Medical student abuse is a major problem in medical
education. The Association of American Medical Colleges' (AAMC) yearly Graduate Questionnaire from 2011 found that 16.8% of medical students report being personally mistreated during
medical school. This number has been
pretty much the same for the past five years (16.6 to 17.0%). The most common
form of mistreatment is public belittling or humiliation which happens
occasionally to 46.8% of medical students and frequently to 4.2%. The scary
part is that there are only 18.3% to whom it never happens. 8.1% of students
were physically harmed or physically punished. The examples given included
being hit, slapped, or kicked. Wow!
Other forms of mistreatment are less common but not
non-existent. Of those who reported mistreatment, almost one percent were asked
for sexual favors in exchange for grades or awards, eight percent were
subjected to unwanted sexual advances, and 20% were subjected to offensive
sexist remarks. Fourteen percent were subjected to racially or ethnically
offensive remarks. The mistreatment of medical students comes from a wide
variety of sources-clinical faculty, residents and interns, nurses, and even
patients. This is scary! These students are highly educated, highly
motivated, and paying a lot of money for the opportunity to become doctors.
A article published in AcademicMedicine, details
the efforts of one medical school to eliminate medical student mistreatment. The article, by Fried and colleagues (1),
describes a 13-year study in which their school (the David Geffen School of
Medicine at UCLA) sought to change the culture of medical education. The school
convened a group of faculty, administrators, and mental health professionals to
develop school-wide interventions that could address the problem of student
mistreatment. These interventions included policies, reporting mechanisms, as
well as resources for discourse among students, faculty, nurses and residents. In addition, they surveyed all of their
medical students at the end of the third year. Now, this is after they finished
their clinical clerkships. They asked questions that were similar to the AAMC's
GQ-how often have you experienced mistreatment which included physical, verbal,
sexual, and ethnic categories. They also asked how often there was power
mistreatment defined as feeling intimidated, dehumanized, or had a threat made
against you.
As an aside at this point. If you are wondering why these
definitions are so specific, you only have to understand how often students are
made to feel this way. It is so much the norm, that the researchers have to
explicitly state what they consider abnormal or students will not even identify
it as abnormal.
The authors included data from 1,946 medical students
between 1996 and 2008. In this study, the authors found that an average of 57%
of students had some form of mistreatment and there was no improvement in this
number after the school instituted mandatory mistreatment education or sexual
harassment prevention training. Women
were significantly more likely to experience sexual harassment than men over
the period from 1996-2008. Students often did not report mistreatment. They
were least likely to report to report incidents of ethnic mistreatment (only 7%
were reported).
The authors' final comment was "despite the proactive
approach taken by our institution to eradicate student mistreatment over this
period, we found that the majority of our students continued to report some
form of mistreatment at least once during their third-year clerkships." They
also admitted that "we
find it disconcerting that students continued to report incidents of all
categories of mistreatment at these rates."
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