Infectious Disease

Residents and medical students often report abuse

August 20, 2021

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Lall does not report any relevant financial information. Dyrbye reports that outside of the study, he received royalties from CWS Inc. for the Well-Being Index. Please refer to the study for all relevant financial information from the other authors.

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Emergency medicine residents were frequently ill-treated in the workplace, including gender and racial discrimination, physical abuse, and sexual harassment, according to results published on JAMA Network Open.

Researchers reported that workplace abuse was often caused by patients or patients’ family members.

Lall, MD, et al. JAMA network open. 2021; doi: 10.1001 / jamanetworkopen.2021.21706.

In a separate study published on JAMA Network Open, data showed that abuse is common among medical students as well. Both studies highlight the need for interventions to improve medical education, the researchers said.

Mistreatment among residents

Michelle D. Lall, MD, MHS, a doctor in the Emergency Medicine Department at Emory University, and colleagues surveyed 7,680 emergency medicine residents about their experiences during assistant training in February 2020. The survey, which consisted of 35 multiple-choice questions, was conducted after residents completed the American Board of Emergency Medicine’s 2020 computer-based in-training exam. Of the study cohort, 62.1% were men, 64% were non-Hispanic whites, and 6.3% were identified as part of the LGBTQ + community.

The data showed that 45.1% of those surveyed had experienced some type of abuse in the workplace in the final year of college. According to Lall and colleagues, respondents often attributed the abuse to the patients or their families. The most common form of abuse by patients or their family members was physical abuse (85.2%), followed by sexual harassment (69.1%), racial discrimination (67.5%) and gender-based discrimination (58.7%).

The survey responses also showed that 2.5% of respondents had thought of suicide in the past year. The prevalence of suicidal ideation was similar across gender, race, and ethnic group, according to the researchers.

Overall, 18% of respondents reported racial discrimination, including 7.9% of white residents and 37.6% of residents of other races and ethnic groups. Three percent of residents said they had been discriminated against because of their sexual orientation or gender.

Some residents – 5.1% – were discriminated against because of their pregnancy or caregiving status, including 10.8% of women and 1.8% of men. Around 15% of those surveyed were sexually harassed. This was more common in women than in men (28.8% vs. 6.5%; P <0.001). Verbal or emotional abuse was reported by 29% of respondents, including 32.2% of women and 27% of men.

“Women were more likely than men to report almost all forms of abuse, with most of the gender-based abuse reported originating from patients and their families,” Lall and colleagues wrote. “The second most likely source of gender abuse was caregivers and staff. Gender bias, discrimination and sexual harassment in medicine have detrimental consequences for the careers and well-being of women doctors. “

The overall prevalence of abuse – 45.1% – was lower than the prevalence of abuse in a 1993 workplace abuse survey, in which 98% of emergency medical professionals reported at least one incident of harassment, according to the researchers. Still, Lall and colleagues found that workplace violence is linked to an increased risk of burnout, depression and PTSD. Therefore, educational interventions are necessary “to reduce abuse in the workplace and to ensure the well-being of the residents of the emergency medicine during the training”.

Burnout in medical school

In the second study, Liselotte N. Dyrbye, MD, MHPE, FACP, Co-director of the Program of Physician Wellbeing, professor of medicine and medical education and advisor in the Mayo Clinic’s internal medicine department, and colleagues noted that medical students who experienced any type of abuse are more likely to develop degrees of fatigue, less Commitment, less empathy, and greater career regrets.

Liselotte N. Dyrbye

“There are several studies that suggest that abuse, poor feedback, high demands on teaching staff, and bad role models are all linked to burnout risk in medical trainees,” Dyrbye told Healio Primary Care. “Few of these previous studies, however, were longitudinal or included large national samples of trainees. ”

Dyrbye and colleagues analyzed the survey responses of 14,126 medical students (52% women) who participated in the Association of American Medical Colleges (AAMC) Medical School Year 2 Questionnaire 2014-2016 and the AAMC Graduation Questionnaire 2016-2018. Overall, 22.9% of those surveyed experienced abuse at the beginning of their sophomore year. According to the researchers, men did better than women on exhaustion and disengagement. They reported that higher scores for fatigue and disengagement correlated with a higher likelihood of career regret.

“Among physicians in the office, career regrets are associated with reduced clinical time, turnover, and leaving the office – all of which negatively impact patient access to care,” said Dyrbye.

Medical schools and faculties are in a position to enhance student experiences, she added.

“Many organizations are trying to improve the well-being of medical students and physicians by increasing an individual’s ability to cope with stress,” she said. “While individuals certainly have a responsibility to be self-sufficient, improving the wellbeing of medical students and physicians is a shared responsibility. Medical schools that effectively train their teachers, empower teachers to teach and mentor learners through meaningful recognition, create inclusive learning environments, and implement meaningful ways to promote social support will improve student wellbeing more than schools that do concentrate exclusively on training resilience. “

References:

Dyrbye LN et al. JAMA network open. 2021; doi: 10.1001 / jamanetworkopen.2021.19110.

Lall, MD, et al. JAMA network open. 2021; doi: 10.1001 / jamanetworkopen.2021.21706.

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