National evaluation of mistreatment and well-being in cardiothoracic surgery trainees

This study analyzes the prevalence of mistreatment among cardiothoracic surgery trainees and its association with burnout, suicidal ideation, and program attrition.

A cross-sectional national survey was conducted immediately after the 2024 Thoracic Surgery Directors Association In-Training Exam. The questionnaire consisted of multiple-choice and Likert-scale questions on trainee experiences with mistreatment (eg, identity discrimination, verbal/emotional abuse, sexual harassment). Multivariable regression was used to evaluate the association between mistreatment and a composite outcome of "trainee distress" encompassing burnout, suicidal thoughts, or program attrition.

A total of 440 trainees from 74 programs participated (74.3% response rate). Overall, 31% identified as female, 64% identified as male, and 5% did not disclose gender. Respondents were 51% White, 23% Asian, 7% Hispanic/Latino, and 5% Black/African American. Female trainees reported higher rates of identity discrimination (56% vs 14%, P < .001), verbal/emotional abuse (46% vs 36%, P = .009), sexual harassment (14% vs 3%, P < .001), and burnout (51% vs 39%, P = .006) compared with male trainees. Sources of mistreatment included faculty, patients and their families, and other healthcare staff. Approximately 50% of trainees reported experiencing the composite measure of trainee distress. Trainees who experienced any form of mistreatment had an increased risk of experiencing the composite distress measure (69.0% vs 31.0%, risk ratio, 1.19 [95% CI, 1.11-1.28]).

There is a high prevalence of perceived mistreatment among cardiothoracic surgery trainees, with female trainees reporting significantly more burnout, perceived discrimination, and abuse than male trainees. Perceived mistreatment is associated with trainee distress.