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Experiences of LGBTQ+ Residents in US General Surgery Training Programs.
Evan A Heiderscheit1, Cary Jo R Schlick1, Ryan J Ellis1
1Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
JAMA Surgery
|October 20, 2021
Summary
Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) surgery residents experience higher rates of mistreatment, including discrimination and harassment. This mistreatment is linked to increased suicidality, highlighting the need for safer learning environments.
Area of Science:
- Medical Education
- Surgical Training
- Health Disparities
Background:
- General surgery residents face high mistreatment rates, impacting well-being.
- Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) residents are a high-risk group for mistreatment.
- Limited research exists on LGBTQ+ surgery residents' experiences.
Purpose of the Study:
- To determine the national prevalence of mistreatment and poor well-being among LGBTQ+ surgery residents.
- To compare mistreatment and well-being outcomes for LGBTQ+ residents versus their non-LGBTQ+ peers.
Main Methods:
- Anonymous survey administered to general surgery residents post-In-Training Examination.
- Validated survey instruments adapted to assess mistreatment, learning environment, career satisfaction, burnout, attrition, and suicidality.
- Multivariable regression models used to examine associations between LGBTQ+ status and outcomes, controlling for gender interactions.
Main Results:
- Of 6381 residents, 4.8% identified as LGBTQ+.
- LGBTQ+ residents reported significantly higher rates of discrimination (59.2% vs 42.3%), sexual harassment (47.5% vs 29.3%), and bullying (74.8% vs 66.9%).
- Attending surgeons were the most common source of mistreatment. LGBTQ+ residents had increased odds of considering leaving their program (OR, 2.04) and suicide (OR, 1.95), with suicidality risk reduced after adjusting for mistreatment.
Conclusions:
- Mistreatment is prevalent among LGBTQ+ surgery residents, with attending surgeons as a primary source.
- Increased suicidality risk in LGBTQ+ residents is associated with mistreatment.
- Interventions are crucial to foster safer and more inclusive surgical training environments.
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