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National Survey Of Plastic Surgery Trainees: Current Status Of Gender Bias And Sexual Misconduct
Wendy Chen, MD, MS1, Benjamin K. Schilling, MS1, Debra A. Bourne, MD2, Sara Myers, MD, MA, MS1, Carolyn Delacruz, MD1.
1University of Pittsburgh, Pittsburgh, PA, USA, 2University of Kentucky, Lexington, KY, USA.

PURPOSE:
While interventions aimed at mitigating sexual harassment and assault are being emphasized withinmedicine (JAMA 1995, 2016), these issues continueto negativelyaffecthealth care providers.Specifically, underrepresentedtraineeswithin traditionally male-dominated fields such as plastic surgery are at particular risk. Maintaining professionalism in academic plastic surgery and plastic surgery training is important. METHODS:
We conducted a nationalsurvey of plastic surgery trainees enrolled in residency during the 2018-2019 academic year using questions from the previously validated surveys(Sexual Harassment Inventory, Minneapolis Veterans Affairs Medical Center, 1998; resident sexual harassment survey, Cook et al, 1996). Analyses consisted of Chi-squared, logistic regression, and ANOVA where appropriate, all of which were performed using SAS JMP Pro 14. Significance was accepted atp<0.05. RESULTS:
There were 211responses(115 female, 88 male, 8 deferred;15% response rate). Average age was 30.7 3.0 years. Races includedCaucasian (n-114), Asian/Pacific Islander (n=34), other (n=26), and deferred (n=11). Respondents included interns (n=30), residents (n=123), chief residents (n=23), fellows (n=24), and declined to respond (n=11). The feeling of hindrance to career advancement was greater for females, by 10-fold (p=0.00), and increased with age (p=0.00). Females feel significantly less comfortable challenging attitudes regarding gender inequality relative to men (p=0.00), with no significant effect of training levels (p=0.30) or race (0.67). Gender bias has a disproportionately diminishing effect on female trainees' career goals.ambition (p=0.00), correlated with increasing age. Compared to men, women feel uncomfortable challenging attitudes regarding gender inequality (p=0.00), regardless of age or race. Compared to men, female trainees reported experiencing sexual harassment in the form of jokes (p=0.00) and comments about their body or sexuality (p=0.01). Harassment more likely experienced by non-Caucasians (p=0.03). Five respondents reported co-workers had exposed themselves sexually; three reports of sexual coercion; three reports of advancement offered in exchange for sexual acts; one report of sexual assault.
Respondents reported perpetrators of gender bias to include attending physicians (30%), other trainees (37%), nurses and ancillary staff (21%), patients and families (11%), and medical students (3%). Most common reasons to not report incidents included "not worth the hassle/no change will result" (29%), "fear of retaliation, distrust in institution" (20%), "it occurs so frequently" (9%), and "advised not to report" (2%). Nearly half of respondents reported at least two symptoms of depression/anxiety, with women experiencing at least three, significantly higher than men (p=0.01).
CONCLUSION: Our results demonstrate gender bias and sexual misconduct negatively affects female trainees' attitudes towards their career and workplace culture. Females experienced sexual harassment from various members of the hospital community, most commonly from physicians. Trainees perceive a culture non-conducive to reporting incidents, plagued by fear and futility. Female trainees report more mental health symptoms than men. Awareness of these findings is highly relevant to training programs, and can help to guide changes and discussions surrounding workplace culture.


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