title: Harassment and discrimination in medical training: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Harassment and discrimination include a wide range of behaviors that medical trainees perceive as being humiliating, hostile, or abusive. To understand the significance of such mistreatment and to explore potential preventive strategies, the authors conducted a systematic review and meta-analysis to examine the prevalence, risk factors, and sources of harassment and discrimination among medical trainees.
  
  
  METHODS
  In 2011, the authors identified relevant studies by searching MEDLINE and EMBASE, scanning reference lists of relevant studies, and contacting experts. They included studies that reported the prevalence, risk factors, and sources of harassment and discrimination among medical trainees. Two reviewers independently screened all articles and abstracted study and participant characteristics and study results. The authors assessed the methodological quality in individual studies using the Newcastle-Ottawa Scale. They also conducted a meta-analysis.
  
  
  RESULTS
  The authors included 57 cross-sectional and 2 cohort studies in their review. The meta-analysis of 51 studies demonstrated that 59.4% of medical trainees had experienced at least one form of harassment or discrimination during their training (95% confidence interval [CI]: 52.0%-66.7%). Verbal harassment was the most commonly cited form of harassment (prevalence: 63.0%; 95% CI: 54.8%-71.2%). Consultants were the most commonly cited source of harassment and discrimination, followed by patients or patients' families (34.4% and 21.9%, respectively).
  
  
  CONCLUSIONS
  This review demonstrates the surprisingly high prevalence of harassment and discrimination among medical trainees that has not declined over time. The authors recommend both drafting policies and promoting cultural change within academic institutions to prevent future abuse.
authors.affiliation: Mr. Fnais is a medical student, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Ms. Soobiah is research coordinator, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Chen is a biostatistician, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Ms. Lillie is research coordinator, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Ms. Perrier is information specialist, Continuing Education and Professional Development, Faculty of Medicine, University of Toronto, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Tashkhandi is an MSc candidate, Institute of Medical Science, University of Toronto, and associate researcher, Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Straus is professor, Department of Medicine, and director, Division of Geriatric Medicine, University of Toronto Faculty of Medicine, and director, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Mamdani is professor, Department of Health Policy, Management, and Evaluation and Leslie Dan Faculty of Pharmacy, University of Toronto, and director, Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Al-Omran is professor and vascular surgeon, Department of Surgery, University of Toronto Faculty of Medicine, and head, Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Tricco is a scientist, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Naif
authors.initials: N
authors.lastname: Fnais
authors.forename: Charlene
authors.initials: C
authors.lastname: Soobiah
authors.forename: Maggie Hong
authors.initials: MH
authors.lastname: Chen
authors.forename: Erin
authors.initials: E
authors.lastname: Lillie
authors.forename: Laure
authors.initials: L
authors.lastname: Perrier
authors.forename: Mariam
authors.initials: M
authors.lastname: Tashkhandi
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Straus
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Omran
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Tricco
mesh_terms: D000328:Adult; D004503:Education, Medical, Graduate / Q000379:methods*; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007400:Interprofessional Relations; D008297:Male; D020380:Needs Assessment; D015995:Prevalence; D028743:Professional Misconduct; D012919:Social Behavior; D063508:Social Discrimination / Q000706:statistics & numerical data*; D013337:Students, Medical / Q000706:statistics & numerical data; D055815:Young Adult