Training Medical Students as Peer-Facilitators to Identify Medical Student Mistreatment in the Clerkship Year

Abstract

Introduction: Data from the Association of American Medical Colleges' Medical School Graduation Questionnaire show persistent trends of medical student mistreatment nationwide. To reduce the barriers and increase actionable reporting of mistreatment, we integrated peer-facilitated learning environment sessions led by a group of trained third-and fourth-year medical students in all core clinical clerkships. Methods: During the 2018-2019 academic year, third-year medical students were recruited, oriented, and trained to act as facilitators of sessions on mistreatment. The sessions occurred once every clerkship block, using a standardized session introduction and guide. After a 6-month pilot, new medical students were recruited and worked as scribe/facilitator pairs, receiving an additional 1.5-hour training midyear, which was evaluated with a postworkshop survey. Results: Thirty-eight students implemented 43 peer-facilitated sessions and completed deidentified minutes of each session, which were shared with clerkship directors and the Medical Education Office for review. Survey data from midyear facilitator training indicated that facilitators highly agreed peer-led sessions were an important avenue for students to process experiences of mistreatment (3.9 out of 4), understood barriers to reporting (3.8 out of 4) and definitions of mistreatment (3.6 out of 4), and felt confident to facilitate these sessions (3.6 out of 4). Discussion: Peer-facilitated sessions offer a method to learn more about student experiences with mistreatment in real time and create a new avenue for communication between faculty and students. Assembling a stable core team of third-and fourth-year students trained in facilitation skills ensures the sustainability and relevance of the program.

Characterizing Asian American medical students’ experiences with microaggression and the impact on their well-being

“…Lastly, the high incidence of microaggressions experienced by Asian American medical students is often goes unaccounted and undocumented. Little is known about resources for reporting microaggressions at medical schools, but reporting of medical student mistreatment is low in general compared to actual incidents [ 44 ] and therefore, it is reasonable to suspect that similar underreporting occurs with regard to microaggression incidents. Our study identified barriers such as discomfort with reporting, fear of retaliation, and not knowing how to report.…”

Identifying Student Mistreatment Through Peer-Facilitated Learning Environment Sessions

“…Peer-facilitators led a discussion on various topics relevant to the student clinical experience using a facilitator guide with standardized questions. 6 During the discussion, detailed LES minutes were captured. Minutes were organized by thematic category following the facilitator guide.…”

“…All facilitators participated in a 2-hour training session briefing on the climate of mistreatment in medical education and reviewing basic group facilitation skills at the beginning of the academic year. 6…”

Using Simulated Encounters with Standardized Patients to Teach Medical Students to Address Implicit Biases and Microaggressions in the Clinical Setting

“…Researchers using peer-led debriefing found students to report increased comfort in discussing difficult topics and increased reassurance that conversations would remain confidential. 16 Various models aim to provide guidance on approaching clinical situations in which the medical provider is the recipient of discriminatory remarks from patients and/or family members. 17,18 Researchers at UCLA developed an educational tool called VITALS (Validate, Inquire, Take time, Assume the best, Leave opportunities, Speak up for others) as a framework for confronting biased statements and microaggressions that may be encountered in health care settings.…”