This blog is about medical education in the US and around the world. My interest is in education research and the process of medical education.

The lawyers have asked that I add a disclaimer that makes it clear that these are my personal opinions and do not represent any position of any University that I am affiliated with including the American University of the Caribbean, the University of Kansas, the KU School of Medicine, Florida International University, or the FIU School of Medicine. Nor does any of this represent any position of the Northeast Georgia Medical Center or Northeast Georgia Health System.

Friday, November 23, 2012

Medical student mistreatment

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."

(1)  Fried JM, Vermillion M, Parker NH, Uijtdehaage, S.  Eradicating Medical Student Mistreatment: A Longitudinal Study of One Institution’s Efforts.  Academic Medicine  2012; 87(9): 1191–1198.