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.
By the end of this program, learners will be able to:
- Discuss preexisting expectations and concerns regarding surgical culture.
- Create a consensus definition of mistreatment as it applies to the clinical learning environment, with reference to trigger videos and group discussion.
- Identify the available resources to report and address mistreatment if it occurs.
None to report.
Supported in part by a grant from the Vice Provost of Online Learning at Stanford University School of Medicine.
- Cook AF, Arora VM, Rasinski KA, Curlin FA, Yoon JD. The prevalence of medical student mistreatment and its association with burnout. Acad Med. 2014;89(5):749-754. http://dx.doi.org/10.1097/ACM.0000000000000204
- Dorsey JK, Roberts NK, Wold B. Feedback matters: the impact of an intervention by the dean on unprofessional faculty at one medical school. Acad Med. 2014;89(7):1032-1037. http://dx.doi.org/10.1097/ACM.0000000000000275
- Fried JM, Vermillion M, Parker NH, Uijtdehaage S. Eradicating medical student mistreatment: a longitudinal study of one institution’s efforts. Acad Med. 2012;87(9):1191-1198. http://dx.doi.org/10.1097/ACM.0b013e3182625408
- Gan R, Snell L. When the learning environment is suboptimal: exploring medical students’ perceptions of “mistreatment.” Acad Med. 2014;89(4):608-617. http://dx.doi.org/10.1097/ACM.0000000000000172
- Heru AM. Using role playing to increase residents’ awareness of medical student mistreatment. Acad Med. 2003;78(1):35-38. http://dx.doi.org/10.1097/00001888-200301000-00008
- Heru A, Gagne G, Strong D. Medical student mistreatment results in symptoms of posttraumatic stress. Acad Psychiatry. 2009;33(4):302-306. http://dx.doi.org/10.1176/appi.ap.33.4.302
- Lewis J, Feldman N, Rich A, Ackerman S, Patel C. Positive Learning Environment and Mistreatment Prevention Module. MedEdPORTAL Publications; 2015. Available from: https://www.mededportal.org/publication/10113 http://dx.doi.org/10.15766/mep_2374-8265.10113
- Medical school graduation questionnaire: 2014 all schools summary report. Association of American Medical Colleges Web site. https://www.aamc.org/download/397432/data/2014gqallschoolssummaryreport.pdf. Published July 2014.
- Musselman LJ, MacRae HM, Reznick RK, Lingard LA. “You learn better under the gun”: intimidation and harassment in surgical education. Med Educ. 2005;39(9):926-934. http://dx.doi.org/10.1111/j.1365-2929.2005.02247.x
- Nagata-Kobayashi S, Sekimoto M, Koyama H, et al. Medical student abuse during clinical clerkships in Japan. J Gen Intern Med. 2006;21(3):212-218. http://dx.doi.org/10.1111/j.1525-1497.2006.00320.x
- Rees CE, Monrouxe LV. “A morning since eight of just pure grill”: a multischool qualitative study of student abuse. Acad Med. 2011;86(11):1374-1382. http://dx.doi.org/10.1097/ACM.0b013e3182303c4c
- Rich A, Ackerman S, Patel C, Feldman N, Adams D, Lewis J. Creating a Positive Learning Environment: Educational Film and Discussion Guide. MedEdPORTAL Publications; 2015. Available from: https://www.mededportal.org/publication/10131 http://dx.doi.org/10.15766/mep_2374-8265.10131
- Schuchert MK. The relationship between verbal abuse of medical students and their confidence in their clinical abilities. Acad Med. 1998;73(8):907-909. http://dx.doi.org/10.1097/00001888-199808000-00018
- Shoukat S, Anis M, Kella DK, et al. Prevalence of mistreatment or belittlement among medical students—a cross sectional survey at a private medical school in Karachi, Pakistan. PloS ONE. 2010;5(10):e13429. http://dx.doi.org/10.1371/journal.pone.0013429
- Silver HK. Medical students and medical school. JAMA. 1982;247(3):309-310. http://dx.doi.org/10.1001/jama.1982.03320280029024
- Stratton TD, McLaughlin MA, Witte FM, Fosson SE, Nora LM. Does students’ exposure to gender discrimination and sexual harassment in medical school affect specialty choice and residency program selection? Acad Med. 2005;80(4):400-408. http://dx.doi.org/10.1097/00001888-200504000-00020
- Uhari M, Kokkonen J, Nuutinen M, et al. Medical student abuse: an international phenomenon. JAMA. 1994;271(13):1049-1051. http://dx.doi.org/10.1001/jama.271.13.1049
This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives license.