Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
J Vasc Surg. 2020 Jan;71(1):220-227. doi: 10.1016/j.jvs.2019.02.064. Epub 2019 Jun 18.
Trainee burnout is on the rise and negative training environments may contribute. In addition, as the proportion of women entering vascular surgery increases, identifying factors that challenge recruitment and retention is vital as we grow our workforce to meet demand. This study sought to characterize the learning environment of vascular residents and to determine how gender-based discrimination and bias (GBDB) affect the clinical experience.
A survey was developed to evaluate the trainee experience; demographics and a two-item burnout index were also included. The instrument was sent electronically to all integrated (0 + 5) vascular surgery residents in the United States. Univariate analyses were performed and predictors of burnout identified.
A total of 284 integrated vascular residents were invited to participate and 212 (75%) completed the survey. Participants were predominantly male (64%) and white (56%), with a median age of 30 years (interquartile range, 28-32 years). Seventy-nine percent of respondents endorsed some form of negative workplace experience and 30% met high-risk criteria for burnout. More than a third (38%) of residents endorsed personally experiencing GBDB, with a significant difference between men and women (14% vs 80%; P < .001). Women were more likely than men to report witnessing GBDB (76% vs 56%; P = .003). Patients and nurses were the most frequently cited sources of GBDB (80% and 64%, respectively), with vascular surgery attendings cited by 41% of trainees. One in four female resident respondents indicated being sexually harassed during the course of training; this was significantly higher than for male residents (25% vs 1%; P < .001). Nearly half (46%) of trainees who witnessed or experienced GBDB thought that quality of patient care, job satisfaction, personal well-being, and personal risk of burnout were directly affected as a result of GBDB. GBDB was predictive of burnout (odds ratio, 1.9; 95% confidence interval, 1.1-3.5; P = .04), as were longer work hours (>80 h/wk; odds ratio, 2.8; 95% confidence interval, 1.1-7.1; P = .03).
GBDB was experienced by 38% of integrated trainees, with women significantly more affected than men. GBDB is predictive of burnout, and this has significant implications for our specialty in the recruitment and retention of female physicians. Resources addressing these issues are needed to maintain a diverse workforce and to promote physician well-being.
学员倦怠正在加剧，负面的培训环境可能是其中的一个因素。此外，随着越来越多的女性进入血管外科学领域，确定影响招聘和留任的因素至关重要，因为我们需要扩大劳动力规模以满足需求。本研究旨在描述血管住院医师的学习环境，并确定基于性别的歧视和偏见（GBDB）如何影响临床经验。
我们开发了一项调查来评估学员的体验；还包括人口统计学和两项倦怠指数。该工具以电子方式发送给美国所有的综合（0+5）血管外科住院医师。进行了单变量分析，并确定了倦怠的预测因素。
共邀请了 284 名综合血管住院医师参加，其中 212 名（75%）完成了调查。参与者主要为男性（64%）和白人（56%），中位年龄为 30 岁（四分位间距，28-32 岁）。79%的受访者表示经历过某种形式的负面工作场所体验，30%的人达到了倦怠的高风险标准。超过三分之一（38%）的住院医师表示个人经历过 GBDB，男性和女性之间存在显著差异（14%比 80%；P<.001）。女性比男性更有可能报告目睹 GBDB（76%比 56%；P=.003）。患者和护士是 GBDB 最常被提及的来源（分别为 80%和 64%），血管外科主治医生被 41%的学员提及。四分之一的女性住院医师表示在培训过程中曾受到性骚扰；这一比例明显高于男性住院医师（25%比 1%；P<.001）。近一半（46%）目睹或经历过 GBDB 的学员认为，由于 GBDB，患者护理质量、工作满意度、个人幸福感和个人倦怠风险直接受到影响。GBDB 是倦怠的预测因素（优势比，1.9；95%置信区间，1.1-3.5；P=.04），工作时间较长（>80 小时/周；优势比，2.8；95%置信区间，1.1-7.1；P=.03）也是如此。
38%的综合住院医师经历过 GBDB，女性受影响的程度明显高于男性。GBDB 是倦怠的预测因素，这对我们专业领域招聘和留住女医生有重大影响。需要解决这些问题的资源，以保持多元化的劳动力队伍并促进医生的健康。
