Perception of Medical Student Mistreatment: Does Specialty Matter?

O’Brien, Kevin; Mechaber, Alex J.; Ledford, Cynthia H.; Klocksieben, Farina; Fagan, Mark J.; Harrell, Heather; Kaib, Susan; Elnicki, Mike; Deusen, Reed Van; Moerdler, Scott; Jagsi, Reshma; Frank, Erica

doi:10.1097/acm.0000000000004223

Cited by 4 publications

(1 citation statement)

References 27 publications

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“…One finding from our study and others is that the organisational culture is a key factor in experiences of negative interpersonal interactions, potentially acting both as an antecedent to maltreatment and as a factor which influences sense-making. Indeed, previous studies demonstrating inter-specialty differences in what types of behaviour are understood to be maltreatment emphasise the importance of organisational culture, 66,67 describing the 'environment-based' nature of maltreatment originating in exploitive organisational cultures that systematically deprive learners of agency. 43 Our data are filled with stories of maltreatment that involve descriptions of environments, norms and resource constraints associated with a corporatised health-care system that prioritises efficiency.…”

Section: Organisational Culture Influences the Appraisal Of Negative ...mentioning

confidence: 99%

How medical learners and educators decide what counts as mistreatment: A qualitative study

et al. 2023

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IntroductionThe mistreatment or abuse (maltreatment) of medical learners by their peers and supervisors has been documented globally for decades, and there is significant research about the prevalence, sequelae and strategies for intervention. However, there is evidence that learners experience maltreatment as being less clear cut than do researchers, educators and administrators. This definitional ambiguity creates problems for understanding and addressing this issue. The objective of this study was to understand how medical learners and educators make sense of less‐than‐ideal interactions in the clinical learning environment, and to describe which factors influenced their perception that the encounter constituted maltreatment.MethodsUsing constructivist grounded theory, we interviewed 16 medical students, 15 residents or fellows, and 18 educators associated with a single medical school (n = 49). Data collection began with the most junior learners, iterating with analysis as we progressed through the project. Constant comparative analysis was used to gather and compare stories of ‘definitely’, ‘maybe’ and ‘definitely not’ maltreatment across a variety of axes including experience level, clinical setting and type of interaction.ResultsOur data show that learners and educators have difficulty classifying their experiences of negative interpersonal interaction, except in the most severe and concrete cases. While there was tremendous variation in the way they categorised similar experiences, there was consistency in the elements drawn upon to make sense of those experiences. Participants interpreted negative interpersonal interactions on an individual basis by considering factors related to the interaction, initiator and recipient.ConclusionsOnly the most negative behaviour is consistently understood as maltreatment; a complex process of individual sense‐making is required to determine the acceptability of each interaction. The differences between how individuals judge these interactions highlight an opportunity for administrative, research and faculty development intervention.

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Section: Organisational Culture Influences the Appraisal Of Negative ...mentioning

confidence: 99%

How medical learners and educators decide what counts as mistreatment: A qualitative study

et al. 2023

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Perceived Mistreatment and Professional Identity of Medical Students in China

Ma,

Shen,

Xiao

et al. 2024

JAMA Netw Open

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ImportanceMistreatment is a common experience among medical students, with various negative consequences of such perceived mistreatment reported. However, few large-scale studies have investigated the association between perceived mistreatment and the formation of medical students’ professional identities.ObjectiveTo investigate medical students’ perceived mistreatment during medical school and its association with professional identity.Design, Setting, and ParticipantsThis repeated cross-sectional study included medical students graduating between 2019 and 2022 at 135 medical schools in China. Analyses were performed from July 25, 2023, to May 15, 2024.ExposureThe China Medical Student Survey includes 5 items designed to measure students’ perceived experiences of mistreatment.Main Outcomes and MeasuresProfessional identity was measured using a validated 7-item scale adapted from the Macleod Clark Professional Identity Scale. Multivariate linear regression was used to determine the association between perceived mistreatment and medical students’ professional identity.ResultsA total of 94 153 students (53 819 female [57.2%]; 83 548 Han ethnicity [88.7%]) were analyzed, representing 67.2% of the medical graduates enrolled in all responding medical schools. Most medical students reported having experienced at least 1 mistreatment incident (79 554 students [84.5%]). Medical students reported being required to perform personal service (57 455 students [61.0%]), experiencing mistreatment by patients (67 439 students [71.6%]), being publicly humiliated (24 348 students [25.9%]), being unjustly treated (35 926 students [38.2%]), and experiencing deliberate harassment (46 082 students [48.9%]). A negative association and saturation effect (where effect size plateaus after moderate exposure of mistreatment) were found between the degree of mistreatment and medical students’ professional identity scores. Compared with students who had not reported mistreatment, students who reported single (β, −0.30; 95% CI, −0.33 to −0.28; P &lt; .001), moderate (β, −0.66; 95% CI, −0.69 to −0.63; P &lt; .001), and high (β, −0.62; 95% CI, −0.65 to −0.58; P &lt; .001) frequency of mistreatment were more likely to have lower professional identity scores; this association persisted but was attenuated after adjusting for students’ sociodemographic characteristics and was consistent across all the types of mistreatment.Conclusions and RelevanceIn this national, repeated cross-sectional study, a high prevalence of mistreatment among medical students in China and a negative association between perceived mistreatment and medical students’ professional identity was found. Further research is needed to ensure that medical schools offer supportive and respectful learning environments.

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