Dissatisfaction with Medical and Surgical Residency Training Is Consistently Higher for Women than for Men
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The Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 2The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; 3The Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Chicago, IL, USA; 4The Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
J Gen Intern Med DOI: 10.1007/s11606-019-05334-7 © Society of General Internal Medicine 2019
INTRODUCTION
In an attempt to balance service and education, there is a renewed focus on trainee work experiences and job satisfaction. Overall measures of dissatisfaction likely disguise differences across defined subgroups, particularly men and women, known to experience job satisfaction and burnout differently across professions.1 A previous study showed gender differences in satisfaction during surgical residency training.2 The objective of this study was to determine gender differences in dissatisfaction with specific aspects of the institutional environment and with trainee wellbeing during both medical and surgical residency training using data from two clinical trials which investigated the effects of removing resident shift length limitations during residency training.3, 4
METHODS
Sixty three internal medicine and 117 surgical residency programs were randomly assigned to be regulated by 2011 ACGME duty hour policies or by more flexible policies that did not specify shift length limits or mandated time-off intervals between shifts.3, 4 By design, parallel instruments were administered in both studies to all residents in enrolled programs at the end of each training year, including 8 identical questions eliciting resident satisfaction with their institutional environment (continuity of care, patient safety, work hours/ scheduling, handoffs/transitions of care, education, and program’s duty hour regulations), and satisfaction with their own wellbeing (time for rest and overall wellbeing) on a 5-point scale from “very dissatisfied” to “very satisfied.”
We included only surveys that included responses identifying gender. We dichotomized satisfaction outcomes (very dissatisfied or dissatisfied vs neutral, satisfied, or very satisfied) for consistency with the previous published trials. We calculated odds ratios (OR) and associated 95% confidence intervals (CI) using a mixed effects logistic regression model with an intercept for clustering of respondents within program and an indicator for gender as the fixed effects covariate in the model and the respondent’s dichotomized response as the outcome.
RESULTS
The response rate was 99.9% for medical and 99.3% for surgical residents. A total of 6271 surveys (96.8%) identified gender. Women medical and surgical residents reported more dissatisfaction in all eight domains compared with men (Tables 1 and 2): continuity of care (7.2% vs 4.9%; OR 0.66, 95% CI 0.54–0.82), patient safety (5.0% vs 3.3%; OR 0.66, 95% CI 0.51–0.85), work hours and scheduling (17.8% vs 12.4%; OR 0.65, 95% CI 0.
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