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

Abstract

Background: Despite widespread implementation of policies to address mistreatment, the proportion of medical students who experience mistreatment during clinical training is significantly higher than the proportion of students who report mistreatment. Understanding barriers to reporting mistreatment from students’ perspectives is needed before effective interventions can be implemented to improve the clinical learning environment.Objective: We explored medical students’ reasons for not reporting perceived mistreatment or abuse experienced during clinical clerkships at the David Geffen School of Medicine at UCLA (DGSOM).Design: This was a sequential two-phase qualitative study. In the first phase, we analyzed institutional survey responses to an open-ended questionnaire administered to the DGSOM graduating classes of 2013–2015 asking why students who experienced mistreatment did not seek help or report incidents. In the second phase, we conducted focus group interviews with third- and fourth-year medical students to explore their reasons for not reporting mistreatment. In total, 30 of 362 eligible students participated in five focus groups. On the whole, 63% of focus group participants felt they had experienced mistreatment, of which over half chose not to report to any member of the medical school administration. Transcripts were analyzed via inductive thematic analysis.Results: The following major themes emerged: fear of reprisal even in the setting of anonymity; perception that medical culture includes mistreatment; difficulty reporting more subtle forms of mistreatment; incident is not important enough to report; reporting process damages the student–teacher relationship; reporting process is too troublesome; and empathy with the source of mistreatment. Differing perceptions arose as students debated whether or not reporting was beneficial to the clinical learning environment.Conclusions: Multiple complex factors deeply rooted in the culture of medicine, along with negative connotations associated with reporting, prevent students from reporting incidents of mistreatment. Further research is needed to establish interventions that will help identify mistreatment and change the underlying culture.

Medical student mistreatment: understanding ‘public humiliation’

“…While not a central finding of our study, our analysis also indicated that students are less likely to report episodes of public humiliation or other forms of mistreatment if they perceive that it will negatively impact their grade or prolong the negative experience. This is consistent with the literature on this topic as fear of reprisal and a desire not to undertake the time and effort involved in reporting have been identified as reasons that limit reporting of medical student mistreatment [25]. Participants also recommended that continued education on teaching skills and feedback skills would improve the learning environment; a continued reminder that education and training on these skills should not be undervalued.…”

Medical student mistreatment: an inconvenient truth?

“…Furthermore, this study does not explore in depth the barriers to reporting mistreatment. Chung et al suggest that reporting mistreatment is low due to a myriad of reasons including fear of reprisal, perception of medical culture as well as the difficult logistics of reporting [4]. This study may benefit from more questions focusing on whether these experiences are not being reported due to fear of reprisal or simply due to the difficult logistical nature of reporting.…”

Medical students’ self-reported gender discrimination and sexual harassment over time

“…Moreover, the context of those experiences is often the clinical environment, which can be hard for universities to monitor and change. Efforts by universities to detect gender discrimination with the currently used instruments such as course evaluations might not be adequate as underreporting is a known problem [41][42][43], and response rates are usually low. As the epidemic of burnout among female medical doctors and students, for example, in Sweden, is a fact [44], we hypothesize that GD/SH experienced during medical education maybe one of the driving forces.…”