Ending student mistreatment: early successes and continuing challenges

Abstract

Problem: Student mistreatment represents an ongoing challenge for US medical schools. Students experiencing mistreatment may become marginalized and cynical, and they have higher rates of burnout, depression and substance use disorders. Although numerous attempts to eliminate mistreatment have been proposed, best practices remain elusive. We formed a unique student-faculty collaboration (the Ending Mistreatment Task Force) that allowed all voices to be heard and enabled identification of five interventions to reduce mistreatment.Intervention: The EMTF developed and implemented five key interventions: 1) a shared mistreatment definition; 2) measures to increase faculty accountability, including adding professionalism expectations to faculty members’ contracts and performance reviews; 3) a Professionalism Office to respond promptly to students’ reports of mistreatment and provide feedback to faculty; 4) tools to help teachers provide authentic learning environments for students, while addressing generational misunderstandings; and 5) student-produced videos, helping faculty understand the impact of mistreatment as seen through students’ eyes.Context: These interventions occurred at one medical school where mistreatment reports were consistently above national averages.Impact: Over 6 years, the interventions helped reduce the rate of student-reported mistreatment by 36% compared with a 4% decline across all US medical schools.Lessons: The collaborations between students and faculty helped each party identify unexpected misunderstandings and challenges. We learned that students want hard questions, although faculty are often afraid to challenge students for fear of offending them or being reported. We clarified differences between mistreatment and sub-optimal learning environments and openly discussed the pervasive opinion that ‘some’ mistreatment is important for learning. We also identified ongoing challenges, including the need to solicit residents’ perspectives regarding mistreatment and develop proper responses to disrespectful comments directed at patients, family and colleagues. The collaboration reinforced students’ and faculty members’ shared commitment to upholding a respectful learning and clinical care environment and ending mistreatment.

Satisfaction with remote teaching during the first semester of the COVID-19 crisis: Psychometric properties of a scale for health students

“…One of its manifestations is to demand over-dimensioned academic tasks that surpass the student’s available resources and its formation-level [ 35 , 54 , 55 ]. These sources of mistreatment generate stress [ 56 , 57 ] and affect the well-being of the student [ 58 , 59 ]. This is especially complex in a context where the students lack certainties about how the formation processes will continue and at what time they will be able to complete them [ 5 ].…”

Systematic review of academic bullying in medical settings: dynamics and consequences

“…Of the 49 unique studies, 10 implemented organisationlevel interventions which included workshops with vignettes to improve recognition of bullying (reported in 4 studies) 23 37 42 44 ; a gender and power abuse committee that established reporting mechanisms and held mandatory workshops on mistreatment (reported in 1) 3 ; a gender equity office to handle reporting (reported in 1) 39 ; a professionalism-focused approach that included professionalism in employee contracts and performance reviews, and a professionalism office to handle student complaints (reported in 1) 26 ; zero-tolerance policies (reported in 1) 53 and institutional-level tracking of mistreatment to provide targeted staff education (reported in 2). 21 24 All 10 studies had an uncontrolled before-after design, and as such, did not establish causality.…”

“…3 Similarly, in a study that used a multifaceted approach of developing a professionalism committee, and including professionalism in contracts and performance reviews, there was a 35.9% decrease in reporting of mistreatment and improved awareness of the reporting process. 26 In a study where a clerkship committee monitored unprofessionalism, there was an associated reduction in narrative comments regarding unprofessionalism on end of rotation surveys. 21 In a study assessing the impact of a professionalism retreat about mistreatment for consultants, there was no reduction in medical student mistreatment.…”

“…90 One approach would be making professionalism a requirement for promotion and career advancement, as in the Department of Medicine at the University of Toronto in Canada 91 or the University of Colorado School of Medicine. 26…”

Mental Strength and Challenges among Thai Medical Students in Their Clinical Years—Study Protocol

“…Although mistreatment remains a challenging issue in medical education, problems are preventable with appropriate communication and a clear understanding between medical personnel and students [ 33 , 35 , 39 ]. However, several studies have shown that managing systems to eliminate such problems remains ineffective and unsafe [ 28 , 32 ].…”