USA: Mistreatment of surgical interns reported

Half of American general surgery residents (particularly women) experience abuse in the workplace. This significantly increases their risk of burnout and the prevalence of suicidal thoughts, according to a study.

Prevalence of mistreatment varies widely across medical centers

According to a study published in the New England Journal of Medicine, half of American general surgery residents (particularly women) experience abuse in the workplace. This significantly increases their risk of burnout and the prevalence of suicidal thoughts.

7,400 surgical residents (more than 99% of them), practicing in the 262 accredited general surgery centers in the US, participated in this survey. By 2016, the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) study had identified increasing burnout among surgical residents, particularly related to abuse in the workplace. The recently published study was designed to analyze this abuse and its impact on burnout and suicidal thoughts.

The study is based on a survey conducted as part of the American Board of Surgery In-Training Examination (ABSITE) program. Each year, general surgery residents are offered a multiple-choice examination designed to measure their progress in applied science and management of clinical problems related to surgery. The 2018 ABSITE assessed abuse, burnout (assessed using the modified Maslach Burnout Inventory), and suicidal thoughts during the past year.

"The greatest risk factor for burnout development was found to be discrimination, abuse, or harassment. Abuse during the medical residency appears to be the cause of their high burnout rate" said Professor Karl Bilimoria, the lead study author.

Discrimination and harassment, more common against women

Over 50% of all respondents reported some form of mistreatment:

Women are the most vulnerable to abuse, as determined by the following responses from women study participants:

About the perpetrators of abuse

The analysis showed that surgeons were the most frequent sources of sexual harassment (27.2%) and violence (51.9%). Other types of discrimination highlighted were those related to/occurring during dealing with pregnancy and time spent with children during the residency period. This discrimination was made by experienced surgeons and other interns.

Sexual and racial discrimination came mainly from patients and their families. 43.6% of respondents mentioned cases of female physicians being mistaken for nurses, being criticized for perceived lack of qualifications or being demanded the provision of a male resident physician. The sexual harassment described consisted of suggestive comments, inappropriate jokes, and touching.

For 47.4% of respondents suffering racial discrimination, they reported the abuse as emanating mainly from patients, typically with refusals of consultation on racial grounds, racist comments, etc.


The burnout symptoms listed next were followed in the study:

Burnout symptoms were reported by 38.5% of residents, while 4.5% reported having had suicidal thoughts in the previous year (vs. roughly 2.5% of the general population).

Residents who reported exposure to discrimination, violence or harassment (at least a few times a month) were more likely to experience symptoms of burnout and suicidal thoughts. The impact on the quality of work was also noted: "This percentage of respondents undergoing abuse is high", and of further concern is the possibility that the effects of the abuse "can be detrimental to the training of surgeons who are emotionally stable and able to work effectively" explained Professor Bilimoria.

To be continued...

A very telling result was that the proportion of residents reporting maltreatment varied considerably across different locations (ranging from 0 to 66.7% for verbal abuse). 100 centers will receive the results of this initial research, as well as tools for improvement. Among these centers, "some schools have the highest rates of burnout or sexual harassment in the country," said Prof. Bilimoria. "Let's hope that this data will allow them to focus on their weaknesses and really improve the situation."

1. Hu YY, Ellis RJ, Hewitt DB, Yang AD, Cheung EO, Moskowitz JT, Potts JR 3rd, Buyske J, Hoyt DB, Nasca TR, Bilimoria KY. Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training. N Engl J Med. 2019 Oct 28. DOI: 10.1056/NEJMsa1903759.
2. General Surgery Residents Who Often Experience Mistreatment During Residency Training are at a Greater Risk of Burnout and Suicidal Thoughts. American Board of Surgery - Oct.28, 2019