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



The response rate to our survey was 84% (119/142). Female residents comprised 37.8% (44/119) of the participants. This was highly representative of the overall population based on review of the residency websites, which demonstrated a female population of 37.3% (52/142). There were 36 PGY1, 35 PGY2, 36 PGY3, and 12 PGY4 residents across all residencies of the 119 residents who completed the survey. Mount Sinai represented 52 of the 119 respondents, Mount Sinai Beth Israel represented 39 of the 119 respondents, and Mount Sinai Saint Luke's Roosevelt represented 28 of the 119 respondents.

Physical Abuse

A majority of subjects (65.5%, 78/119) reported an experience of physical violence in the ED committed by a patient, while 11.8% (14/119) reported experiencing violence committed by visitors. The median number of times a resident experienced violence by a patient during their EM residency was 1.0 (IQR [2.0–0.0]) while the median number of times a resident experienced violence from a visitor was 0.0 (IQR [0.0–0.0]). The frequency of number of reported violent incidents committed by patients and visitors is displayed in Table 1.

There was a statistically significant difference between PGY level and frequency of violent incidents from patients as determined by one-way ANOVA F(3,115)=5.3, p=0.002. A Tukey post-hoc analysis revealed a statistically significant difference in violent incidents between PGY1s (0.7 ± 1.2) when compared to PGY2s (1.9±2.1, p=0.02 CI [0.13–2.3]) and PGY3s (2.2±1.6, p=0.002 CI [0.42–2.5]), however no significant difference when compared to PGY4s (2.0±2.1, p=0.105 CI [−0.2–2.8]). There was no significant difference for PGY2s when compared to PGY3s (p=0.899 CI [−1.3–0.77]) or PGY4s (p=0.997 CI [−1.4–1.6]), and PGY's had no statistically significant difference in attacks when compared to PGY3's (p=0.991 CI [−1.6–1.3]), suggesting both a consistent pattern of exposure time and violence and no protective or harmful effect of years of experience. Mean number of violent incidents for each PGY level is depicted in the Figure.


Mean number of violent events from patients by postgraduate year (PGY) level.

Verbal Harassment

Nearly all of the respondents (115/119, 96.6%) reported prior verbal harassment from a patient in the ED. Slightly fewer (103/119, 86.6%) reported prior verbal harassment from a visitor. More than three quarters (93/119, 78.2%) reported having experienced verbal threats from a patient while a majority (66/119, 55.5%) reported prior verbal threats by a visitor. Further descriptive statistics can be found in Table 2.

Sexual Harassment

Sexual harassment by a patient was reported by a majority (62/119, 52.1%) of the residents. Of these, 31/74 (41.9%) of the male responders reported sexual harassment, while 31/45 (68.9%) of the female responders reported the same. Descriptive statistics for sexual harassment are provided in Table 2. There was an increased odds ratio between gender and likelihood of sexual harassment (OR=3.071 95% CI [1.4–6.7]). Sexual harassment by a visitor was reported by 26/119 (21.8%) of the respondents, with 15/74 (20.3%) of the male and 11/45 (24.4%) of the females reporting this experience. There was minimal difference in odds between these groups with OR=1.273 (95% CI [0.5–3.1]). Resident reported sexual harassment is further characterized in Table 2.

Contributing Factors

Almost all of the respondents (118/119, 99.2%) reported that certain patient factors contribute to physical abuse. Among these, the most frequently reported were alcohol (113/119, 95.0%) and drug use (112/119, 94.1%). Psychiatric disease was also reported frequently as a contributing factor with (109/119, 91.6%) respondents reporting that this may have contributed to their experiences, while 70/119 (58.8%) reported organic causes such as dementia leading to physical abuse. The patient's inability to deal with a crisis situation was cited by 76/119 (63.9%) of the respondents cited as a factor for physical abuse.

Nearly all participants (118/119, 99.2%) reported environmental factors such as a lack of security or police presence (82.4%; 95% CI [75.5–89.2%]), and security or police not responding in a timely manner (68.1%; 95% CI [59.7–76.4%]) as the most common contributors to physical abuse. Patient areas being open to the public, and ease of bringing weapons into the ED were both cited by 69 (58.0%) as leading to increased risk of violence.

Slightly fewer residents (115/119, 96.6%) reported staffing factors as a cause of physical abuse, with a lack of adequate staff (79.8%; 95% CI [72.6–87.0]) being the most common. Slightly less than half (59/119, 49.6%; 95% CI [40.6–58.6%]) of respondents felt that working evening and nights made them more likely to encounter violence.

Workplace Safety

Nearly a quarter of resident responders (27/119, 22.7%) reported feeling "Occasionally," "Seldom" or "Never" safe while at work in the ED. Almost half (58/119, 48.7%) felt "Very Dissatisfied" or "Somewhat Dissatisfied" with the current security in their ED. Table 3 and Table 4 demonstrate the descriptive statistics for questions regarding workplace safety in our survey.

Violence Prevention

A small minority of residents (20/119, 16.8%) confirmed prior training in violence prevention or de-escalation techniques, 17 of these within the preceding 12 months. Nine of these (45%) were PGY 1s, with four (20%), three (15%) and four (20%) representing PGY 2, 3 and 4s respectively. Fourteen (74%) of those who took violence prevention training courses were male.