E. A. Heiderscheit1, C. R. Schlick1, R. J. Ellis1, E. O. Cheung2, D. Irizarry3, D. Amortegui1, K. Y. Bilimoria1, Y. Hu1,4 1Feinberg School Of Medicine – Northwestern University,Surgical Outcomes And Quality Improvement Center,Chicago, IL, USA 2Feinberg School Of Medicine – Northwestern University,Department Of Medical Social Sciences,Chicago, IL, USA 3Stanford School of Medicine,Department Of Psychiatry & Behavioral Sciences,Palo Alto, CA, USA 4Ann & Robert H. Lurie Children’s Hospital,Division Of Pediatric Surgery,Chicago, IL, USA
Introduction: Mistreatment is commonly reported by minorities in surgery residency. Little attention has been given to the experiences of LGBTQ trainees in surgery.
Methods: A cross-sectional survey was administered with the 2019 American Board of Surgery In-Training Examination, querying perceptions of the learning environment and experiences with sexual harassment, discrimination based on gender/gender identity/sexual orientation, bullying, thoughts of attrition, and suicidality during the last academic year. Individual items were compared between LGBTQ and non-LGBTQ respondents using chi-square tests. Associations between LGBTQ status, gender, and mistreatment were evaluated by multivariable logistic regression.
Results: 6562 clinically-active surgery residents completed the survey (85.6% response rate), of which 314 (4.8%) identified as LGBTQ: 198 gay or lesbian, 100 bisexual, 15 ‘other sexual orientation’, and 16 transgender or ‘other gender identity’. Of the 314 LGBTQ residents, 46.8% reported experiencing sexual harassment, 58.9% discrimination, and 75.2% bullying, which was significantly more than non-LGBTQ residents after adjusting for other resident and program-level characteristics (Table). Attendings were the most frequent source of all 3 types of mistreatment of LGBTQ residents (harassment 34.1%, discrimination 35.1%, and bullying 48.1%). Other common sources included patients/families (harassment 27.7%) and co-residents (harassment 23.5%, bullying 33.2%). In non-LGBTQ residents, attendings were also the most frequent source of discrimination (35.4%) and bullying (47.1%), but harassment was primarily attributable to patients/families (35.4%). No statistical differences were found between the LGBTQ and non-LGBTQ respondents’ perceptions that their work was appreciated by attendings (69.3% vs 73.7%) or co-residents (81.5% vs 83.8%), that their co-residents cooperated with one another (87.3% vs 88.3%) or were among their closest friends (63.4% vs 64.0%), that favoritism determined how decisions were made (27.2% vs 23.0%), and/or that they had a mentor who genuinely cared about them (63.4% vs 64.0%). While LGBTQ respondents were just as likely to be satisfied with their decision to become a surgeon (80.1 vs 81.5%), they were almost twice as likely to have considered leaving their program (21.1% vs 11.0%, p<0.001) and/or had suicidal thoughts (8.28% vs 4.19%, p<0.001) in the past year.
Conclusion: LGBTQ surgical residents were more likely to report experiencing sexual harassment, discrimination, and bullying. Surgical residency programs should consider this vulnerable subgroup when working to foster safe, inclusive work and learning environments.
