Abstract
BackgroundThe learning environment within a school of medicine influences medical students’ values and their professional development. Despite national requirements to monitor the learning environment, mistreatment of medical students persists.MethodsWe designed a program called WE SMILE: We can Eradicate Student Mistreatment In the Learning Environment with a vision to enhance trainee and faculty awareness and ultimately eliminate medical student mistreatment. We provide a description of our program and early outcomes.ResultsThe program has enhanced student awareness of what constitutes mistreatment and how to report it. Faculty members are also aware of the formal processes and procedures for review of such incidents. Our proposed model of influences on the learning environment and the clinical workforce informs the quality of trainee education and safety of patient care. Institutional leadership and culture play a prominent role in this model. Our integrated institutional response to learning environment concerns is offered as a strategy to improve policy awareness, reporting and management of student mistreatment concerns.ConclusionsOur WE SMILE program was developed to enhance education and awareness of what constitutes mistreatment and to provide multiple pathways for student reporting, with clear responsibilities for review, adjudication and enforcement. The program is demonstrating several signs of early success and is offered as a strategy for other schools to adopt or adapt. We have recognized a delicate balance between preserving student anonymity and informing them of specific actions taken. Providing students and other stakeholders with clear evidence of institutional response and accountability remains a key challenge. Multiple methods of reporting have been advantageous in eliciting information on learning environment infringements. These routes and types of reporting have enhanced our understanding of student perceptions and the specific contexts in which mistreatment occurs, allowing for targeted interventions. A common platform across the healthcare professions to report and review concerns has afforded us opportunities to deal with interprofessional issues in a respectful and trustworthy manner. We offer a model of learning environment influences with leadership and institutional culture at the helm, as a way to frame a comprehensive perspective on this challenging and complex concern.
Highlights
The learning environment within a school of medicine influences medical students’ values and their professional development
In 1992, the Association of American Medical Colleges (AAMC) began to include questions related to this problem in the graduation questionnaire (GQ) that is offered to all U.S graduating medical students for completion [8]
The 2011 AAMC GQ included a definition of mistreatment as a preamble to the 13 questions regarding medical student mistreatment: “Mistreatment, either intentional or unintentional, occurs when behavior shows disrespect for the dignity of others and unreasonably interferes with the learning process: Examples of mistreatment include sexual harassment; discrimination or harassment based on race, religion, ethnicity, gender, or sexual orientation; humiliation, psychological or physical punishment and the use of grading and other forms of assessment in a punitive manner.”
Summary
The learning environment within a school of medicine influences medical students’ values and their professional development. Reports of inappropriate learning environments, abuse and mistreatment of medical trainees abound. While the earliest report of abuse of medical interns dates to 1928 [1], two commentaries published over thirty years ago brought this issue to heightened attention [2, 3] resulting in several studies of medical student perceptions of mistreatment at individual medical schools [4,5,6,7]. The AAMC defined specific behaviors in the faculty trainee relationship in their teacher-learner compact [9]. The Liaison Committee on Medical Education (LCME), the accrediting body of U.S medical education programs, and the Committee on the Accreditation of Canadian Medical Schools (CACMS) have recommended that medical schools “define the standards of conduct in the teacher-learner relationship, develop procedures to address complaints that are received confidentially and devoid of retaliation, and develop educational programs to prevent the behaviors.”. Priority ought to be given to the clinical learning environment in our effort to impact trainee experiences and professionalism favorably [11]
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