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patients or their families over the last year. While 44% and 40% felt that they intervened effectively when they or their colleagues were mistreated, respectively, 13% reported having received training on how to intervene. Verbal threats or intimidation, threats of physical harm, or actual physical harm were reported by 89%, 24%, and 9%, respectively. Eighty percent of residents were targets of offensive behavior or remarks. Remarks based on age and gender were reported by 69% and 49%, followed by appearance (27%), race/ethnicity (18%), language proficiency (9%) and sexual orientation (2%). Seventeen percent of residents reported these events; the most common reasons for not reporting were that the incident did not seem important enough (71%) or that the resident thought nothing would be done about it (49%). CONCLUSIONS: Pediatric residents commonly experience mistreatment from patients and their families. Effective intervention is limited by lack of training, self-efficacy, and perceived institutional responsiveness. Based on these results, we are now implementing and evaluating educational and systems-based interventions to address this mistreatment and optimize resident learning, wellness, and patient care.