11. MISTREATMENT OF PEDIATRIC RESIDENTS BY PATIENTS AND THEIR FAMILIES IS COMMON AND REQUIRES MORE EFFECTIVE INTERVENTIONS

Abstract

Background Mistreatment of trainees adversely impacts their learning and wellbeing and can lead to medical errors and preventable adverse outcomes. However, few studies have examined mistreatment of trainees by patients and their families. We hypothesized that pediatric residents commonly experience mistreatment from patients and their families and lack training to effectively intervene. Methods We created an anonymous Qualtrics survey to assess resident experiences of mistreatment based on the AAMC Graduation Questionnaire, review by departmental and hospital leadership, and pilot testing. We emailed the survey to all categorical pediatrics (60), combined internal medicine-pediatrics (16), and child psychiatry residents (2). Results Of 78 residents, 45 completed the survey (58%). Ninety-eight percent reported experiencing mistreatment from 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.