Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
JAMA Surg. 2022 Jan 1;157(1):23-32. doi: 10.1001/jamasurg.2021.5246.
Previous studies have shown high rates of mistreatment among US general surgery residents, leading to poor well-being. Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) residents represent a high-risk group for mistreatment; however, their experience in general surgery programs is largely unexplored.
To determine the national prevalence of mistreatment and poor well-being for LGBTQ+ surgery residents compared with their non-LGBTQ+ peers.
DESIGN, SETTING, AND PARTICIPANTS: A voluntary, anonymous survey adapting validated survey instruments was administered to all clinically active general surgery residents training in Accreditation Council for Graduate Medical Education-accredited general surgery programs following the 2019 American Board of Surgery In-Training Examination.
Self-reported mistreatment, sources of mistreatment, perceptions of learning environment, career satisfaction, burnout, thoughts of attrition, and suicidality. The associations between LGBTQ+ status and (1) mistreatment, (2) burnout, (3) thoughts of attrition, and (4) suicidality were examined using multivariable regression models, accounting for interactions between gender and LGBTQ+ identity.
A total of 6956 clinically active residents completed the survey (85.6% response rate). Of 6381 respondents included in this analysis, 305 respondents (4.8%) identified as LGBTQ+ and 6076 (95.2%) as non-LGBTQ+. Discrimination was reported among 161 LGBTQ+ respondents (59.2%) vs 2187 non-LGBTQ+ respondents (42.3%; P < .001); sexual harassment, 131 (47.5%) vs 1551 (29.3%; P < .001); and bullying, 220 (74.8%) vs 3730 (66.9%; P = .005); attending surgeons were the most common overall source. Compared with non-LGBTQ+ men, LGBTQ+ residents were more likely to report discrimination (men: odds ratio [OR], 2.57; 95% CI, 1.78-3.72; women: OR, 25.30; 95% CI, 16.51-38.79), sexual harassment (men: OR, 2.04; 95% CI, 1.39-2.99; women: OR, 5.72; 95% CI, 4.09-8.01), and bullying (men: OR, 1.51; 95% CI, 1.07-2.12; women: OR, 2.00; 95% CI, 1.37-2.91). LGBTQ+ residents reported similar perceptions of the learning environment, career satisfaction, and burnout (OR, 1.22; 95% CI, 0.97-1.52) but had more frequent considerations of leaving their program (OR, 2.04; 95% CI, 1.52-2.74) and suicide (OR, 1.95; 95% CI, 1.26-3.04). This increased risk of suicidality was eliminated after adjusting for mistreatment (OR, 1.47; 95% CI, 0.90-2.39).
Mistreatment is a common experience for LGBTQ+ surgery residents, with attending surgeons being the most common overall source. Increased suicidality among LGBTQ+ surgery residents is associated with this mistreatment. Multifaceted interventions are necessary to develop safer and more inclusive learning environments.
先前的研究表明，美国普通外科住院医师中存在较高的虐待率，导致其健康状况不佳。同性恋、双性恋、跨性别、酷儿和其他性与性别少数群体（LGBTQ+）的住院医师是遭受虐待的高风险群体；然而，他们在普通外科项目中的经历在很大程度上尚未得到探索。
确定 LGBTQ+ 外科住院医师与非 LGBTQ+ 同行相比，其遭受虐待和健康状况不佳的全国流行率。
设计、环境和参与者：一项自愿、匿名的调查，使用经过验证的调查工具，对所有在经美国外科住院医师委员会认证的普通外科项目中接受临床培训的普通外科住院医师进行了调查。这项调查是在 2019 年美国外科学会住院医师考试之后进行的。
自我报告的虐待、虐待的来源、对学习环境的看法、职业满意度、职业倦怠、离职想法、自杀念头。使用多变量回归模型，考虑到性别和 LGBTQ+身份之间的相互作用，检查了 LGBTQ+身份与（1）虐待、（2）职业倦怠、（3）离职想法和（4）自杀念头之间的关联。
共有 6956 名临床活跃的住院医师完成了调查（85.6%的回复率）。在 6381 名应答者中，有 305 名应答者（4.8%）认为自己是 LGBTQ+，6076 名（95.2%）认为自己是非 LGBTQ+。报告称，161 名 LGBTQ+应答者（59.2%）遭受歧视，而 2187 名非 LGBTQ+应答者（42.3%）遭受歧视（P<0.001）；131 名 LGBTQ+应答者（47.5%）遭受性骚扰，而 1551 名非 LGBTQ+应答者（29.3%）遭受性骚扰（P<0.001）；220 名 LGBTQ+应答者（74.8%）遭受欺凌，而 3730 名非 LGBTQ+应答者（66.9%）遭受欺凌（P=0.005）；主治外科医生是最常见的总体来源。与非 LGBTQ+男性相比，LGBTQ+住院医师更有可能报告遭受歧视（男性：优势比[OR]，2.57；95%置信区间[CI]，1.78-3.72；女性：OR，25.30；95% CI，16.51-38.79）、性骚扰（男性：OR，2.04；95% CI，1.39-2.99；女性：OR，5.72；95% CI，4.09-8.01）和欺凌（男性：OR，1.51；95% CI，1.07-2.12；女性：OR，2.00；95% CI，1.37-2.91）。LGBTQ+住院医师对学习环境、职业满意度和职业倦怠的看法相似（OR，1.22；95% CI，0.97-1.52），但考虑离开项目的频率更高（OR，2.04；95% CI，1.52-2.74），自杀的念头也更频繁（OR，1.95；95% CI，1.26-3.04）。在调整了虐待因素后，自杀风险的这种增加就消失了（OR，1.47；95% CI，0.90-2.39）。
虐待是 LGBTQ+外科住院医师的常见经历，主治外科医生是最常见的总体来源。LGBTQ+外科住院医师的自杀率较高与这种虐待有关。需要采取多方面的干预措施，以建立更安全、更包容的学习环境。
