PS4 - 06: SCREENING FOR HARRASSMENT, ABUSE, AND DISCRIMINATION AMONG SURGERY RESIDENTS: AN EAST MULTICENTER TRIAL
Caitlin A Fitzgerald, MD1, Randi N Smith, MD1, Xian Luo-Owen, PhD2, David Turay, PhD2, Paula Ferrada, MD3, Jinfeng Han3, Brian H Williams, MD4, Munira Hussain5, A Peter Ekeh, MD6, Karen Herzing, BSN, RN6, Tanya L Zakrison, MD, MPH7, Rondi B Gelbard, MD1; 1Emory University School of Medicine, 2Loma Linda University and Medical Center, 3Virginia Commonwealth University School of Medicine, 4UT Southwestern Medical Center, Parkland Memorial Hospital, 5West Virginia University Hospitals, 6Wright State University Boonshoft School of Medicine, Miami Valley Hospital, 7Ryder Trauma Center, University of Miami Miller School of Medicine
Objectives: Harassment, verbal abuse, and discrimination is not uncommon among physician trainees. Estimating the prevalence among residents is difficult as events are often under-reported and there are no validated tools to screen physicians-in-training. We set out to determine the prevalence of discrimination and abuse among surgical residents using the HITS screening tool.
Methods: Multi-center, cross-sectional, survey-based study at five academic teaching hospitals. General surgery residents were surveyed anonymously at all sites. Questions included the validated HITS (Hurt, Insult, Threaten, Scream) tool which is widely used to screen for domestic abuse within emergency departments. Other data collected included incidence of harassment and discrimination.
Results: Of 310 residents, 76 (24.5%) completed the survey. The mean age of participants was 30.5 ± 3.5 years and 52.9% identified as male. The HITS screening tool was positive in 5.0% of respondents with 80.0% of respondents noting at least one positive answer. A total of 26.3% (20/76) experienced sexually inappropriate behavior at work. The most common forms of abuse included sexual harassment (28.9%), discrimination based on gender (15.7%), and discrimination based on ethnicity (7.9%). These events were reported 0-30% of the time. The supervising physician was the most frequent perpetrator of sexual harassment (50.0%), gender discrimination (43.5%), and ethnic discrimination (71.4%). There was a positive correlation between individuals that reported gender discrimination and racial discrimination (r=.778, n=13, p=.002). Individuals that experienced insults were more likely to experience physical threats (r=.437, n=79, p<.001) or verbal abuse (r=.690, n=79, p<.001). Participants most often felt frustration (38.2%), anger (35.5%), and embarrassment (32.9%) after being harassed. Learning variables most effected by discrimination and harassment were mentorship (25.0%), ability to learn (22.4%), freedom to ask questions (21.1%), and intellectual curiosity (21.1%).
Conclusions: Discrimination and harassment among surgical residents in academic teaching hospitals across the U.S. is not uncommon. Abuse can be screened for using the HITS tool for intimate partner violence. Further research is needed to determine the impact of these findings on resident attrition and interest in surgery as a career choice. A multi-disciplinary approach is needed to develop interventions and preventative measures aimed at addressing this problem.