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Objective <p>The stressful nature of surgical training can trigger mistreatment and incivility towards learners. Retaliation, the act of punishing others for speaking up, and fear of retaliation itself have not been well characterized in surgery. We aimed to examine trainee and faculty experiences with fear of retaliation and disrespect in surgical residency.</p> Methods <p>Qualitative study of surgical trainees and faculty from nine institutions (4 University-based, 3 Community-based, and 2 Community-based/University-affiliated) from Feb-May 2024. Participants were recruited for semi-structured interviews via purposive sampling. Thematic analysis was performed using interpretive description.</p> Results <p>A total of 25 surgical trainees and 20 faculty were included. Trainees consisted of 52% (13) female, 28% (7) racial/ethnic minorities, 52% (13) junior residents (PGY1-3), and 48% (12) from community-based and community-based/University-affiliated institutions. Faculty consisted of 55% (11) female, 30% (6) racial/ethnic minorities, 45% (9) within ten years in practice, and 50% (10) from community-based and community-based/University-affiliated institutions. Three themes were identified—(1) Retaliation is real, (2) Fear of retaliation (presence, root causes, protective factors, consequences), and (3) Disrespect in the workplace. Retaliation is real existed for both trainees and faculty. Likewise, fear of retaliation was present for both trainees and faculty. Root causes of fear were attributed to hearsay and flipped power dynamics in the learner-educator relationship. Protective factors such as structuring feedback, managing interpersonal conflicts, alignment and setting expectations, and increasing familiarity in the trainee-faculty relationship helped to mitigate fear of retaliation. For trainees, consequences of fear of retaliation included lack of reporting due to potential loss of learning opportunities, impact on future career advancement, and not wanting to establish a negative reputation within their program. In contrast, consequences of fear of retaliation for faculty inhibited delivery of negative or constructive feedback to trainees. Lastly, acts of disrespect in the workplace centered around a culture of disregard and unwanted jokes for trainees. While faculty often did not intend to be disrespectful, impact of their actions and heightened emotional responses in stressful situations were perceived as mistreatment by trainees.</p> Conclusion <p>Fear of retaliation and disrespect have pervasive negative impacts on surgical training that are ultimately detrimental to learning. Recognition of both in the workplace and identification of barriers to reporting serve as first steps in promoting a psychologically safe environment in surgical training.</p>

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“I don’t want to be seen as a complainer”: a multi-institutional qualitative study of fear of retaliation and disrespect in surgical residency

  • 期刊论文

  • 发表日期：

    2026年2月9日

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  • Jennifer H. Chen,
  • Alyssa A. Pradarelli,
  • Julie Evans,
  • Niki Matusko,
  • Norah N. Naughton,
  • Roy Phitayakorn,
  • John T. Mullen,
  • Lily Chang,
  • Melissa Johnson,
  • Thavam Thambi-Pillai,
  • Jon Ryckman,
  • Melissa Alvarez-Downing,
  • Nell Maloney Patel,
  • Sebastiano Cassaro,
  • Felicia Ivascu,
  • David T. Hughes,
  • Gurjit Sandhu

摘要

Objective

The stressful nature of surgical training can trigger mistreatment and incivility towards learners. Retaliation, the act of punishing others for speaking up, and fear of retaliation itself have not been well characterized in surgery. We aimed to examine trainee and faculty experiences with fear of retaliation and disrespect in surgical residency.

Methods

Qualitative study of surgical trainees and faculty from nine institutions (4 University-based, 3 Community-based, and 2 Community-based/University-affiliated) from Feb-May 2024. Participants were recruited for semi-structured interviews via purposive sampling. Thematic analysis was performed using interpretive description.

Results

A total of 25 surgical trainees and 20 faculty were included. Trainees consisted of 52% (13) female, 28% (7) racial/ethnic minorities, 52% (13) junior residents (PGY1-3), and 48% (12) from community-based and community-based/University-affiliated institutions. Faculty consisted of 55% (11) female, 30% (6) racial/ethnic minorities, 45% (9) within ten years in practice, and 50% (10) from community-based and community-based/University-affiliated institutions. Three themes were identified—(1) Retaliation is real, (2) Fear of retaliation (presence, root causes, protective factors, consequences), and (3) Disrespect in the workplace. Retaliation is real existed for both trainees and faculty. Likewise, fear of retaliation was present for both trainees and faculty. Root causes of fear were attributed to hearsay and flipped power dynamics in the learner-educator relationship. Protective factors such as structuring feedback, managing interpersonal conflicts, alignment and setting expectations, and increasing familiarity in the trainee-faculty relationship helped to mitigate fear of retaliation. For trainees, consequences of fear of retaliation included lack of reporting due to potential loss of learning opportunities, impact on future career advancement, and not wanting to establish a negative reputation within their program. In contrast, consequences of fear of retaliation for faculty inhibited delivery of negative or constructive feedback to trainees. Lastly, acts of disrespect in the workplace centered around a culture of disregard and unwanted jokes for trainees. While faculty often did not intend to be disrespectful, impact of their actions and heightened emotional responses in stressful situations were perceived as mistreatment by trainees.

Conclusion

Fear of retaliation and disrespect have pervasive negative impacts on surgical training that are ultimately detrimental to learning. Recognition of both in the workplace and identification of barriers to reporting serve as first steps in promoting a psychologically safe environment in surgical training.