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Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical Students.
JAMA Netw Open. 2021 02 01; 4(2):e2036136.JN

Abstract

Importance

Medical trainee burnout is associated with poor quality care and attrition. Medical students in sexual minority groups report fear of discrimination and increased mistreatment, but the association between sexual orientation, burnout, and mistreatment is unknown.

Objective

To evaluate whether medical student burnout differs by sexual orientation and whether this association is mediated by experiences of mistreatment.

Design, Setting, and Participants

This cross-sectional study surveyed US medical students graduating from Association of American Medical Colleges (AAMC)-accredited US allopathic medical schools who responded to the AAMC graduation questionnaire in 2016 and 2017. Statistical analyses were performed from March 15, 2019, to July 2, 2020, and from November 20 to December 9, 2020.

Main Outcomes and Measures

Burnout was measured using the Oldenburg Burnout Inventory for Medical Students, and sexual orientation was categorized as either heterosexual or lesbian, gay, or bisexual (LGB). Logistic regression models were constructed to evaluate the association between sexual orientation and experiencing burnout (defined as being in the top quartile of exhaustion and disengagement burnout dimensions) and to test the mediating association of mistreatment.

Results

From 2016 to 2017, 30 651 students completed the AAMC Graduation Questionnaire, and 26 123 responses were analyzed. Most respondents were younger than 30 years (82.9%) and White (60.3%). A total of 13 470 respondents (51.6%) were male, and 5.4% identified as LGB. Compared with heterosexual students, a greater proportion of LGB students reported experiencing mistreatment in all categories, including humiliation (27.0% LGB students vs 20.7% heterosexual students; P < .001), mistreatment not specific to identity (17.0% vs 10.3%; P < .001), and mistreatment specific to gender (27.3% vs 17.9%; P < .001), race/ethnicity (11.9% vs 8.6%; P < .001), and sexual orientation (23.3% vs 1.0%; P < .001). Being LGB was associated with increased odds of burnout (adjusted odds ratio, 1.63 [95% CI, 1.41-1.89]); this association persisted but was attenuated after adjusting for mistreatment (odds ratio, 1.36 [95% CI, 1.16-1.60]). The odds of burnout increased in a dose-response manner with mistreatment intensity. Lesbian, gay, or bisexual students reporting higher mistreatment specific to sexual orientation had and 8-fold higher predicted probability of burnout compared with heterosexual students (19.8% [95% CI, 8.3%-31.4%] vs 2.3% [95% CI, 0.2%-4.5%]; P < .001). Mediation analysis showed that mistreatment accounts for 31% of the total association of LGB sexual orientation with overall burnout (P < .001).

Conclusions and Relevance

This study suggests that LGB medical students are more likely than their heterosexual peers to experience burnout, an association that is partly mediated by mistreatment. Further work is needed to ensure that medical schools offer safe and inclusive learning environments for LGB medical students.

Authors+Show Affiliations

Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut.Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.Yale School of Medicine, New Haven, Connecticut.Yale School of Medicine, New Haven, Connecticut.Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33528552

Citation

Samuels, Elizabeth A., et al. "Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical Students." JAMA Network Open, vol. 4, no. 2, 2021, pp. e2036136.
Samuels EA, Boatright DH, Wong AH, et al. Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical Students. JAMA Netw Open. 2021;4(2):e2036136.
Samuels, E. A., Boatright, D. H., Wong, A. H., Cramer, L. D., Desai, M. M., Solotke, M. T., Latimore, D., & Gross, C. P. (2021). Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical Students. JAMA Network Open, 4(2), e2036136. https://doi.org/10.1001/jamanetworkopen.2020.36136
Samuels EA, et al. Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical Students. JAMA Netw Open. 2021 02 1;4(2):e2036136. PubMed PMID: 33528552.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical Students. AU - Samuels,Elizabeth A, AU - Boatright,Dowin H, AU - Wong,Ambrose H, AU - Cramer,Laura D, AU - Desai,Mayur M, AU - Solotke,Michael T, AU - Latimore,Darin, AU - Gross,Cary P, Y1 - 2021/02/01/ PY - 2021/2/2/entrez PY - 2021/2/3/pubmed PY - 2021/4/13/medline SP - e2036136 EP - e2036136 JF - JAMA network open JO - JAMA Netw Open VL - 4 IS - 2 N2 - Importance: Medical trainee burnout is associated with poor quality care and attrition. Medical students in sexual minority groups report fear of discrimination and increased mistreatment, but the association between sexual orientation, burnout, and mistreatment is unknown. Objective: To evaluate whether medical student burnout differs by sexual orientation and whether this association is mediated by experiences of mistreatment. Design, Setting, and Participants: This cross-sectional study surveyed US medical students graduating from Association of American Medical Colleges (AAMC)-accredited US allopathic medical schools who responded to the AAMC graduation questionnaire in 2016 and 2017. Statistical analyses were performed from March 15, 2019, to July 2, 2020, and from November 20 to December 9, 2020. Main Outcomes and Measures: Burnout was measured using the Oldenburg Burnout Inventory for Medical Students, and sexual orientation was categorized as either heterosexual or lesbian, gay, or bisexual (LGB). Logistic regression models were constructed to evaluate the association between sexual orientation and experiencing burnout (defined as being in the top quartile of exhaustion and disengagement burnout dimensions) and to test the mediating association of mistreatment. Results: From 2016 to 2017, 30 651 students completed the AAMC Graduation Questionnaire, and 26 123 responses were analyzed. Most respondents were younger than 30 years (82.9%) and White (60.3%). A total of 13 470 respondents (51.6%) were male, and 5.4% identified as LGB. Compared with heterosexual students, a greater proportion of LGB students reported experiencing mistreatment in all categories, including humiliation (27.0% LGB students vs 20.7% heterosexual students; P < .001), mistreatment not specific to identity (17.0% vs 10.3%; P < .001), and mistreatment specific to gender (27.3% vs 17.9%; P < .001), race/ethnicity (11.9% vs 8.6%; P < .001), and sexual orientation (23.3% vs 1.0%; P < .001). Being LGB was associated with increased odds of burnout (adjusted odds ratio, 1.63 [95% CI, 1.41-1.89]); this association persisted but was attenuated after adjusting for mistreatment (odds ratio, 1.36 [95% CI, 1.16-1.60]). The odds of burnout increased in a dose-response manner with mistreatment intensity. Lesbian, gay, or bisexual students reporting higher mistreatment specific to sexual orientation had and 8-fold higher predicted probability of burnout compared with heterosexual students (19.8% [95% CI, 8.3%-31.4%] vs 2.3% [95% CI, 0.2%-4.5%]; P < .001). Mediation analysis showed that mistreatment accounts for 31% of the total association of LGB sexual orientation with overall burnout (P < .001). Conclusions and Relevance: This study suggests that LGB medical students are more likely than their heterosexual peers to experience burnout, an association that is partly mediated by mistreatment. Further work is needed to ensure that medical schools offer safe and inclusive learning environments for LGB medical students. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/33528552/Association_Between_Sexual_Orientation_Mistreatment_and_Burnout_Among_US_Medical_Students_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.36136 DB - PRIME DP - Unbound Medicine ER -