Clerkship-Specific Medical Student Mistreatment

Abstract

Few meaningful changes have been made to reduce medical student mistreatment despite years of interventions undertaken based on data regarding mistreatment gathered annually in the Association of American Medical College’s (AAMC) Medical School Graduation Questionnaire (GQ). No studies to date have compared clerkship-specific mistreatment to identify problems unique to individual learning environments. The purpose of this study was to investigate medical student mistreatment during third-year clerkships at a university-based medical school and to evaluate specific mistreatment patterns by clerkship. In the 2012–2013 academic year, 122 third-year medical students were surveyed using the AAMC GQ questions on mistreatment behaviors witnessed or experienced during medical school. During each of their clerkships, students were asked to report mistreatment and to specify the individuals responsible for it. Public humiliation was the most commonly reported form of mistreatment. This was more prominent on Surgery (23.8%), Obstetrics and Gynecology (15.2%), and Internal Medicine (12.4%) versus Neurology (4.8%), Psychiatry (4.3%), Pediatrics (2.1%), and Family Medicine (0%). Faculty (36–64%) and residents (29–50%) were primarily responsible for mistreatment. Students identified many instances of mistreatment in the operating room. More students reported being denied opportunities based solely on gender during Obstetrics and Gynecology than all other clerkships (12 versus 0–2%). Students reported higher incidences of mistreatment on Surgery, Obstetrics and Gynecology, and Internal Medicine. Operating room culture may contribute to medical student mistreatment. Gender-specific mistreatment occurs during the Obstetrics and Gynecology clerkship, which may affect the educational experience of male students. We recommend a clerkship-specific approach to evaluate mistreatment to successfully identify and address mistreatment across learning environments.