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Gender-based Discrimination is Prevalent in the Integrated Vascular Trainee Experience and Serves as a Predictor of Burnout
Linda J. Wang, MD, MBA1, Adam Tanious, MD, MMSc1, Catherine Go, MD2, Dawn Coleman, MD3, Sophia McKinley, MD1, Matthew J. Eagleton, MD1, W. Darrin Clouse, MD1, Mark F. Conrad, MD, MMSc1.
1Massachusetts General Hospital, Boston, MA, USA, 2University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 3University of Michigan, Ann Arbor, MI, USA.

OBJECTIVES: Trainee burnout is on the rise and negative training environments may contribute. Additionally, as the proportion of women entering vascular surgery increases, identifying factors that challenge recruitment and retention is vital as we grow our workforce to meet demand. This study sought to characterize the learning environment of vascular residents and determine how gender-based discrimination and bias (GBDB) affect the clinical experience.
METHODS: A survey was developed to evaluate the trainee experience; demographics and a two-item burnout index were included. It was sent electronically to all integrated vascular surgery residents in the United States. Univariate analyses were performed and predictors of burnout identified.
RESULTS: 284 residents were invited and 208 (73%) completed the survey. Participants were predominantly male (64%) and Caucasian (57%) with a mean age of 30.73.2 years. 79% endorsed some form of negative workplace experience and 29% were at high risk for burnout. 38% endorsed personal experience of GBDB, with a significant difference between men and women (14% vs 81%, p<.000). While men were significantly more likely to witness GBDB than experience it, women were still more likely to observe these occurrences (77% vs 56%, p=.003). Patients and nurses were the most frequently cited sources of GBDB (80% and 65%, respectively) with vascular surgery attendings cited by 42% of trainees. Over 1 in 4 female resident respondents indicated being sexually harassed over the course of training, with a significant gender difference (1% vs 26%, p<.001). Nearly half (46%) of trainees who witnessed or experienced GBDB felt quality of patient care, job satisfaction, personal well-being, and/or personal risk of burnout were affected. GBDB was predictive of high risk of burnout (OR 1.9, 95% CI 1.1-3.6, p=.035) as were longer work hours (>80/week) (OR 2.6, 95% CI 1.1-6.7, p=.049).
CONCLUSIONS: GBDB was experienced by 38% of integrated trainees, with women significantly more affected than men. GBDB is predictive of high risk of burnout and this has significant implications for our specialty in the recruitment and retention of female physicians. Programs addressing these issues are needed in order to maintain a diverse workforce and promote physician well-being.


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