LGBTQ+ Surgery Residents Say Mistreatment Is Common

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) residents in general surgery training programs across the U.S. reported more instances of mistreatment than their non-LGBTQ+ colleagues, a new survey study found.

An analysis of survey responses sent out to general surgery residents in all Accreditation Council for Graduate Medical Education (ACGME)-accredited programs found that 59.2% (161 of 305) of respondents identifying as LGBTQ+ had experienced discrimination compared with 42.3% (2,187 of 6,076) of non-LGBTQ+ residents (P<0.001), reported Yue-Yung Hu, MD, MPH, of Northwestern University Feinberg School of Medicine in Chicago, and colleagues.

Hu and team also found similarly significant trends for experiences of sexual harassment (47.5% of LGBTQ+ residents vs 29.3% of non-LGBTQ+ residents; P<0.001) and bullying (74.8% vs 66.9%, respectively; P<0.005). Attending surgeons were found to be the most common source of mistreatment overall, they noted in JAMA Surgery.

"The surgical training and work environments should facilitate learning, caring for patients, and advancing knowledge, rather than a hazing initiation or a trial by fire," wrote Michaela West, MD, PhD, of North Memorial Health in Minneapolis, in an accompanying commentary. "While the identified problems are not new, the willingness to acknowledge them may be."

Compared with straight male residents, the likelihood of experiencing mistreatment was higher for LGBTQ+ men, with ORs for discrimination of 2.57, for sexual harassment of 2.04, and for bullying of 1.51.

However, both straight women and women in the LGBTQ+ community were at higher odds of experiencing all three -- discrimination: ORs 21.51 and 25.30; sexual harassment: ORs 2.79 and 5.72; and bullying: ORs 1.55 and 2.00, respectively.

For this study, Hu and colleagues sent a survey to 8,907 general surgery residents, garnering responses from 6,956 clinically active residents (85.6% response rate). Of the 6,381 respondents who were ultimately included in the analysis, 305 identified as LGBTQ+ (4.8%) and 6,076 identified as non-LGBTQ+ (95.2%).

In general, residents identifying as LGBTQ+ and their non-LGBTQ+ peers reported satisfaction with their career decision (80.7% and 81.5%, respectively), and were similarly likely to report burnout (OR 1.22, 95% CI 0.97-1.52); however, LGBTQ+ residents reported more frequent thoughts about leaving their program (21.1% vs 10.9% for non-LGBTQ+ residents; OR 2.04, 95% CI 1.52-2.74), and were more likely to have suicidal thoughts (8.2% vs 4.2%, respectively; OR 1.95, 95% CI 1.26-3.04), though this was decreased after adjusting for mistreatment (OR 1.47, 95% CI 0.90-2.39).

"Notably, bullying demonstrated a stronger association with suicidality than either discrimination (which was not associated) or sexual harassment," Hu and team wrote. "Therefore, addressing mistreatment in the learning environment, particularly bullying, may have a considerable impact on rates of suicide, the second leading cause of death among residents."

The fact that LGBTQ+ surgical residents reported feeling as satisfied with their career choice as their straight colleagues, yet had more frequent thoughts about leaving their program, indicated that thoughts of attrition are likely a result of negative environmental factors, rather than a lack of fulfillment, the authors pointed out.

Both the study authors and West acknowledged that, despite the survey's assurance of confidentiality, there may have been a portion of respondents who did not feel comfortable disclosing their sexuality, therefore underestimating the number of LGBTQ+ residents in their sample. Hu and colleagues also recognized the inherent recall bias that comes along with self-report surveys, as well as the possibility that trauma associated with mistreatment can lead to either overreporting or underreporting.

"The identification of mistreatment behaviors and their sources allows for the development and implementation of targeted interventions," the authors concluded. "Recommendations to improve workplace and learning environments for LGBTQ+ students and employees in health professional schools address admissions and recruitment, resources and support, ally training, and equitable institutional policies."

"We must heed this call to improve because the call is coming from inside the house," urged West.

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