Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine

IMPORTANCE: The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measure...

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Published in:	JAMA : the journal of the American Medical Association Vol. 329; no. 21; pp. 1848 - 1858
Main Authors:	Jagsi, Reshma, Griffith, Kent, Krenz, Chris, Jones, Rochelle D, Cutter, Christina, Feldman, Eva L, Jacobson, Clare, Kerr, Eve, Paradis, Kelly, Singer, Kanakadurga, Spector, Nancy, Stewart, Abby, Telem, Dana, Ubel, Peter, Settles, Isis
Format:	Journal Article
Language:	English
Published:	United States American Medical Association 06-06-2023
Subjects:	Academic Medical Centers - organization & administration Academic Medical Centers - statistics & numerical data Asian - psychology Asian - statistics & numerical data Bisexuality Careers Culture Cyberbullying - psychology Cyberbullying - statistics & numerical data Ethnicity Ethnicity - psychology Ethnicity - statistics & numerical data Faculty, Medical - organization & administration Faculty, Medical - psychology Faculty, Medical - statistics & numerical data Female Gender Heterosexuality Humans Incivility - statistics & numerical data Male Medicine Medicine - organization & administration Medicine - statistics & numerical data Men Mental health Mental Health - statistics & numerical data Minority & ethnic groups Minority Groups - psychology Minority Groups - statistics & numerical data Non-binary gender Organizational aspects Organizational Culture Original Investigation Prejudice - ethnology Prejudice - psychology Prejudice - statistics & numerical data Professional development Race Racism - psychology Racism - statistics & numerical data Sexism - psychology Sexism - statistics & numerical data Sexual and Gender Minorities - psychology Sexual and Gender Minorities - statistics & numerical data Sexual harassment Sexual Harassment - psychology Sexual Harassment - statistics & numerical data Social Marginalization - psychology Surveys and Questionnaires United States - epidemiology White - psychology White - statistics & numerical data Women Working Conditions - organization & administration Working Conditions - psychology Working Conditions - statistics & numerical data Workplace - organization & administration Workplace - psychology Workplace - statistics & numerical data United States
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Summary:	IMPORTANCE: The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender). OBJECTIVE: To evaluate academic medical culture, faculty mental health, and their relationship. DESIGN, SETTING, AND PARTICIPANTS: A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health. EXPOSURES: Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status. MAIN OUTCOMES AND MEASURES: Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health. RESULTS: Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis. CONCLUSIONS AND RELEVANCE: High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0098-7484 1538-3598
DOI:	10.1001/jama.2023.7232