Browsing by Author "Hu, Yue-Yung"
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Item Assessing Resident Well-Being After the ABSITE: A Bad Time to Ask?(Wolters Kluwer, 2022-09-28) Cheung, Elaine O.; Hu, Yue-Yung; Jones, Andrew; Ma, Meixi; Schlick, Cary Jo R.; Moskowitz, Judith T.; Agarwal, Gaurava; Bilimoria, Karl Y.; Surgery, School of MedicineObjectives: Assess the association of residents' exam performance and transient emotions with their reports of burnout, suicidality, and mistreatment. Background: An annual survey evaluating surgical resident well-being is administered following the American Board of Surgery In-Training Examination (ABSITE). One concern about administering a survey after the ABSITE is that stress from the exam may influence their responses. Methods: A survey was administered to all general surgery residents following the 2018 ABSITE assessing positive and negative emotions (scales range from 0 to 12), as well as burnout, suicidality over the past 12 months, and mistreatment (discrimination, sexual harassment verbal/emotional or physical abuse) in the past academic year. Multivariable hierarchical regressions assessed the associations of exam performance and emotions with burnout, suicidality, and mistreatment. Results: Residents from 262 programs provided complete responses (N = 6987, 93.6% response rate). Residents reported high mean positive emotion (M = 7.54, SD = 2.35) and low mean negative emotion (M = 5.33, SD = 2.43). While residents in the bottom ABSITE score quartile reported lower positive and higher negative emotion than residents in the top 2 and 3 quartiles, respectively (P < 0.005), exam performance was not associated with the reported likelihood of burnout, suicidality, or mistreatment. Conclusions: Residents' emotions after the ABSITE are largely positive. Although poor exam performance may be associated with lower positive and higher negative emotion, it does not seem to be associated with the likelihood of reporting burnout, suicidality, or mistreatment. After adjusting for exam performance and emotions, mistreatment remained independently associated with burnout and suicidality. These findings support existing evidence demonstrating that burnout and suicidality are stable constructs that are robust to transient stress and/or emotions.Item Experiences of Gender Discrimination and Sexual Harassment Among Residents in General Surgery Programs Across the US(American Medical Association, 2021) Schlick, Cary Jo R.; Ellis, Ryan J.; Etkin, Caryn D.; Greenberg, Caprice C.; Greenberg, Jacob A.; Turner, Patricia L.; Buyske, Jo; Hoyt, David B.; Nasca, Thomas J.; Bilimoria, Karl Y.; Hu, Yue-Yung; Surgery, School of MedicineImportance: Mistreatment is a common experience among surgical residents and is associated with burnout. Women have been found to experience mistreatment at higher rates than men. Further characterization of surgical residents' experiences with gender discrimination and sexual harassment may inform solutions. Objective: To describe the types, sources, and factors associated with (1) discrimination based on gender, gender identity, or sexual orientation and (2) sexual harassment experienced by residents in general surgery programs across the US. Design, setting, and participants: This cross-sectional national survey study was conducted after the 2019 American Board of Surgery In-Training Examination (ABSITE). The survey asked respondents about their experiences with gender discrimination and sexual harassment during the academic year starting July 1, 2018, through the testing date in January 2019. All clinical residents enrolled in general surgery programs accredited by the Accreditation Council for Graduate Medical Education were eligible. Exposures: Specific types, sources, and factors associated with gender-based discrimination and sexual harassment. Main outcomes and measures: Primary outcome was the prevalence of gender discrimination and sexual harassment. Secondary outcomes included sources of discrimination and harassment and associated individual- and program-level factors using gender-stratified multivariable logistic regression models. Results: The survey was administered to 8129 eligible residents; 6956 responded (85.6% response rate)from 301 general surgery programs. Of those, 6764 residents had gender data available (3968 [58.7%] were male and 2796 [41.3%] were female individuals). In total, 1878 of 2352 female residents (79.8%) vs 562 of 3288 male residents (17.1%) reported experiencing gender discrimination (P < .001), and 1026 of 2415 female residents (42.5%) vs 721 of 3360 male residents (21.5%) reported experiencing sexual harassment (P < .001). The most common type of gender discrimination was being mistaken for a nonphysician (1943 of 5640 residents [34.5%] overall; 1813 of 2352 female residents [77.1%]; 130 of 3288 male residents [4.0%]), with patients and/or families as the most frequent source. The most common form of sexual harassment was crude, demeaning, or explicit comments (1557 of 5775 residents [27.0%] overall; 901 of 2415 female residents [37.3%]; 656 of 3360 male residents [19.5%]); among female residents, the most common source of this harassment was patients and/or families, and among male residents, the most common source was coresidents and/or fellows. Among female residents, gender discrimination was associated with pregnancy (odds ratio [OR], 1.93; 95% CI, 1.03-3.62) and higher ABSITE scores (highest vs lowest quartile: OR, 1.67; 95% CI, 1.14-2.43); among male residents, gender discrimination was associated with parenthood (OR, 1.72; 95% CI, 1.31-2.27) and lower ABSITE scores (highest vs lowest quartile: OR, 0.57; 95% CI, 0.43-0.76). Senior residents were more likely to report experiencing sexual harassment than interns (postgraduate years 4 and 5 vs postgraduate year 1: OR, 1.77 [95% CI, 1.40-2.24] among female residents; 1.31 [95% CI, 1.01-1.70] among male residents). Conclusions and relevance: In this study, gender discrimination and sexual harassment were common experiences among surgical residents and were frequently reported by women. These phenomena warrant multifaceted context-specific strategies for improvement.Item Experiences of LGBTQ+ Residents in US General Surgery Training Programs(American Medical Association, 2022) Heiderscheit, Evan A.; Schlick, Cary Jo R.; Ellis, Ryan J.; Cheung, Elaine O.; Irizarry, Dre; Amortegui, Daniela; Eng, Joshua; Sosa, Julie Ann; Hoyt, David B.; Buyske, Jo; Nasca, Thomas J.; Bilimoria, Karl Y.; Hu, Yue-Yung; Surgery, School of MedicineImportance: Previous studies have shown high rates of mistreatment among US general surgery residents, leading to poor well-being. Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) residents represent a high-risk group for mistreatment; however, their experience in general surgery programs is largely unexplored. Objective: To determine the national prevalence of mistreatment and poor well-being for LGBTQ+ surgery residents compared with their non-LGBTQ+ peers. Design, setting, and participants: A voluntary, anonymous survey adapting validated survey instruments was administered to all clinically active general surgery residents training in Accreditation Council for Graduate Medical Education-accredited general surgery programs following the 2019 American Board of Surgery In-Training Examination. Main outcomes and measures: Self-reported mistreatment, sources of mistreatment, perceptions of learning environment, career satisfaction, burnout, thoughts of attrition, and suicidality. The associations between LGBTQ+ status and (1) mistreatment, (2) burnout, (3) thoughts of attrition, and (4) suicidality were examined using multivariable regression models, accounting for interactions between gender and LGBTQ+ identity. Results: A total of 6956 clinically active residents completed the survey (85.6% response rate). Of 6381 respondents included in this analysis, 305 respondents (4.8%) identified as LGBTQ+ and 6076 (95.2%) as non-LGBTQ+. Discrimination was reported among 161 LGBTQ+ respondents (59.2%) vs 2187 non-LGBTQ+ respondents (42.3%; P < .001); sexual harassment, 131 (47.5%) vs 1551 (29.3%; P < .001); and bullying, 220 (74.8%) vs 3730 (66.9%; P = .005); attending surgeons were the most common overall source. Compared with non-LGBTQ+ men, LGBTQ+ residents were more likely to report discrimination (men: odds ratio [OR], 2.57; 95% CI, 1.78-3.72; women: OR, 25.30; 95% CI, 16.51-38.79), sexual harassment (men: OR, 2.04; 95% CI, 1.39-2.99; women: OR, 5.72; 95% CI, 4.09-8.01), and bullying (men: OR, 1.51; 95% CI, 1.07-2.12; women: OR, 2.00; 95% CI, 1.37-2.91). LGBTQ+ residents reported similar perceptions of the learning environment, career satisfaction, and burnout (OR, 1.22; 95% CI, 0.97-1.52) but had more frequent considerations of leaving their program (OR, 2.04; 95% CI, 1.52-2.74) and suicide (OR, 1.95; 95% CI, 1.26-3.04). This increased risk of suicidality was eliminated after adjusting for mistreatment (OR, 1.47; 95% CI, 0.90-2.39). Conclusions and relevance: Mistreatment is a common experience for LGBTQ+ surgery residents, with attending surgeons being the most common overall source. Increased suicidality among LGBTQ+ surgery residents is associated with this mistreatment. Multifaceted interventions are necessary to develop safer and more inclusive learning environments.Item Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff(American Medical Association, 2024-07-01) Foote, Darci C.; Rosenblatt, Audrey E.; Amortegui, Daniela; Diaz, Carmen M.; Brajcich, Brian C.; Schlick, Cary Jo R.; Bilimoria, Karl Y.; Hu, Yue-Yung; Johnson, Julie K.; Surgery, School of MedicineImportance: Labor unions are a mechanism for employee advocacy, but their role in surgery resident wellness is poorly characterized. Objective: To understand experiences with unionization among general surgery residents and residency program faculty and staff. Design, setting, and participants: This exploratory qualitative study included data from the Surgical Education Culture Optimization Through Targeted Interventions Based on National Comparative Data (SECOND) trial. In the exploratory phase of the SECOND trial (from March 6, 2019, to March 12, 2020), semistructured interviews about wellness were conducted with residents, faculty (attending physicians), and staff (program administrators) at 15 general surgery residency programs. Unionization was identified as an emergent theme in the interviews. Data analysis was performed from March 2019 to May 2023. Main outcomes and measures: The main outcome was resident and faculty experience with resident labor unions. In the qualitative analysis, lexical searches of interview transcripts identified content regarding resident labor unions. A codebook was developed inductively. Transcripts were coded by dyads, using a constant comparative approach, with differences reconciled by consensus. Results: A total of 22 interview transcripts were identified with relevant content. Of these, 19 were individual interviews conducted with residents (n = 10), faculty (n = 4), administrative staff (n = 1), a program director (n = 1), a department chair (n = 1), and designated institutional officials (n = 2), and 3 were from resident focus groups. Residents from all postgraduate year levels, including professional development (ie, research) years, were represented. Interviewees discussed resident unions at 2 programs (1 recently unionized and 1 with a decades-long history). Interviewees described the lack of voice and the lack of agency as drivers of unionization ("Residents…are trying to take control of their well-being"). Increased salary stipends and/or housing stipends were the most concretely identified union benefits. Unanticipated consequences of unionization were described by both residents and faculty, including (1) irrelevance of union-negotiated benefits to surgical residents, (2) paradoxical losses of surgery department-provided benefits, and (3) framing of resident-faculty relationships as adversarial. Union executives were noted to be nonphysician administrators whose participation in discussions about clinical education progression may increase the time and effort to remediate a resident and/or reduce educators' will to meaningfully intervene. Active surgical resident participation within the union allows for an understanding of surgical trainees' unique needs and reduced conflict. Conclusions and relevance: In this qualitative study, unionization was a mechanism for resident voice and agency; the desire to unionize likely highlighted the lack of other such mechanisms in the training environment. However, these findings suggest that unionization may have had unintended consequences on benefits, flexibility, and teaching. Effective advocacy, whether within or outside the context of a union, was facilitated by participation from surgical residents. Future research should expand on this exploratory study by including a greater number of institutions and investigating the evolution of themes over time.Item Mistreatment and Wellness Among International Medical Graduates in US General Surgical Residency(American Medical Association, 2023) Delgado Felipa, Jennifer; Hu, Andrew; Eng, Joshua; Alam, Hasan B.; McKoy, June M.; Bilimoria, Karl Y.; Hu, Yue-Yung; Surgery, School of MedicineThis study uses data from a cross-sectional national survey of medical residents in the US to assess whether mistreatment experiences and wellness differ between international medical graduates and US medical graduates.Item National Evaluation of Surgical Resident Grit and the Association With Wellness Outcomes(American Medical Association, 2021) Hewitt, D. Brock; Chung, Jeanette W.; Ellis, Ryan J.; Cheung, Elaine O.; Moskowitz, Judith T.; Hu, Yue-Yung; Etkin, Caryn D.; Nussbaum, Michael S.; Choi, Jennifer N.; Greenberg, Caprice C.; Bilimoria, Karl Y.; Surgery, School of MedicineImportance: Grit, defined as perseverance and passion for long-term goals, is predictive of success and performance even among high-achieving individuals. Previous studies examining the effect of grit on attrition and wellness during surgical residency are limited by low response rates or single-institution analyses. Objectives: To characterize grit among US general surgery residents and examine the association between resident grit and wellness outcomes. Design, setting, and participants: A cross-sectional national survey study of 7464 clinically active general surgery residents in the US was administered in conjunction with the 2018 American Board of Surgery In-Training Examination and assessed grit, burnout, thoughts of attrition, and suicidal thoughts during the previous year. Multivariable logistic regression models were constructed to assess the association of grit with resident burnout, thoughts of attrition, and suicidal thoughts. Statistical analyses were performed from June 1 to August 15, 2019. Exposures: Grit was measured using the 8-item Short Grit Scale (scores range from 1 [not at all gritty] to 5 [extremely gritty]). Main outcomes and measures: The primary outcome was burnout. Secondary outcomes were thoughts of attrition and suicidal thoughts within the past year. Results: Among 7464 residents (7413 [99.3%] responded; 4469 men [60.2%]) from 262 general surgery residency programs, individual grit scores ranged from 1.13 to 5.00 points (mean [SD], 3.69 [0.58] points). Mean (SD) grit scores were significantly higher in women (3.72 [0.56] points), in residents in postgraduate training year 4 or 5 (3.72 [0.58] points), and in residents who were married (3.72 [0.57] points; all P ≤ .001), although the absolute magnitude of the differences was small. In adjusted analyses, residents with higher grit scores were significantly less likely to report duty hour violations (odds ratio [OR], 0.85; 95% CI, 0.77-0.93), dissatisfaction with becoming a surgeon (OR, 0.53; 95% CI, 0.48-0.59), burnout (OR, 0.53; 95% CI, 0.49-0.58), thoughts of attrition (OR, 0.61; 95% CI, 0.55-0.67), and suicidal thoughts (OR, 0.58; 95% CI, 0.47-0.71). Grit scores were not associated with American Board of Surgery In-Training Examination performance. For individual residency programs, mean program-level grit scores ranged from 3.18 to 4.09 points (mean [SD], 3.69 [0.13] points). Conclusions and relevance: In this national survey evaluation, higher grit scores were associated with a lower likelihood of burnout, thoughts of attrition, and suicidal thoughts among general surgery residents. Given that surgical resident grit scores are generally high and much remains unknown about how to employ grit measurement, grit is likely not an effective screening instrument to select residents; instead, institutions should ensure an organizational culture that promotes and supports trainees across this elevated range of grit scores.Item The Role of Personal Accomplishment in General Surgery Resident Well-being(Wolters Kluwer, 2021) Khorfan, Rhami; Hu, Yue-Yung; Agarwal, Gaurava; Eng, Joshua; Riall, Taylor; Choi, Jennifer; Are, Chandrakanth; Shanafelt, Tait; Bilimoria, Karl Y.; Cheung, Elaine O.; Surgery, School of MedicineObjective: To investigate the association of personal accomplishment (PA) with the other subscales, assess its association with well-being outcomes, and evaluate drivers of PA by resident level. Background: Most studies investigating physician burnout focus on the emotional exhaustion (EE) and depersonalization (DP) subscales, neglecting PA. Therefore, the role of PA is not well understood. Methods: General surgery residents were surveyed following the 2019 American Board of Surgery In-Training Examination regarding their learning environment. Pearson correlations of PA with EE and DP were assessed. Multivariable logistic regression models assessed the association of PA with attrition, job satisfaction, and suicidality and identified factors associated with PA by PGY. Results: Residents from 301 programs were surveyed (85.6% response rate, N = 6956). Overall, 89.4% reported high PA, which varied by PGY-level (PGY1: 91.0%, PGY2/3: 87.7%, PGY4/5: 90.2%; P = 0.02). PA was not significantly correlated with EE (r = -0.01) or DP (r = -0.08). After adjusting for EE and DP, PA was associated with attrition (OR 0.60, 95%CI 0.46-0.78) and job satisfaction (OR 3.04, 95%CI 2.45-3.76) but not suicidality (OR 0.72, 95%CI 0.48-1.09). Although the only factor significantly associated with PA for interns was resident cooperation, time in operating room and clinical autonomy were significantly associated with PA for PGY2/3. For PGY4/5s, PA was associated with time for patient care, resident cooperation, and mentorship. Conclusion: PA is a distinct metric of resident well-being, associated with job satisfaction and attrition. Drivers of PA differ by PGY level and may be targets for intervention to promote resident wellness and engagement.Item What They Are Not Telling Us: Analysis of Nonresponders on a National Survey of Resident Well-Being(Wolters Kluwer, 2022-12-12) Cardell, Chelsea F.; Yuce, Tarik K.; Zhan, Tiannan; Eng, Josh S.; Cheung, Elaine O.; Etkin, Caryn D.; Amortegui, Daniela; Jones, Andrew; Buyske, Jo; Bilimoria, Karl Y.; Hu, Yue-Yung; Surgery, School of MedicineObjectives: To characterize nonrespondents to a national survey about trainee well-being, examine response patterns to questions of sensitive nature, and assess how nonresponse biases prevalence estimates of mistreatment and well-being. Background: Surgical trainees are at risk for burnout and mistreatment, which are discernible only by self-report. Therefore, prevalence estimates may be biased by nonresponse. Methods: A survey was administered with the 2018 and 2019 American Board of Surgery In-Training Examinations assessing demographics, dissatisfaction with education and career, mistreatment, burnout, thoughts of attrition, and suicidality. Responders in 2019 were characterized as survey "Completers," "Discontinuers" (quit before the end), and "Selective Responders" (selectively answered questions throughout). Multivariable logistic regression assessed associations of respondent type with mistreatment and well-being outcomes, adjusting for individual and program characteristics. Longitudinal survey identifiers linked survey responses for eligible trainees between 2018 and 2019 surveys to further inform nonresponse patterns. Results: In 2019, 6956 (85.6%) of 8129 eligible trainees initiated the survey, with 66.5% Completers, 17.5% Discontinuers, and 16.0% Selective Responders. Items with the highest response rates included dissatisfaction with education and career (93.2%), burnout (86.3%), thoughts of attrition (90.8%), and suicidality (94.4%). Discontinuers and Selective Responders were more often junior residents and racially/ethnically minoritized than Completers. No differences were seen in burnout and suicidality rates between Discontinuers, Selective Responders, and Completers. Non-White or Hispanic residents were more likely to skip questions about racial/ethnic discrimination than non-Hispanic White residents (21.2% vs 15.8%; odds ratio [OR], 1.35; 95% confidence interval [CI], 1.19-1.53), particularly when asked to identify the source. Women were not more likely to omit questions regarding gender/gender identity/sexual orientation discrimination (OR, 0.91; 95% CI, 0.79-1.04) or its sources (OR, 1.02; 95% CI, 0.89-1.16). Both Discontinuers and Selective Responders more frequently reported physical abuse (2.5% vs 1.1%; P = 0.001) and racial discrimination (18.3% vs 13.6%; P < 0.001) on the previous survey (2018) than Completers. Conclusions: Overall response rates are high for this survey. Prevalence estimates of burnout, suicidality, and gender discrimination are likely minimally impacted by nonresponse. Nonresponse to survey items about racial/ethnic discrimination by racially/ethnically minoritized residents likely results in underestimation of this type of mistreatment.