Intimidation or harassment among family medicine residents in Saskatchewan: a cross-sectional survey
DOI:
https://doi.org/10.36834/cmej.75364Abstract
Introduction: Up to 98% of practicing family physicians, and over 75% of resident physicians in Canada experience abusive incidents. Despite the negative consequences of abusive incidents, few residents report these events to their supervisors or institution. We sought to estimate the prevalence of abusive incidents experienced or witnessed by Saskatchewan family medicine residents (FMRs) and identify their responses to these events.
Methods: Anonymous survey invitations were emailed to all 110 Saskatchewan FMRs in Saskatchewan in November and December 2020. Demographic characteristics, frequency of witnessed and experienced abusive incidents, sources of incidents and residents’ responses were collected. Incidents were classified as minor, major, severe, or as racial discrimination based on a previously published classification system.
Results: The response rate was 34.5% (38/110). Ninety-two percent (35/38) of residents witnessed a minor incident and 91.7% (32/36) of residents experienced a minor incident. Seventy-one percent (27/38) of residents witnessed racial discrimination while 19.4% (7/36) of residents experienced racial discrimination. Patients were the most common source of abusive incidents. Twenty-nine percent of residents reported abusive incidents to their supervisors. Most residents were aware of institutional reporting policies.
Conclusions: Most Saskatchewan FMRs experienced or witnessed abusive incidents, but few were reported. This study provided the opportunity to reassess policies on abusive incidents, which should consider sources of abuse, confidence in reporting, and education.
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References
Karim S, Duchcherer M. Intimidation and harassment in residency: a review of the literature and results of the 2012 Canadian Association of Interns and Residents National Survey. Can Med Educ J. 2014 Dec 17;5(1):e50-e57. https://doi.org/10.36834/cmej.36667 DOI: https://doi.org/10.36834/cmej.36667
Bahji A, Altomare J. Prevalence of intimidation, harassment, and discrimination among resident physicians: a systematic review and meta-analysis. Can Med Educ J. 2020 Mar;11(1):97–123. https://doi.org/10.36834/cmej.57019 DOI: https://doi.org/10.36834/cmej.57019
Miedema B, Hamilton R, Anita LL, et al. Prevalence of abusive encounters in the workplace of family physicians: A minor, major, or severe problem? Can Fam Physician. 2010 Mar;56(3):e101–e108.
Miedema B, Hamilton R, Tatemichi S, et al. Monthly incidence rates of abusive encounters for Canadian family physicians by patients and their families. Int J Family Med. 2010;2010:387202. https://doi.org/10.1155/2010/387202 DOI: https://doi.org/10.1155/2010/387202
Resident Doctors of Canada (RDOC). 2018 national resident survey. Ottawa (ON): RDOC; 2018. 52 p. Available from: https://residentdoctors.ca/wp-content/uploads/2018/10/National-Resident-Survey-2018-R8.pdf. [Accessed on May 10, 2021]
Phillips SP, Webber J, Imbeau S, et al. Sexual harassment of Canadian medical students: a national survey. EClinicalMedicine. 2019 Jan 1;7:15-20. https://doi.org/10.1016/j.eclinm.2019.01.008 DOI: https://doi.org/10.1016/j.eclinm.2019.01.008
Daugherty SR, Baldwin DWC, Rowley BD. Learning, satisfaction, and mistreatment during medical internship: a national survey of working conditions. JAMA. 1998 Apr;279(15):1194–1199. https://doi.org/10.1001/jama.279.15.1194 DOI: https://doi.org/10.1001/jama.279.15.1194
Fernandes CMB, Bouthillette F, Raboud JM, et al. Violence in the emergency department: a survey of health care workers. Can Med Assoc J. 1999 Nov;161(10):1245–1248.
Frank E, Carrera JS, Stratton T, Bickel J, Nora LM. Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey. BMJ. 2006 Sep;333(7570):682–4. https://doi.org/10.1136/bmj.38924.722037.7C DOI: https://doi.org/10.1136/bmj.38924.722037.7C
Miedema B, Tatemichi S, Hamilton R, et al. Effect of colleague and coworker abuse on family physicians in Canada. Can Fam Physician. 2011 Dec;57(12):1424–1431.
Crutcher RA, Szafran O, Woloschuk W, Chatur F, Hansen C. Family medicine graduates' perceptions of intimidation, harassment, and discrimination during residency training. BMC Med Educ. 2011 Oct 24;11:88. https://doi.org/10.1186/1472-6920-11-88 DOI: https://doi.org/10.1186/1472-6920-11-88
Zimbroff JA. Cultural differences in perceptions of and responses to sexual harassment. Duke J Gender Law Pol. 2017; 14: 1311-1342. Available at: https://scholarship.law.duke.edu/djglp/vol14/iss2/14.
Miedema B, Macintyre L, Tatemichi S, et al. How the medical culture contributes to coworker-perpetrated harassment and abuse of family physicians. Ann Fam Med. 2012 Mar-Apr;10(2):111–117. https://doi.org/10.1370/afm.1341 DOI: https://doi.org/10.1370/afm.1341
Resident Doctors of Canada (RDOC). 2020 national resident survey. Ottawa (ON): RDOC; 2020. 9 p. Available from: https://residentdoctors.ca/wp-content/uploads/2021/05/RDoC-Summary-of-Findings-2020-R3.pdf. [Accessed on May 27, 2021]
Hershcovis MS, Barling J. Towards a multi-foci approach to workplace aggression: a meta-analytic review of outcomes from different perpetrators. J Organ Behav. 2010 Jan;31(1):24–44. https://doi.org/10.1002/job.621 DOI: https://doi.org/10.1002/job.621
Canadian Medical Protective Association. When physicians feel bullied or threatened. 2020. Available from: https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2014/when-physicians-feel-bullied-effective-coping-strategies. [Accessed on Jan 3, 2023]
Canadian Medical Protective Association. Ending the doctor-patient relationship. 2022. Available from: https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2006/ending-the-doctor-patient-relationship. [Accessed on Jan 3, 2023]
Government of Saskatchewan. Harassment prevention: an employer’s guide for developing a harassment prevention policy. 2022. Available from: https://publications.saskatchewan.ca/api/v1/products/68981/formats/109297/download [Accessed on Sept 13, 2022]
College of Physicians and Surgeons of Ontario. Ending the physician-patient relationship. 2017. Available from: https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Ending-the-Physician-Patient-Relationship [Accessed on Jan 3, 2023]
Stene J, Larson E, Levy M, Dohlman M. Workplace violence in the emergency department: giving staff the tools and support to report. Perm J. 2015;19(2):e113-e117. https://doi.org/10.7812/TPP/14-187 DOI: https://doi.org/10.7812/TPP/14-187
Paludi MA, Martin JL, Gruber JE, Fineran S. Sexual Harassment in Education and Work Settings: Current Research and Best Practices for Prevention. Praeger, 2015, p 35.
University of Calgary. Harassment and Violence: Harassment and Violence Awareness Training course . 2020. Available from: https://www.ucalgary.ca/risk/environment-health-safety/report-ohs-concern-or-incident/harassment-and-violence [Accessed on Jan 3, 2023]
University of Saskatchewan. USask discrimination and harassment prevention services online awareness course. 2022. Available from: https://wellness.usask.ca/safety/discrimination-harassment.php#Resources [Accessed on Jan 3, 2023]
Di Martino V; Joint Programme on Workplace Violence in the Health Sector. Relationship of work stress and workplace violence in the health sector. Geneva (CE): World Health Organization; 2003. 39 p.
Afshari Saleh L, Niroumand S, Dehghani Z, Afshari Saleh T, Mousavi SM, Zakeri H. Relationship between workplace violence and work stress in the emergency department. J Inj Violence Res. 2020 Jul 12;12(2). https://doi.org/10.5249/jivr.v12i2.1526 DOI: https://doi.org/10.5249/jivr.v12i2.1526
Rhead R, Chui Z, Bakolis I, et al. Impact of workplace discrimination and harassment among National Health Service staff working in London trusts: Results from the TIDES study. BJPsych Open. 2021;7(1): e10. https://doi.org/10.1192/bjo.2020.137 DOI: https://doi.org/10.1192/bjo.2020.137
Lind KT, Osborne CM, Badesch B, Blood A, Lowenstein SR. Ending student mistreatment: early successes and continuing challenges. Med Educ Online. 2020 Dec;25(1):1690846 https://doi.org/10.1080/10872981.2019.1690846 DOI: https://doi.org/10.1080/10872981.2019.1690846
Burns KE, Duffett M, Kho ME, et al. A guide for the design and conduct of self-administered surveys of clinicians. CMAJ. 2008 Jul 29;179(3):245-52. https://doi.org/10.1503/cmaj.080372. DOI: https://doi.org/10.1503/cmaj.080372
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