Hi Andy, thank you for your interest in this topic.

We plan to increase the response rate by making the survey easy, interesting and safe. We will use REDCap to distribute the survey, send reminders, and collect responses from the surveys. Participant tracking will be separate from the participant responses and there will be no link between the participant tracking and the responses.

There has been no published/ established tools or scales that are gold standard and hence we made this questoinnaire.

Please find attached my updated protocol and survey.

PROTOCOL

Background:

Discrimination is an unfortunate but common occurrence in the work place today. Academic medical centers are not immune to this either. At all levels of training; medical students, residents, and provider levels; nursing, midlevel providers there has been documented discrimination in the workplace. A meta-analysis preformed (Fnais, N., et al. (2014). "Harassment and discrimination in medical training: a systematic review and meta-analysis." Acad Med 89(5): 817-827) in 2011 of studies documenting discrimination among all levels of health care providers (HCP) had shown verbal abuse 63%, gender discrimination at 54%, and racial discrimination at 24%.  In 2011, the Institute of Medicine released a report calling for the inclusion of questions around sexual orientation to be included in national surveys. More data is needed to understand how sexual orientation might contribute to stigma, discrimination and violence especially so that we can improve culture competency

(https://report.nih.gov/UploadDocs/LGBT%20Health%20Report_FINAL_2013-01-03-508%20compliant.pdf)

My own personal experience with discrimination happened a few years ago. I was belittled as clinician woman of color by a well-educated middle aged patient. I continued to provide excellent care to this patient while keeping my feelings to myself as I had no place to turn, no one to help me deal with this situation. Currently there are no studies, surveying how health care providers deal with racism/discrimination from patients/families while they continue to care for these people.

Aim/ objectives:

Primary:

1. Understand the magnitude of discrimination for the hospitalists in the work place

2. Are there resources/ procedures in place for the hospitalists to deal with discrimination?

Secondary:

1. Blue States with Republican leadership experience more discrimination against hospitalists

2. Institutions with women leaders likely to have more support and policies in place

Impact: Academic medical centers are not immune from discrimination that is being reported in numerous sectors of the economy

Study design: We will conduct a brief, anonymous, cross-sectional, electronic survey of academic hospitalists’ nationwide.

The issue of discrimination against health care workers is a growing concern. Our survey aims to address these issues and create a culture that supports clinicians. Surveys are anonymous. Our study has minimal to no risk to the subjects. The surveys are voluntary. The benefit of conducting this survey will help us lay the foundation for making novel hospital policies and protocols. It will help us discuss possible interventions and responsibilities of clinicians and hospital leadership in taking care of patients and family members who exhibit racism and discrimination.

Data Collection: We will be collecting survey responses using REDCap, which is an IRB approved web-based system for distributing and collecting survey data. At the end of the study, data will be downloaded from REDCap on to a secure password protected local server at Weill Cornell Medicine. The PIs, will be the only ones that have access to the data.

Analysis Plan: Descriptive statistics will first be calculated for all questions and sociodemographic information. Differences between the different types of discrimination will be assessed by a Fisher’s exact test or a Chi-square test where appropriate. Additional analyses will be completed for data collected for secondary outcomes. Unless otherwise specified, all statistical tests will be two sided and the alpha will be set at 0.05 for consideration of statistical significance.

If ten or more institutions agree to distribute our survey, we will use random effect models to control for differences between institutions. These models will help describe variation and test if variation at different sites is significant.

SURVEY

Demographic characteristics

1. How many years have you worked in a health care setting: 1-5, 5-10, 10-15, >15

1. Academic Rank: instructor/ assistant professor/ associate professor/ professor

1. Age: <35, 35-45, 45-55, >55

1. Gender: female, male

1. Race: American Indian/ Alaska Native, Asian, Native Hawaiian or other pacific islander, Black or African American, White, More than one race

1. Ethnicity: Hispanic/Latino, Non-Hispanic/non-Latino

1. Do you consider yourself to be :

¨  Heterosexual or straight

¨ Gay or Lesbian

¨ Bisexual

¨ Transgender

¨ Other

1. Religion: Which of the following best represents your religious beliefs?

¨ Christian (this category includes all denominations i.e. Catholic, Protestant, Anglican etc.)

¨ Jewish

¨ Muslim

¨ Buddhist

¨ Hindu

¨ Sikhism

¨ Atheist

¨ Agnostic

¨ Something else (specify): ___________________

¨ Nothing in particular

1. Institution Name :

1. State:

Items about discrimination

Within the past 6 months, has a patient or patient’s family member discriminated against you based on your:

1. Race/Ethnicity
2. Gender
3. Religion
4. Sexual orientation

During your entire career as a health care worker, has a patient or patient’s family member discriminated against you based on your:

1. Race/Ethnicity        Yes      No
2. Gender
3. Religion
4. Sexual orientation

During your entire career as hospitalist, has someone else in the hospital, discriminated against you based on your:

1. 9.       Race/Ethnicity
2. 10.   Gender
3. Religion
4. Sexual orientation

Please indicate how much you agree or disagree with the following statements.

1. Experiencing discrimination while working in the hospital has caused me to consider leaving my job.
   1. agree
   2. disagree
   3. not applicable; never experienced discrimination

1. Experiencing discrimination while working in the hospital has caused me distress.
   1. agree
   2. disagree
   3. not applicable; never experienced discrimination

1. Experiencing discrimination while working in the hospital has compromised my confidence in the work place.
   1. agree
   2. disagree
   3. not applicable; never experienced discrimination

1. Does your hospital have a formal policy on what you should do if you experience discrimination in the hospital?
   1. yes
      1. no
      2. not sure

1. Is there an ombudsman office that you could contact in the event you experience discrimination?
   1. yes
   2. no
   3. not sure

1. Should there be more resources to address discrimination experienced by hospitalists?
   1. yes
   2. no

1. Have you experienced work place violence?
   1. yes
   2. no
   3. not sure

1. Please feel free to share any experience where you felt discriminated. Optional

1. If you have experienced discrimination, did it inspire you to

             a.   Change policy  

             b.   Seek a leadership position  

             c.   Join an established group or taskforce  

            d.   Create a working group or taskforce   

            e.   other 

            f.   Not applicable

Now we would like to ask you two questions about how you have been feelings over the last 2 weeks.

Over the past 2 weeks, how often have you been bothered by any of the following problems?

                                                                  Not at all / several days/ > half the days/ nearly every day

1. little interest or pleasure              0                  1                     2                                 3

              in doing things

1. Feeling down, depressed              0                   1                     2                                 3

              or hopeless