PS6-07: PHYSICIAN MISTREATMENT IN THE CLINICAL LEARNING ENVIRONMENT
Nathaniel Lee, MD1, Nital Appelbaum, PhD2, Sally Santen, MD, PhD2, Stephanie Goldberg, MD, FACS1, Amelia Grover, MD, FACS1; 1VCU Health, 2VCU School of Medicine
Background: The ACGME regards psychological, emotional, and physical well-being as critical to physician development. Mistreatment has been correlated with burnout and poor well-being in medical students, but data regarding residents and faculty are limited. We aimed to investigate the prevalence of mistreatment and characterize the mistreatment experienced by our housestaff and faculty.
Methods: Between May-June 2018, a Department of Surgery surveyed its housestaff and faculty on incidents of mistreatment towards them by other healthcare providers. Seventeen mistreatment behaviors were assessed on a four-point frequency scale (1=Never, 4=frequently). Mann Whitney U group comparison test was conducted to identify differences between Surgery housestaff and faculty. Frequencies were calculated on types of mistreatment, instigators of mistreatment, reporting behavior and barriers to reporting events.
Results: Attendings and residents (n=96) completed the mistreatment survey and 53% (n=51) of respondents experienced at least one incident of mistreatment. 37% (n=20) of residents reported public humiliation at least once compared to 17% (n=7) of attendings. 13% (n=7) of residents were subjected both to sexist remarks and lower evaluations attributed to gender rather than performance. Regarding reporting behaviors, three attendings reported mistreatment to their division chief or their departmental chair. Only one resident reported mistreatment—to a co-resident. The majority of residents deemed the mistreatment not important enough to report. Attendings resolved the issue themselves or deemed reporting to be futile. Seven individuals listed fear of reprisal as a barrier to reporting. For attendings, faculty within their department (n=7) and faculty external to their department (n=4) were most cited as instigators of mistreatment. Residents experienced mistreatment most often by faculty (n=12), other residents (n=8), and nurses (n=5). Residents experienced public embarrassment (U=873, p=.031) and public humiliation (U=915, p=.040) more frequently than attendings, however attendings were subjected to racially or ethnically offense remarks/names more frequently than residents (U=1017.50, p=.040).
Conclusions: Mistreatment continues after medical school and residency; however, the effects of mistreatment on the clinical learning environment are not well established. Mistreatment is underreported, and fear of reprisal and futility are major barriers to reporting.