RS03 - Defining Sources and Ramifications of Mistreatment Among Female Vascular Surgery Trainees

Objectives: Mistreatment among vascular surgery trainees is a known risk factor for physician burnout. This study aims to characterize forms of and identify sources of mistreatment.

Methods: This a cross-sectional study of U.S. vascular surgery trainees who voluntarily participated in an anonymous survey administered after the 2021 Vascular Surgery In-Training Examination. The primary outcome measures were self-reported mistreatment and sources of mistreatment between genders. Logistic regression was used for multivariable analysis.

Results: Representing all 125 vascular surgery training programs, 510 trainees (66.9% male) participated in the survey (83.6% response rate). Mistreatment was reported by 54.8% of trainees, with twice as many women reporting as men (82.3% vs 41.0%, p< 0.001). Women reported higher rates of being shouted at (44.1% vs 21.1%, p< 0.001), repeated reminders of errors (24.3% vs 16.%1, p=0.04), being ignored/facing hostile reaction when approaching (28.9% vs 10.5%, p< 0.001), crude/sexually demeaning remarks, stories, jokes (19.2% vs 2.1%, p< 0.001), different standards of evaluation (29.3% vs 2.1%, p< 0.001), and mistaken for a non-physician (75.2% vs 3.5%, p< 0.001) than men (Table I). Regarding bullying, attendings were the most common source (68.5%). Patients/families were the most common source of sexual harassment (66.7%), gender discrimination (90.4%), and racial discrimination (74.4%). Sources of mistreatment subgroup analysis demonstrated patients/families disproportionately were the source of bullying (50.0% vs 29.7%, p=0.005), gender discrimination (97.2% vs 50.0%, p< 0.001), and sexual harassment (78.4% vs 27.3%, p=0.003) for women compared to men. Women were more likely to report that their institution/program would not take their mistreatment report seriously, compared to men (9.0% vs 3.9%, p=0.002). Women more frequently felt unprepared to respond to the behavior in the moment (10.4% vs 4.6%, p=0.002), and they often did not know how to report mistreatment at their institution, compared to men (7.6% vs 3.2% p=.04). On multivariable analysis, female gender was a risk factor for both gender discrimination (odds ratio [OR] 56.62 confidence interval [CI] 27.89-115) and sexual harassment (OR 26.2 CI 3.34-14.8) when adjusting for children, training year, relationship status, and training program location (Table II).

Conclusions: A majority of vascular surgery trainees experience mistreatment during training, but instigators differ by the type of abuse. Possible confounding factors may have further elevated female gender OR in multivariable analysis but agree with trend. Understanding the sources of mistreatment is critical as multiple intervention strategies such as faculty remediation, allyship training for hospital employees, and institutional procedures for patient-initiated abuse will be required.