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Harassment and Discrimination in Medical Training: A Systematic Review and Meta-Analysis

Fnais, Naif MS; Soobiah, Charlene; Chen, Maggie Hong PhD, MSc; Lillie, Erin MSc; Perrier, Laure MLIS; Tashkhandi, Mariam MD; Straus, Sharon E. MD, MSc; Mamdani, Muhammad PharmD, MA, MPH; Al-Omran, Mohammed MD, MSc; Tricco, Andrea C. PhD, MSc

doi: 10.1097/ACM.0000000000000200
Reviews

Purpose Harassment and discrimination include a wide range of behaviors that medical trainees perceive as being humiliating, hostile, or abusive. To understand the significance of such mistreatment and to explore potential preventive strategies, the authors conducted a systematic review and meta-analysis to examine the prevalence, risk factors, and sources of harassment and discrimination among medical trainees.

Method In 2011, the authors identified relevant studies by searching MEDLINE and EMBASE, scanning reference lists of relevant studies, and contacting experts. They included studies that reported the prevalence, risk factors, and sources of harassment and discrimination among medical trainees. Two reviewers independently screened all articles and abstracted study and participant characteristics and study results. The authors assessed the methodological quality in individual studies using the Newcastle–Ottawa Scale. They also conducted a meta-analysis.

Results The authors included 57 cross-sectional and 2 cohort studies in their review. The meta-analysis of 51 studies demonstrated that 59.4% of medical trainees had experienced at least one form of harassment or discrimination during their training (95% confidence interval [CI]: 52.0%–66.7%). Verbal harassment was the most commonly cited form of harassment (prevalence: 63.0%; 95% CI: 54.8%–71.2%). Consultants were the most commonly cited source of harassment and discrimination, followed by patients or patients’ families (34.4% and 21.9%, respectively).

Conclusions This review demonstrates the surprisingly high prevalence of harassment and discrimination among medical trainees that has not declined over time. The authors recommend both drafting policies and promoting cultural change within academic institutions to prevent future abuse.

Mr. Fnais is a medical student, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Ms. Soobiah is research coordinator, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada.

Dr. Chen is a biostatistician, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada.

Ms. Lillie is research coordinator, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada.

Ms. Perrier is information specialist, Continuing Education and Professional Development, Faculty of Medicine, University of Toronto, and Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada.

Dr. Tashkhandi is an MSc candidate, Institute of Medical Science, University of Toronto, and associate researcher, Applied Health Research Centre, St. Michael’s Hospital, Toronto, Ontario, Canada.

Dr. Straus is professor, Department of Medicine, and director, Division of Geriatric Medicine, University of Toronto Faculty of Medicine, and director, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada.

Dr. Mamdani is professor, Department of Health Policy, Management, and Evaluation and Leslie Dan Faculty of Pharmacy, University of Toronto, and director, Applied Health Research Centre, St. Michael’s Hospital, Toronto, Ontario, Canada.

Dr. Al-Omran is professor and vascular surgeon, Department of Surgery, University of Toronto Faculty of Medicine, and head, Division of Vascular Surgery, St. Michael’s Hospital, Toronto, Ontario, Canada.

Dr. Tricco is a scientist, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada.

Please see the end of this article for information about the authors.

Funding/Support: This review was conducted as part of a systematic review course taught by Drs. Straus and Tricco through the Li Ka Shing Knowledge Institute of St. Michael’s Hospital (Toronto, Ontario, Canada), which is funded by the King Saud University (Riyadh, Saudi Arabia). The funder had no role in the conception or conduct of the project, the acquisition of data, or the decision to submit for publication. Dr. Straus is funded by a Tier 1 Canada Research Chair in Knowledge Translation and Dr. Tricco by a Canadian Institutes for Health Research/Drug Safety and Effectiveness Network New Investigator Award in Knowledge Synthesis.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Previous presentation: Abstract presentation at the Association for Medical Education in Europe 2012 Annual Meeting in Lyon, France.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A197.

Correspondence should be addressed to Dr. Tricco, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 38 Shuter St., Room 721, Toronto, ON M5B 1T8; telephone: (416) 864-6060 ext. 77521; e-mail: triccoa@smh.ca.

© 2014 by the Association of American Medical Colleges