Importance 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.

重要性 虐待是外科住院医师的常见经历，并且与倦怠有关。已发现女性遭受虐待的比率高于男性。进一步描述外科住院医师在性别歧视和性骚扰方面的经历可能会为解决方案提供信息。

目的 描述与 (1) 基于性别、性别认同或性取向的歧视以及 (2) 住院医师在美国普外科项目中经历的性骚扰相关的类型、来源和因素。

设计、设置和参与者 这项横断面全国调查研究是在 2019 年美国外科委员会培训考试 (ABSITE) 之后进行的。该调查向受访者询问了他们在从 2018 年 7 月 1 日开始的学年到 2019 年 1 月的测试日期期间的性别歧视和性骚扰经历。所有参加研究生医学教育认证委员会认可的普通外科课程的临床住院医师都有资格.

暴露 与基于性别的歧视和性骚扰相关的特定类型、来源和因素。

主要成果和措施 主要成果是性别歧视和性骚扰的普遍性。次要结果包括歧视和骚扰的来源以及相关的个人和项目层面的因素，使用性别分层的多变量逻辑回归模型。

结果 对 8129 名符合条件的居民进行了调查；来自 301 个普外科项目的 6956 人做出了回应（85.6% 的回应率）。其中，6764 名居民有可用的性别数据（3968 名 [58.7%] 为男性，2796 名 [41.3%] 为女性）。总体而言，2352 名女性居民中有 1878 人（79.8%）与 3288 名男性居民中的 562 人（17.1%）报告遭受性别歧视（P  < .001），2415 名女性居民中有 1026 人（42.5%）与 3360 名男性居民中的 721 人（ 21.5%）报告遭受性骚扰（P < .001)。最常见的性别歧视类型被误认为是非医生（5640 名居民中的 1943 名 [34.5%]；2352 名女性居民中的 1813 名 [77.1%]；3288 名男性居民中的 130 名 [4.0%]），有患者和/或家庭是最常见的来源。最常见的性骚扰形式是粗鲁、贬低或露骨的评论（5775 名居民中的 1557 名 [27.0%]；2415 名女性中的 901 名 [37.3%]；3360 名男性中的 656 名 [19.5%]）；在女性居民中，这种骚扰最常见的来源是患者和/或家人，而在男性居民中，最常见的来源是同住者和/或同事。在女性居民中，性别歧视与怀孕有关（优势比 [OR]，1.93；95% CI，1.03-3.62）和更高的 ABSITE 评分（最高四分位数与最低四分位数：OR，1.67；95% CI，1.14-2.43）；在男性居民中，性别歧视与父母身份（OR，1.72；95% CI，1.31-2.27）和较低的 ABSITE 分数（最高与最低四分位数：OR，0.57；95% CI，0.43-0.76）相关。与实习生相比，高级居民更有可能报告遭受性骚扰（研究生 4 年和 5 年与研究生 1 年：OR，1.77 [95% CI，1.40-2.24] 在女性居民中；1.31 [95% CI，1.01-1.70]男性居民）。

结论和相关性 在这项研究中，性别歧视和性骚扰是外科住院医师的常见经历，并且经常被女性报告。这些现象需要多方面的针对具体情况的改进策略。