Original Publication
Open Access

Positive Learning Environment and Mistreatment Prevention Module

Published: June 10, 2015 | 10.15766/mep_2374-8265.10113

Included in this publication:

  • Instructor's Guide.docx
  • MCQ for Module.docx
  • List of Edits for Module.docx
  • Mistreatment Prevention Module Version A folder
  • Mistreatment Prevention Module Version B folder
  • Mistreatment Prevention Module Version C folder

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


This multimedia module is designed to increase awareness of and knowledge about the national problem of medical student mistreatment as defined by the Association of American Medical Colleges for all participants in the learning environment. The modules also provide an opportunity to (1) communicate institutional efforts to prevent and eliminate mistreatment in the learning environment; (2) post institutional policies and reporting routes for mistreatment; and (3) collect documentation that learners have thoroughly reviewed this material and are aware of institutional policies via an attestation prompt and postmodule quiz. So far, we have assigned a pilot version of the module to medical students at two curriculum points, in the second year prior to the start of the clerkships and in the fourth year prior to graduation. These assignments have used the attestation function to demonstrate student awareness of the policy and procedures regarding student mistreatment. One pitfall of the original version of the module is its length, especially when used in conjunction with classroom discussion. For this purpose, we created a shortened version of the module without the film for assignment prior to conducting a film and discussion session. We plan to use this during orientation for incoming clerkship students and new residents. The module has been well received by students, residents, faculty, and staff at our institution and by colleagues at other institutions who saw earlier versions. Viewers appreciate that the module captures the nuances and ambiguity inherent in the problem of mistreatment rather than simplifying the issue by using black-and-white examples.

Educational Objectives

By the end of the module, the learner will be able to:

  1. Provide a standard curriculum that defines medical student mistreatment, describes the AAMC categories of mistreatment, and identifies some of the complex factors that contribute to a negative learning environment.
  2. Demonstrate institutional support for the elimination of mistreatment from the learning environment, including the encouragement of student reporting.
  3. Provide a platform for the review of institutional policies and procedures with an optional attestation prompt to document compliance.
  4. Promote the creation of an optimal learning environment by raising awareness and cultivating an understanding of the phenomenon of learner mistreatment.

Author Information

  • Judith Lewis, MD: University of Vermont College of Medicine
  • Nathalie Feldman, MD, CM: University of Vermont College of Medicine
  • Anne Rich, MD: University of Vermont College of Medicine
  • Sean Ackerman, MD: University of Vermont College of Medicine
  • Charmaine Patel, MD: University of Vermont College of Medicine

None to report.

None to report.


  1. Ogden PE, Edward HW, Elnicki MD. Do Attending Physicians, Nurses, Residents and Medical Students Agree on What Constitutes Medical Student Abuse? Acad Med, 2005; Vol. 80, No.10. http://dx.doi.org/10.1097/00001888-200510001-00022
  2. Lebenthal A, Kaiserman I, Lernau O. Student abuse in medical school: a comparison of students' and faculty's perceptions. Isr J Med Sci. 1996 Mar-Apr;32(3-4):229-38.
  3. Sheehan KH Sheehan DV, White K, Leibowitz A, Baldwin DC Jr. A pilot study of medical student "abuse". Student perceptions of mistreatment and misconduct in medical school. JAMA 1990 Jan 26;263(4):533-7. http://dx.doi.org/10.1001/jama.263.4.533
  4. Kassebaum DG, Cutler ER. On the culture of student abuse in medical school. Acad Med 1998;73:1149-1158. http://dx.doi.org/10.1097/00001888-199811000-00011
  5. Baldwin DC, Daugherty SR, Eckenfels EJ. Student perceptions of mistreatment and harassment during medical school – A survey of 10 United States schools. West J Med 1991; 155:140-145.
  6. Silver HK, Glicken AD. Medical Student abuse. Incidence, severity and significance. JAMA, 1990; 263:527-532. http://dx.doi.org/10.1001/jama.263.4.527
  7. Johnson, SL. International perspectives on workplace bullying among nurses: a review. Int Nurs Rev. 2009 Mar; 56(1): 34-40. http://dx.doi.org/10.1111/j.1466-7657.2008.00679.x
  8. Yang LQ, Caughlin DE, Gazica MW, Truxillo DM, Spector PE. Workplace mistreatment climate and potential employee and organizational outcomes: A meta-analytic review from the target's perspective. J Occup Health Psychol. 2014 Jul; 19(3):315-35. http://dx.doi.org/10.1037/a0036905
  9. Richman JA, Flaherty JA, Rospenda KM, Christenson ML. Mental health consequences and correlates of reported medical student abuse. JAMA 1992 Feb 5;267(5):692-4. http://dx.doi.org/10.1001/jama.267.5.692
  10. Laschinger HK. Impact of workplace mistreatment on patient safety risk and nurse-assessed patient outcomes. J Nurs Adm. 2014 May;44(5):284-90. http://dx.doi.org/10.1097/NNA.0000000000000068
  11. Mikkelsen EG, Einarsen S. Relationships between exposure to bullying at work and psychological and psychosomatic health complaints: the role of state negative affectivity and generalised self-efficacy. Scand J Psych 2002, 43(5): 397-405. http://dx.doi.org/10.1111/1467-9450.00307
  12. Sofield L, Salmon SW. Workplace violence: a focus on verbal abuse and intent to leave the organisation. Orthop Nurs 2003, 22(4):274-283. http://dx.doi.org/10.1097/00006416-200307000-00008
  13. Björkqvist, K. Social defeat as a stressor in humans. Physiology & Behavior. 2001. 73(3): 435–42. http://dx.doi.org/10.1016/S0031-9384(01)00490-5


Lewis J, Feldman N, Rich A, Ackerman S, Patel C. Positive learning environment and mistreatment prevention module. MedEdPORTAL. 2015;11:10113. https://doi.org/10.15766/mep_2374-8265.10113