societies to promote a diverse and equitable workforce.

Assessment of the Prevalence of Medical Student Mistreatment by Sex, Race/Ethnicity, and Sexual Orientation

IMPORTANCE

Previous studies have shown that medical student mistreatment is common. However, few data exist to date describing how the prevalence of medical student mistreatment varies by student sex, race/ethnicity, and sexual orientation.

OBJECTIVE

To examine the association between mistreatment and medical student sex, race/ethnicity, and sexual orientation.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study analyzed data from the 2016 and 2017 Association of American Medical Colleges Graduation Questionnaire. The questionnaire annually surveys graduating students at all 140 accredited allopathic US medical schools. Participants were graduates from allopathic US medical schools in 2016 and 2017. Data were analyzed between April 1 and December 31, 2019.

MAIN OUTCOMES AND MEASURES

Prevalence of self-reported medical student mistreatment by sex, race/ethnicity, and sexual orientation.

RESULTS

A total of 27 504 unique student surveys were analyzed, representing 72.1% of graduating US medical students in 2016 and 2017. The sample included the following: 13 351 female respondents (48.5%), 16 521 white (60.1%), 5641 Asian (20.5%), 2433 underrepresented minority (URM) (8.8%), and 2376 multiracial respondents (8.6%); and 25 763 heterosexual (93.7%) and 1463 lesbian, gay, or bisexual (LGB) respondents (5.3%). At least 1 episode of mistreatment was reported by a greater proportion of female students compared with male students (40.9% vs 25.2%, P < .001); Asian, URM, and multiracial students compared with white students (31.9%, 38.0%, 32.9%, and 24.0%, respectively; P < .001); and LGB students compared with heterosexual students (43.5% vs 23.6%, P < .001). A higher percentage of female students compared with male students reported discrimination based on gender (28.2% vs 9.4%, P < .001); a greater proportion of Asian, URM, and multiracial students compared with white students reported discrimination based on race/ethnicity (15.7%, 23.3%, 11.8%, and 3.8%, respectively; P < .001), and LGB students reported a higher prevalence of discrimination based on sexual orientation than heterosexual students (23.1% vs 1.0%, P < .001). Moreover, higher proportions of female (17.8% vs 7.0%), URM, Asian, and multiracial (4.9% white, 10.7% Asian, 16.3% URM, and 11.3% multiracial), and LGB (16.4% vs 3.6%) students reported 2 or more types of mistreatment compared with their male, white, and heterosexual counterparts (P < .001).

CONCLUSIONS AND RELEVANCE

Female, URM, Asian, multiracial, and LGB students seem to bear a disproportionate burden of the mistreatment reported in medical schools. It appears that addressing the disparate mistreatment reported will be an important step to promote diversity, equity, and inclusion in medical education.