Cross-sectional study data published in the New England Journal of Medicine indicate that discrimination, abuse, and harassment are highly prevalent in surgical residency training, especially in female residents. Among survey respondents, mistreatment was strongly associated with burnout and suicidal thoughts.

Investigators abstracted data from a cross-sectional survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination. The survey captured residents’ experiences with mistreatment, burnout, and suicidal thoughts. Burnout was assessed per a modified Maslach Burnout Inventory. Respondents were also asked to report self-identified gender. Multivariable logistic regression was performed to assess the relationship between maltreatment, burnout, and suicidal thoughts. Results were compared across gender and residence program strata.

A total of 7409 residents from all 262 surgical residency programs provided survey data. Overall, 31.9% of respondents reported gender-based discrimination; 16.6% reported racial discrimination; 30.3% reported verbal and/or physical abuse; and 10.3% reported sexual harassment. Compared with men, women experienced more mistreatment in all modalities. Specifically, nearly two-thirds (65.1%) of women reported gender discrimination, and 19.9% reported sexual harassment. Nearly half of all respondents reported having had at least 1 experience with mistreatment in the prior year; 19.0% indicated experiencing mistreatment at least a few times per month. Patients and patients’ families were the most frequent sources of gender (43.6%) and racial (47.4%) discrimination. Attending surgeons were the most frequently reported sources of sexual harassment (27.2%) and verbal or emotional abuse (52.4%).

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Burnout symptoms occurring once or more per week were reported by 38.5% of residents, and 4.5% reported experiencing suicidal thoughts in the past year. Compared with no mistreatment, a greater likelihood of burnout was observed among those experiencing mistreatment a few times a year (odds ratio [OR], 2.02; 95% CI], 1.81-2.25) and a few times a month (OR, 2.94; 95% CI, 2.58-3.36). While women were more likely to report burnout in unadjusted models (42.4% vs 35.9%), between-gender differences disappeared after adjustment for mistreatment. Compared with those with no exposure to mistreatment, increasing odds of suicidal thoughts were observed in residents experiencing mistreatment a few times a year (OR, 2.08; 95% CI, 1.57-2.76) and a few times a month or more (OR, 3.07; 95% CI, 2.25-4.19). Mistreatment rates varied widely between specific programs, with no specific trends identified.

Mistreatment was a common experience among US surgical residents in 2018 and was significantly associated with burnout and suicidal thoughts. The increased prevalence of mistreatment among women and residents of color warrants further research and intervention. “Our results provide initial insights on how we may build safer, more equitable, and more effective educational environments for trainees,” investigators wrote.


Hu YY, Ellis RJ, Hewitt DB, et al. Discrimination, abuse, harassment, and burnout in surgical residency training. N Engl J Med. 2019;381(18):1741-1752.