Advertisement

Bullying, Discrimination, Sexual Harassment, and Physical Violence: Common and Associated With Burnout in Pediatric Residents

  • Kathi J Kemper
    Correspondence
    Address correspondence to Kathi J Kemper, MD, MPH, College of Medicine, the Ohio State University, 370 W 9th Ave Columbus, OH 43210
    Affiliations
    Department of Pediatrics (KJ Kemper), College of Medicine, the Ohio State University, Columbus, Ohio
    Search for articles by this author
  • Alan Schwartz
    Affiliations
    Departments of Medical Education and Pediatrics (A Schwartz), University of Illinois College of Medicine, Chicago, Ill
    Search for articles by this author
  • on behalf of the?>Pediatric Resident Burnout-Resilience Study Consortium
Published:February 27, 2020DOI:https://doi.org/10.1016/j.acap.2020.02.023

      Abstract

      Background

      Many pediatric residents suffer from burnout. We aimed to describe the prevalence, source, and epidemiology of bullying, discrimination, harassment, and physical violence, and the relationship between these experiences and burnout.

      Methods

      We analyzed data from the Spring, 2019 Pediatric Resident Burnout and Resilience Study Consortium's 72-item online survey. Surveys included screening questions about burnout; residents’ characteristics and experiences, and attitudes about their learning environment.

      Results

      Nineteen hundred fifty-six residents (66% of those eligible) from 46 programs participated; most (70%) were women and most (66%) were Caucasian. Overall 45% reported weekly or more frequent burnout symptoms; 33% reported 1 or more of these experiences (“mistreatment”) during the past year: 19% reported experiencing bullying; 18% reported discrimination; 5% reported sexual harassment; and 1% reported physical violence. The most frequent sources of mistreatment were clinical staff (60%), patients’ families (54%), and faculty (43%). Women were more likely than men to report mistreatment (36% vs 25%, P < .01) Residents who reported experiencing mistreatment were more likely than those who did not to report symptoms of burnout (adjusted odds ratio 1.98; 95% confidence interval, CI 1.62–2.42); they also reported higher stress levels, lower quality of life, and were less likely to agree that their program prioritized collaboration, education, or mentoring (P < .001 for all).

      Conclusions

      Mistreatment occurs frequently among pediatric residents, especially women; mistreatment is associated with burnout, stress, lower quality of life, and worse attitudes about the learning environment. Future studies could explore whether institutional efforts to improve workplace civility improves resident well-being and attitudes about training.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Pantaleoni JL
        • Augustine EM
        • Sourkes BM
        • et al.
        Burnout in pediatric residents over a 2-year period: a longitudinal study.
        Acad Pediatr. 2014; 14: 167-172
        • Baer TE
        • Feraco AM
        • Tuysuzoglu Sagalowsky S
        • et al.
        Pediatric resident burnout and attitudes toward patients.
        Pediatrics. 2017; 139e20162163
        • Kemper KJ
        • McClafferty H
        • Wilson PM
        • et al.
        Do mindfulness and self-compassion predict burnout in pediatric residents?.
        Acad Med. 2018;
        • Brunsberg KA
        • Landrigan CP
        • Garcia BM
        • et al.
        Association of pediatric resident physician depression and burnout with harmful medical errors on inpatient services.
        Acad Med. 2019; 94: 1150-1156
        • Kemper KJ
        • Schwartz A
        • Wilson PM
        • et al.
        Burnout in pediatric residents: three years of national survey data.
        Pediatrics. 2020; 145e20191030
        • Viotti S
        • Gilardi S
        • Guglielmetti C
        • et al.
        Verbal aggression from care recipients as a risk factor among nursing staff: a study on burnout in the JD-R model perspective.
        BioMed Res Int. 2015; 2015215267
        • Rayan A
        • Sisan M
        • Baker O
        Stress, workplace violence, and burnout in nurses working in King Abdullah Medical City during Al-Hajj season.
        J Nurs Res. 2019; 27e26
        • Choi SH
        • Lee H
        Workplace violence against nurses in Korea and its impact on professional quality of life and turnover intention.
        J Nurs Manag. 2017; 25: 508-518
        • Yang BX
        • Stone TE
        • Petrini MA
        • et al.
        Incidence, type, related factors, and effect of workplace violence on mental health nurses: a cross-sectional survey.
        Arch Psychiatr Nurs. 2018; 32: 31-38
        • Hu YY
        • Ellis RJ
        • Hewitt DB
        • et al.
        Discrimination, abuse, harassment, and burnout in surgical residency training.
        N Engl J Med. 2019; 381: 1741-1752
        • Frank E
        • Brogan D
        • Schiffman M
        Prevalence and correlates of harassment among US women physicians.
        Arch Intern Med. 1998; 158: 352-358
        • Nunez-Smith M
        • Pilgrim N
        • Wynia M
        • et al.
        Race/ethnicity and workplace discrimination: results of a national survey of physicians.
        J Gen Intern Med. 2009; 24: 1198-1204
        • Fnais N
        • Soobiah C
        • Chen MH
        • et al.
        Harassment and discrimination in medical training: a systematic review and meta-analysis.
        Acad Med. 2014; 89: 817-827
        • Kemper KJ
        • Wilson P
        • Schwartz A
        • et al.
        Burnout in pediatric residents: comparing brief screening questions to the Maslach burnout inventory.
        Acad Pediatr. 2019; 19: 251-255
        • Cohen S
        • Kamarck T
        • Mermelstein R
        A global measure of perceived stress.
        J Health Soc Behav. 1983; 24: 385-396
        • Cohen S
        • Janicki-Deverts D
        Who's stressed? distributions of psychological stress in the United States in probability samples from 1983, 2006, and 2009.
        J Appl Soc Psychol. 2012; 42: 1320-1334
        • Harwani N
        • Motz K
        • Graves K
        • et al.
        Impact of changes in mindfulness on perceived stress and empathic concern in medical students.
        J Altern Complement Med. 2014; 20: A7
        • Atanes AC
        • Andreoni S
        • Hirayama MS
        • et al.
        Mindfulness, perceived stress, and subjective well-being: a correlational study in primary care health professionals.
        BMC Complement Altern Med. 2015; 15: 303
        • Feldman G
        • Hayes A
        • Kumar S
        • et al.
        Mindfulness and emotion regulation: the development and initial validation of the cognitive and affective mindfulness scale-revised (CAMS-R).
        J Psychopathol Behav Assess. 2007; 29: 177-190
        • Feldman G
        • Dunn E
        • Stemke C
        • et al.
        Mindfulness and rumination as predictors of persistence with a distress tolerance task.
        Pers Individ Dif. 2014; 56: 154-158
        • Raes F
        • Pommier E
        • Neff KD
        • et al.
        Construction and factorial validation of a short form of the Self-Compassion Scale.
        Clin Psychol Psychother. 2011; 18: 250-255
        • Davis MH
        Measuring individual-differences in empathy - evidence for a multidimensional approach.
        J Personality Soc Psychol. 1983; 44: 113-126
        • Crebbin W
        • Campbell G
        • Hillis DA
        • et al.
        Prevalence of bullying, discrimination and sexual harassment in surgery in Australasia.
        ANZ J Surg. 2015; 85: 905-909