P3C135: Exploring Discrimination in the Workplace of Pediatric Housestaff: A National Survey of Trainee Experiences

Background: Discrimination in the medical field directed towards physician trainees including residents and fellows has been well-documented. Forms of this discrimination include but are not limited to unjust treatment targeting gender, racial, ethnic, and religious differences. Despite increasing education centered on the importance of equity, diversity, and inclusion (EDI) over the past few years spurred by social movements, trainees continue to report instances of discrimination during their medical training by colleagues, patients and other medical staff. The American Academy of Pediatrics (AAP) has published policy statements on the importance of EDI efforts including grand rounds presentations, dedicated lectures, and the use of translators for non-English speaking patients and families. Due to limited publications that focus solely on the trainee perspectives, we aimed to fill this data gap by performing a national survey of housestaff.

Methods: A national needs assessment survey was sent to 15,395 pediatric residents and fellows who subscribe to the AAP Section on Pediatric Trainees listserv between May - July 2022. Participation in the survey was voluntary and completion of the survey constituted consent. The AAP Institutional Review Board approved the study as exempt. Participants were asked to report race, ethnicity, gender, post-graduate year (PGY), and AAP district. Questions measured discrimination, comfort level discussing culture/religion, and workplace hostility. Data were analyzed using Chi-Square analysis.

Results: 345 pediatric trainees completed the survey. The majority of participants identify as female (76.5%), white (45.2%), PGY-2 (23%), with all 10 districts having similar response rates (Table 1). 191 (55.4%) of trainees reported experiencing workplace hostility and/or discrimination, 87 (25.2%) reported feeling uncomfortable discussing cultural and/or religious beliefs and 31 (9%) reported feeling their sexual orientation and/or gender identity was not acknowledged. PGY-1s were more likely than non-PGY-1s (15.4% vs 7.1%, p<.05 ) to report that their sexual orientation/gender identity was not acknowledged; non-white trainees were more likely than white trainees (30% vs 19.2%, p<.05) to report both feeling uncomfortable discussing religious/cultural beliefs and experiencing workplace hostility; and females were more likely than males (60.6% vs 38.6%, p<.05) to report experiencing workplace hostility. Trainees who never received an EDI lecture were more likely than trainees who received more than one lecture a year (81% vs 52.3%, p<.05) to report experiencing workplace hostility/microaggressions (Figure 1).

Conclusion: Trainees who either identified as non-white, female, and/or a PGY-1 trainees were more likely to report either workplace hostility and/or feeling uncomfortable discussing religious and cultural beliefs compared to white, male non-PGY-1 trainees. Although EDI lectures are associated with decreased reporting of workplace hostility, institution-level interventions are necessary to improve disparate experiences and promote a safe space for all trainees.