Workplace Violence: Experiences of Internal Medicine Trainees at an Academic Medical Center.

OBJECTIVES: Healthcare professionals are at higher risk for workplace violence (WPV) than workers in other sectors. This elevated risk exists despite the vast underreporting of WPV in the medical setting. The challenge of responding to this risk is compounded by limited empirical research on medical training environments. Understanding trainees' experience and educating them on workplace safety, WPV reporting, and awareness of resources are shared goals of educational and institutional leadership. In our setting, clear understanding and education were urgent after the enactment of a statewide "constitutional carry" law affording individuals a right to carry concealed firearms in all state-owned universities and hospitals, beginning in July 2017. We sought to examine the incidence of WPV affecting Internal Medicine trainees to understand the types of violence encountered, reporting rates, and the factors that influence reporting. METHODS: We conducted a cross-sectional online survey of Internal Medicine residents and fellows in practice for the previous 12 months. Survey items included both forced choice and open-ended questions. Descriptive statistics were calculated and used to summarize the study variables. χ2 tests were performed to examine whether sex differences existed for each of the survey questions. Qualitative responses were content analyzed and organized thematically. RESULTS: Of 186 trainees, 88 completed the survey. Forty-seven percent of respondents experienced WPV, with >90% of cases involving a patient, a patient's family member, or a patient's friend. Verbal assault was the most common type of incident encountered. Trainees formally reported fewer than half of the violent incidents disclosed in the survey. Major factors that influenced reporting included the severity of the incident, condition of the patient, and clarity of the reporting mechanism. CONCLUSIONS: Previous research indicates similar amounts and types of WPV. Likewise, a large percentage of the incidents are not reported. Addressing the key factors related to why physicians underreport can inform institutions on how to make systematic changes to reduce WPV and its negative impact. Future research is needed to examine whether specific interventions can be implemented to improve reporting and reduce the incidence of WPV.

Examining the Impact of Victimization on Girls' Delinquency: A Study of Direct and Indirect Effects.

Previous research has acknowledged that there is a relationship between victimization and later delinquency, but the specific attributes of this relationship are unclear because measures of both direct and indirect victimization are rarely explored in a single study. We included both indirect and direct victimization to examine which form of victimization was a stronger predictor of substance use, fighting, running away, and sex work among girls committed to a juvenile justice facility. Findings indicated that direct victimization was typically a more salient predictor of delinquency than indirect forms of victimization. Further, running away and sex work appear to be unique outcomes that are particularly likely when girls experience direct rather than indirect victimization. Findings are summarized with implications for health and public policy.

Rape and Mental Health Outcomes Among Women: Examining the Moderating Effects of "Healthy" Fear Levels.

This study examined the mediating and moderating impact of fear of victimization on the relationships between forcible and vicarious rape on depression and post-traumatic stress disorder (PTSD) among college women. Forcible and vicarious rape positively affected PTSD and depression symptomology, but fear did not mediate these relationships. Fear moderated the impact of forcible rape on PTSD, but was not a moderator for depression. Findings suggest that there may be "healthy" levels of fear in the aftermath of victimization where having too little fear may leave women unnecessarily vulnerable to victimization, while having too much fear may lead to social isolation and withdrawal.

Syringocystadenocarcinoma papilliferum: a rare tumor with a favorable prognosis.

Syringocystadenocarcinoma papilliferum (SCACP) is a rare adenexal carcinoma with only 21 cases reported in the literature. Most patients describe a long-standing mass with recent change, supporting the idea that SCACP arises from malignant transformation of pre-existing syringocystadenoma papilliferum (SCAP). Syringocystadenocarcinoma papilliferum is generally treated with wide surgical excision of the lesion and patients do exceeding well and require no systemic therapy.