How medical learners and educators decide what counts as mistreatment: A qualitative study

Abstract

IntroductionThe mistreatment or abuse (maltreatment) of medical learners by their peers and supervisors has been documented globally for decades, and there is significant research about the prevalence, sequelae and strategies for intervention. However, there is evidence that learners experience maltreatment as being less clear cut than do researchers, educators and administrators. This definitional ambiguity creates problems for understanding and addressing this issue. The objective of this study was to understand how medical learners and educators make sense of less‐than‐ideal interactions in the clinical learning environment, and to describe which factors influenced their perception that the encounter constituted maltreatment.MethodsUsing constructivist grounded theory, we interviewed 16 medical students, 15 residents or fellows, and 18 educators associated with a single medical school (n = 49). Data collection began with the most junior learners, iterating with analysis as we progressed through the project. Constant comparative analysis was used to gather and compare stories of ‘definitely’, ‘maybe’ and ‘definitely not’ maltreatment across a variety of axes including experience level, clinical setting and type of interaction.ResultsOur data show that learners and educators have difficulty classifying their experiences of negative interpersonal interaction, except in the most severe and concrete cases. While there was tremendous variation in the way they categorised similar experiences, there was consistency in the elements drawn upon to make sense of those experiences. Participants interpreted negative interpersonal interactions on an individual basis by considering factors related to the interaction, initiator and recipient.ConclusionsOnly the most negative behaviour is consistently understood as maltreatment; a complex process of individual sense‐making is required to determine the acceptability of each interaction. The differences between how individuals judge these interactions highlight an opportunity for administrative, research and faculty development intervention.

The socialisation of mistreatment in the healthcare workplace: Moving beyond narrative content to analyse educator data as discourse

“…And, if that profession or organisational culture could be described as abusive to a reasonable outsider, the more acclimatised they become to abuse. Given this background, we believe that differences in the data presented by Vanstone et al 11 can (at least in part) be explained by the length of time participants had spent in specific workplace settings.…”

“…Whereas Vanstone et al 11 highlight actors' active (versus passive) constructions of their social world through experiences, we think it valuable to add the important constructivist concept of socialisation to their data analysis. Socialisation is the active process through which objective events in the world are incorporated into existing understandings to become subjectively meaningful 12 .…”

“…It is impossible to contextualise Vanstone et al's 11 data according to potential narrator levels of socialisation because they do not report the demographic features of their sample (to preserve confidentiality). It is also difficult to make sense of data privileging socialisation whenever investigators focus on the surface level of what participants said.…”

“…This mistreatment not only affects learners' well-being but also negatively impacts patient care and safety. 6 We applaud Vanstone et al, 11 therefore, for contributing to ongoing conversations around student and trainee workplace mistreatment, adding to voluminous prior research and keeping the spotlight on this continuing challenge. We have been researching this topic internationally since 2007 (using the terminology 'professionalism dilemmas' and 'workplace dignity').…”

“…It is impossible to contextualise Vanstone et al's 11 data according to potential narrator levels of socialisation because they do not report the demographic features of their sample (to preserve confidentiality).…”