See No Evil, Hear No Evil, Stop No Evil: Institutional-Level Tracking to Combat Mistreatment of Residents and Fellows

Abstract

Background Mistreatment of trainees, including discrimination and harassment, is a problem in graduate medical education. Current tools to assess the prevalence of mistreatment often are not administered institutionally and may not account for multiple sources of mistreatment, limiting an institution's ability to respond and intervene. Objective We describe the utility of a brief questionnaire, embedded within longer institutional program evaluations, measuring the prevalence of different types of trainee mistreatment from multiple sources, including supervisors, team members, colleagues, and patients. Methods In 2018, we administered a modified version of the mistreatment questions in the Association of American Medical Colleges Graduation Questionnaire to investigate the prevalence and sources of mistreatment in graduating residents and fellows. We conducted analyses to determine the prevalence, types, and sources of mistreatment of trainees at the institutional level across graduate medical education programs. Results A total of 234 graduating trainees (77%) from the University of Minnesota—Twin Cities completed the questions. Patients were cited as the primary source of mistreatment in 5 of 6 categories, including both direct and indirect offensive remarks, microaggressions, sexual harassment, and physical threats (paired t test comparisons from t = 3.92 to t = 9.71, all P < .001). The only category of mistreatment in which patients were not the most significant source was humiliation and shaming. Conclusions Six questions concerning types and sources of trainee mistreatment, embedded within an institutional survey, generated new information for institutional-, departmental- and program-based future interventions. Patients were the greatest source for all types of mistreatment except humiliation and shaming.

Resident Physician Experiences With and Responses to Biased Patients

“…10 Characterizing the nature and frequency of these occurrences may be particularly important for academic medical centers, as these incidents undermine learning for trainees and may result in delayed or suboptimal patient care. 3,4 Data on the frequency of these occurrences among trainees-and even more so on physicians' responses to them-are limited, as much of the literature consists of first-person physician accounts of interactions with racist patients or online surveys of practicing physicians. [5][6][7][11][12][13][14][15][16][17][18] A recent national survey of general surgery residents reported that 43% of residents experienced discrimination on the basis of gender identity and 47% experienced racial/ethnic discrimination from patients or patients' families.…”

“…Biased patient behaviors can range from offensive quips to outright refusal of care 3 and can exact a heavy psychological toll on physicians. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 It is possible that physicians’ encounters with biased patients have become more common in recent years: the health care workforce is increasingly diverse along multiple social dimensions, and the number of hate groups and hate crimes in the US has grown during the past 5 years, suggesting increased social polarization. 10 Characterizing the nature and frequency of these occurrences may be particularly important for academic medical centers, as these incidents undermine learning for trainees and may result in delayed or suboptimal patient care.…”

“…10 Characterizing the nature and frequency of these occurrences may be particularly important for academic medical centers, as these incidents undermine learning for trainees and may result in delayed or suboptimal patient care. 3 , 4 …”

Influence of Psychological Safety and Organizational Support on the Impact of Humiliation on Trainee Well-Being

“…Humiliation and belittlement are the most frequently occurring forms of mistreatment for residents, and also the most distressing. [42][43][44] Humiliation and shame are found to be most perpetuated by departmental faculty for residents 2 and are expected as normal experiences during training. 45 Although approximately 22% of U.S. medical students graduating in 2020 reported being publicly humiliated at least once during their training, 46 there are no comparable data for U.S. residents.…”

The Impact of Patient Prejudice on Minoritized Female Physicians

“…The increasing frequency of PPtP also at academic medical centers is important to document, especially where a diverse body of healthcare providers is providing care in less diverse settings. These occurrences pose a psychological toll on trainees, undermine learning opportunities, and may result in suboptimal patient care (5)(6)(7).…”