Original Publication
Open Access

Establishing a Positive Clinical Learning Environment in the Surgery Core Clerkship: A Video-Based Mistreatment Curriculum

Published: December 11, 2015 | 10.15766/mep_2374-8265.10313

Included in this publication:

  • Mistreatment Instructor's Guide.docx
  • Mistreatment Definition Worksheet.docx
  • Mistreatment Eval Form.docx
  • Scenario 1 Wards.mp4
  • Scenario 2 Wards.mp4
  • Scenario 3 Wards.mp4
  • Scenario 4 OR.mp4
  • Scenario 5 OR.mp4
  • Scenario 6 OR.mp4
  • Scenario 7 OR.mp4
  • Scenario 8 Resident Wards.mp4

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.


Medical student mistreatment has been a pervasive problem in the educational literature since the 1980s. In the 2014 Association of American Medical Colleges (AAMC) Graduation Questionnaire, excluding reports of public embarrassment, 39.9% of graduating medical students reported experiencing some form of mistreatment during medical school. This video-based module was designed to establish a positive clinical learning environment and reduce medical student mistreatment in the surgical core clerkship. The program consists of a preclerkship session to set expectations and an end-of-clerkship debriefing. The program’s objectives include discussing preexisting expectations of the clerkship, creating a consensus definition of mistreatment, and identifying available resources for responding to mistreatment if it occurs. Both sessions are based around short trigger videos designed to spark discussion. This program has been implemented at one surgical clerkship program for over a year, and elements of the program have been used in other clerkship programs, including emergency medicine and obstetrics and gynecology. Eighty-four students (N = 89, 94% response rate) who participated in the mistreatment program between March 2014 and February 2015 completed the anonymous, electronic, end-of-curriculum survey. Students rated each session on a 5-point Likert scale (1 = poor, 5 = outstanding). Mean (standard deviation) ratings for the mistreatment program sessions during the first and last weeks of the clerkship were 4.04 (0.90) and 4.30 (0.76), respectively. The majority of students rated the initial mistreatment session as “excellent” or “outstanding” (78%), with 90% rating the second session as “excellent” or “outstanding.” In the open-ended survey, 100% of student responses were coded as “positive” by two independent reviewers.

Educational Objectives

By the end of this program, learners will be able to:

  1. Discuss preexisting expectations and concerns regarding surgical culture.
  2. Create a consensus definition of mistreatment as it applies to the clinical learning environment, with reference to trigger videos and group discussion.
  3. Identify the available resources to report and address mistreatment if it occurs.

Author Information

  • Laura Mazer, MD: Stanford University School of Medicine
  • Cara Liebert, MD: Stanford University School of Medicine
  • Sylvia Bereknyei Merrell, DrPH, MS: Stanford University School of Medicine
  • Dana Lin, MD: Stanford University School of Medicine
  • James Lau, MD, MHPE, FACS: Stanford University School of Medicine

None to report.

Supported in part by a grant from the Vice Provost of Online Learning at Stanford University School of Medicine.


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Mazer L, Liebert C, Bereknyei Merrell S, Lin D, Lau J. Establishing a positive clinical learning environment in the surgery core clerkship: a video-based mistreatment curriculum. MedEdPORTAL. 2015;11:10313. https://doi.org/10.15766/mep_2374-8265.10313