How do rates of self-reported mistreatment and sources of mistreatment vary between lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) general surgery residents and their non-LGBTQ+ peers?
In this survey study of 6381 surgical residents, LGBTQ+ general surgery residents reported higher rates of discrimination, harassment, and bullying than their non-LGBTQ+ peers, with attending surgeons as the most common source. Despite reporting similar career satisfaction, LGBTQ+ residents were twice as likely to consider leaving their program and/or have thoughts of suicide.
Mistreatment is a common experience for LGBTQ+ general surgery residents, and multifaceted interventions are necessary to develop safer and more inclusive learning environments.
Previous studies have shown high rates of mistreatment among US general surgery residents, leading to poor well-being. Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) residents represent a high-risk group for mistreatment; however, their experience in general surgery programs is largely unexplored.
To determine the national prevalence of mistreatment and poor well-being for LGBTQ+ surgery residents compared with their non-LGBTQ+ peers.
Design, Setting, and Participants
A voluntary, anonymous survey adapting validated survey instruments was administered to all clinically active general surgery residents training in Accreditation Council for Graduate Medical Education–accredited general surgery programs following the 2019 American Board of Surgery In-Training Examination.
Main Outcomes and Measures
Self-reported mistreatment, sources of mistreatment, perceptions of learning environment, career satisfaction, burnout, thoughts of attrition, and suicidality. The associations between LGBTQ+ status and (1) mistreatment, (2) burnout, (3) thoughts of attrition, and (4) suicidality were examined using multivariable regression models, accounting for interactions between gender and LGBTQ+ identity.
A total of 6956 clinically active residents completed the survey (85.6% response rate). Of 6381 respondents included in this analysis, 305 respondents (4.8%) identified as LGBTQ+ and 6076 (95.2%) as non-LGBTQ+. Discrimination was reported among 161 LGBTQ+ respondents (59.2%) vs 2187 non-LGBTQ+ respondents (42.3%; P < .001); sexual harassment, 131 (47.5%) vs 1551 (29.3%; P < .001); and bullying, 220 (74.8%) vs 3730 (66.9%; P = .005); attending surgeons were the most common overall source. Compared with non-LGBTQ+ men, LGBTQ+ residents were more likely to report discrimination (men: odds ratio [OR], 2.57; 95% CI, 1.78-3.72; women: OR, 25.30; 95% CI, 16.51-38.79), sexual harassment (men: OR, 2.04; 95% CI, 1.39-2.99; women: OR, 5.72; 95% CI, 4.09-8.01), and bullying (men: OR, 1.51; 95% CI, 1.07-2.12; women: OR, 2.00; 95% CI, 1.37-2.91). LGBTQ+ residents reported similar perceptions of the learning environment, career satisfaction, and burnout (OR, 1.22; 95% CI, 0.97-1.52) but had more frequent considerations of leaving their program (OR, 2.04; 95% CI, 1.52-2.74) and suicide (OR, 1.95; 95% CI, 1.26-3.04). This increased risk of suicidality was eliminated after adjusting for mistreatment (OR, 1.47; 95% CI, 0.90-2.39).
Conclusions and Relevance
Mistreatment is a common experience for LGBTQ+ surgery residents, with attending surgeons being the most common overall source. Increased suicidality among LGBTQ+ surgery residents is associated with this mistreatment. Multifaceted interventions are necessary to develop safer and more inclusive learning environments.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: August 10, 2021.
Published Online: October 20, 2021. doi:10.1001/jamasurg.2021.5246
Corresponding Author: Yue-Yung Hu, MD, MPH, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, 633 N St Clair St, 20th Floor, Chicago, IL 60611 (email@example.com).
Author Contributions: Dr Hu had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Mr Heiderscheit and Dr Schlick contributed equally to this work.
Study concept and design: Heiderscheit, Ellis, Irizarry, Eng, Hoyt, Bilimoria, Hu.
Acquisition, analysis, or interpretation of data: Heiderscheit, Schlick, Ellis, Cheung, Amortegui, Eng, Sosa, Hoyt, Buyske, Nasca, Bilimoria, Hu.
Drafting of the manuscript: Heiderscheit, Hoyt, Hu.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Heiderscheit, Schlick, Eng, Bilimoria, Hu.
Obtained funding: Nasca, Bilimoria, Hu.
Administrative, technical, or material support: Ellis, Amortegui, Hoyt, Buyske, Nasca, Hu.
Study supervision: Ellis, Cheung, Sosa, Hoyt, Bilimoria, Hu.
Conflict of Interest Disclosures: Dr Sosa has received institutional research funding from Exelixis and Eli Lilly and is a member of the data monitoring committee of the Medullary Thyroid Cancer Consortium Registry, which is supported by GlaxoSmithKline, NovoNordisk, AstraZeneca, and Eli Lilly. Drs Bilimoria and Hu have received grants for serving as co–principal investigators of the SECOND trial from the American College of Surgeons and the Accreditation Council for Graduate Medical Education as well as nonfinancial support from the American Board of Surgery. No other disclosures were reported.
Funding/Support: Funding for this work was provided by the Accreditation Council for Graduate Medical Education and American College of Surgeons. The American Board of Surgery provided in-kind support. Dr Ellis was supported by a postdoctoral research fellowship from the Agency for Healthcare Research and Quality (grant 5T32HS000078).
Role of the Funder/Sponsor: The funding agencies had no role in the design and conduct of the study; analysis of data; preparation or review of the manuscript; and decision to submit the manuscript for publication. Authors affiliated with funding agencies were involved in the collection and interpretation of the data and review and approval of the manuscript.
Disclaimer: The views expressed in this work represent those of the authors only.
Meeting Information: This paper was presented at the Academic Surgical Congress; February 4 and 6, 2020; Orlando, Florida.
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