Importance 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.

重要性 以前的研究表明，美国普通外科住院医师的虐待率很高，导致健康状况不佳。女同性恋、男同性恋、双性恋、跨性别者、酷儿和其他性少数和性别少数 (LGBTQ+) 居民是遭受虐待的高风险群体；然而，他们在普通外科项目中的经验在很大程度上是未经探索的。

目的 确定与非 LGBTQ+ 同龄人相比，LGBTQ+ 手术住院者在全国遭受虐待和幸福感不佳的患病率。

设计、设置和参与者 在 2019 年美国外科学会培训考试之后，对接受研究生医学教育认证委员会认可的普外科项目的所有临床活跃普外科住院医师进行了一项采用经过验证的调查工具的自愿匿名调查。

主要结果和措施 自我报告的虐待、虐待的来源、对学习环境的看法、职业满意度、职业倦怠、减员想法和自杀倾向。使用多变量回归模型检查了 LGBTQ+ 身份与 (1) 虐待、(2) 倦怠、(3) 减员和 (4) 自杀之间的关联，考虑了性别与 LGBTQ+ 身份之间的相互作用。

结果 共有6956名临床活跃居民完成了调查（回复率为85.6%）。在此次分析中纳入的 6381 名受访者中，305 名受访者（4.8%）确定为 LGBTQ+，6076 名（95.2%）确定为非 LGBTQ+。161 名 LGBTQ+ 受访者（59.2%）与 2187 名非 LGBTQ+ 受访者（42.3%；P  < .001）之间报告了歧视；性骚扰，131 (47.5%) vs 1551 (29.3%；P  < .001)；和欺凌，220 (74.8%) vs 3730 (66.9%; P = .005); 主治外科医生是最常见的总体来源。与非 LGBTQ+ 男性相比，LGBTQ+ 居民更有可能报告歧视（男性：优势比 [OR]，2.57；95% CI，1.78-3.72；女性：OR，25.30；95% CI，16.51-38.79）、性骚扰（男性：OR，2.04；95% CI，1.39-2.99；女性：OR，5.72；95% CI，4.09-8.01）和欺凌（男性：OR，1.51；95% CI，1.07-2.12；女性：或，2.00；95% CI，1.37-2.91）。LGBTQ+ 居民报告了对学习环境、职业满意度和倦怠的相似看法（OR，1.22；95% CI，0.97-1.52），但更频繁地考虑离开他们的计划（OR，2.04；95% CI，1.52-2.74）和自杀（OR，1.95；95% CI，1.26-3.04）。在对虐待进行调整后，这种增加的自杀风险被消除（OR，1.47；95% CI，0.90-2.39）。

结论和相关性 虐待是 LGBTQ+ 手术住院者的常见经历，主治外科医生是最常见的整体来源。LGBTQ+ 手术住院者的自杀率增加与这种虐待有关。多方面的干预对于发展更安全和更具包容性的学习环境是必要的。