Eradicating Medical Student Mistreatment

Abstract

Purpose Since 1995, the David Geffen School of Medicine at UCLA (DGSOM) has created policies to prevent medical student mistreatment, instituted safe mechanisms for reporting mistreatment, provided resources for discussion and resolution, and educated faculty and residents. In this study, the authors examined the incidence, severity, and sources of perceived mistreatment over the 13-year period during which these measures were implemented. Method From 1996 to 2008, medical students at DGSOM completed an anonymous survey after their third-year clerkships and reported how often they experienced physical, verbal, sexual harassment, ethnic, and power mistreatment, and who committed it. The authors analyzed these data using descriptive statistics and the students’ descriptions of these incidents qualitatively, categorizing them as “mild,” “moderate,” or “severe.” They compared the data across four periods, delineated by milestone institutional measures to eradicate mistreatment. Results Of 2,151 eligible students, 1,946 (90%) completed the survey. More than half (1,166/1,946) experienced some form of mistreatment. Verbal and power mistreatment were most common, but 5% of students (104/1,930) reported physical mistreatment. The pattern of incidents categorized as “mild,” “moderate,” or “severe” remained across the four study periods. Students most frequently identified residents and clinical faculty as the sources of mistreatment. Conclusions Despite a multipronged approach at DGSOM across a 13-year period to eradicate medical student mistreatment, it persists. Aspects of the hidden curriculum may be undermining these efforts. Thus, eliminating mistreatment requires an aggressive approach both locally at the institution level and nationally across institutions.

Exploring medical students’ barriers to reporting mistreatment during clerkships: a qualitative study

“…These national statistics reflect survey results at our own institution [10]. Reluctance to report mistreatment may very well contribute to a persisting culture of abuse despite our multi-pronged efforts to eradicate it [10].…”

“…In the spring of 2015, we reviewed archived, anonymous DGSOM Well-Being Survey data (described elsewhere [10]) from the graduating classes of 2013–2015. We administer this survey annually to the rising senior students to monitor the extent of mistreatment in clerkships.…”

“…Reluctance to report mistreatment may very well contribute to a persisting culture of abuse despite our multi-pronged efforts to eradicate it [10]. Our efforts include publicizing clear institutional policies on harassment and discrimination, and developing multiple safe mechanisms to anonymously report mistreatment.…”

Perceptions of mistreatment among trainees vary at different stages of clinical training

“…The themes selected for their study, “belittlement”, “ethnic insensitivity”, “negative feedback”, “sexual harassment” and “excluding from a learning opportunity” closely parallel themes identified at our institution and others, demonstrating the pervasiveness of these issues [5, 14, 21, 22]. Similar to our study, in the scenarios of “belittlement”, “ethnic insensitivity” and “sexual harassment”, these themes were generally perceived to represent mistreatment.…”

“…Beyond hampering the clinical learning environment (CLE), the negative consequences of this behavior on trainees have been well documented [6–13]. Some authors have conceded that efforts to eradicate learner mistreatment have been hindered by the effect of the “hidden curriculum [14]”. Others have highlighted the “eye of the beholder”, describing the spectrum of differing perspectives engendered by the term “mistreatment [12]”.…”