Workplace Violence and Harassment Against Emergency Medicine Residents

Benjamin H. Schnapp, MD; Benjamin H. Slovis, MD; Anar D. Shah, MD, MBA; Abra L. Fant, MD, MS; Michael A. Gisondi, MD; Kaushal H. Shah, MD; Christie A. Lech, MD


Western J Emerg Med. 2016;17(5):567-573. 

In This Article


Study Design, Setting, and Population

This was a cross-sectional survey study conducted at three EM residency training programs based within the Mount Sinai Health System in New York City, including four large tertiary care facilities as well as two public hospitals and two trauma centers with a combined census of over 500,000 annual ED visits. All 142 EM residents within the Mount Sinai system were eligible to participate (60 at one postgraduate year [PGY]1–4 program and 82 at two PGY1–3 programs).

This study was approved as exempt research by the institutional review boards at each of the participating institutions.

Study Protocol

Two independent investigators searched PubMed using the search terms "violence," "assault," "emergency department," "staff," "residents," "housestaff," and "health care workers" to identify a potential survey instrument. Among the studies identified through this search, the investigators determined by mutual agreement which set of survey questions had the greatest applicability to the resident population to be evaluated. The survey instrument selected as most relevant was published by Gates et al (2006) and included a variety of multiple-choice questions regarding the amount and types of violence (e.g. physical, sexual) that staff experienced or witnessed as well as perceived barriers to safety in their EDs (see Appendix A).

The residency leadership team at Mt. Sinai, comprised of the program director, assistant program directors and chief residents, reviewed the survey instrument and adapted it. Questions unrelated to the experience of resident physicians were removed from the original Gates instrument. Additionally, exhaustive definitions of each type of violence that were included in the original study were omitted and condensed descriptors were substituted for brevity; language limiting the reportable incidents to the previous six months was also removed as off-service rotations creating uneven amounts of time in the ED was thought to be a potential confounder. The revised instrument was piloted on two recent Mount Sinai Health System residency graduates who were not a part of the study; slight revisions were made to the wording of questions for clarification.

Paper copies of the survey instrument were distributed to residents at the time of their 2015 annual American Board of Emergency Medicine In-Training Examination (ABEM ITE). Participation in the study was optional, and responses were kept anonymous. Residents were informed that exclusion or non-participation in the study would not affect their performance on the ABEM ITE or their resident standing, and instructed to report their personal experiences only. Completion of the survey implied assent. We excluded from participation residents who were absent from the ABEM ITE or did not complete the survey at that time. Surveys were collected at the end of the ABEM ITE, and results were entered into a secure database.

To compare respondent demographics to those of the entire population in order to assess for nonresponse bias, we reviewed demographic data provided by each residency. Sex demographics of the entire population were compared to those that anonymously participated in the survey.

Outcome Measures

The primary outcome was the incidence of violence experienced by residents while working in the ED during their EM residency thus far. The secondary outcomes were the subtypes of violence experienced by residents as well as the perceived barriers to safety while at work.

Data Analysis

Completed survey data were entered into a secure Microsoft Excel (2011, Redmond WA) spreadsheet by a trained research assistant blinded to the objectives of the study. We calculated descriptive statistics as well as one-way ANOVA and odds ratios using IBM SPSS version 20.0 (2011, Armonk NY).