Abstract
Mistreatment of medical students is pervasive and has negative effects on performance, well-being, and patient care. To document the published programmatic and curricular attempts to decrease the incidence of mistreatment. PubMed, Scopus, ERIC, the Cochrane Library, PsycINFO, and MedEdPORTAL were searched. Comprehensive searches were run on "mistreatment" and "abuse of medical trainees" on all peer-reviewed publications until November 1, 2017. Citations were reviewed for descriptions of programs to decrease the incidence of mistreatment in a medical school or hospital with program evaluation data. A mistreatment program was defined as an educational effort to reduce the abuse, mistreatment, harassment, or discrimination of trainees. Studies of the incidence of mistreatment without description of a program, references to a mistreatment program without outcome data, or a program that has never been implemented were excluded. Authors independently reviewed all retrieved citations. Articles that any author found to meet inclusion criteria were included in a full-text review. The data extraction form was developed based on the guidelines for Best Evidence in Medical Education. An assessment of the study quality was conducted using a conceptual framework of 6 elements essential to the reporting of experimental studies in medical education. A descriptive review of the interventions and outcomes is presented along with an analysis of the methodological quality of the studies. A separate review of the MedEdPORTAL mistreatment curricula was conducted. Of 3347 citations identified, 10 studies met inclusion criteria. Of the programs included in the 10 studies, all were implemented in academic medical centers. Seven programs were in the United States, 1 in Canada, 1 in the United Kingdom, and 1 in Australia. The most common format was a combination of lectures, workshops, and seminars over a variable time period. Overall, quality of included studies was low and only 1 study included a conceptual framework. Outcomes were most often limited to participant survey data. The program outcome evaluations consisted primarily of surveys and reports of mistreatment. All of the included studies evaluated participant satisfaction, which was mostly qualitative. Seven studies also included the frequency of mistreatment reports; either surveys to assess perception of the frequency of mistreatment or the frequency of reports via official reporting channels. Five mistreatment program curricula from MedEdPORTAL were also identified; of these, only 2 presented outcome data. There are very few published programs attempting to address mistreatment of medical trainees. This review identifies a gap in the literature and provides advice for reporting on mistreatment programs.
Highlights
Mistreatment and abuse of medical trainees has been extensively documented since the 1980s, when Henry Silver drew comparisons between medical students and battered foster children.[1]
Of the programs included in the 10 studies, all were implemented in academic medical centers
This review identifies a gap in the literature and provides advice for reporting on mistreatment programs
Summary
Mistreatment and abuse of medical trainees has been extensively documented since the 1980s, when Henry Silver drew comparisons between medical students and battered foster children.[1]. Mistreatment is associated with increased burnout,[8] decreased confidence in clinical abilities,[9] and symptoms of posttraumatic stress disorder.[10] And trainees are not the only ones affected: there is mounting evidence that abuse and mistreatment within the care team leads to worse outcomes for patients. A recent Israeli study by Riskin et al[11] assessed neonatal intensive care unit team performance in a simulation involving a critically ill preterm infant. The study by Riskin and colleagues provides empirical evidence for the theory that interpersonal aggression can cause iatrogenic events by negatively affecting professionals’ cognitive processing and communication.[12] In nonmedical workplaces, interpersonal aggression is a well-documented threat to productivity.[13,14]
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