Neglect in Undergraduate Medical Education: A Systematic Review

Abstract

OBJECTIVE: To describe and compare the definitions of neglect used in the medical education literature and the estimated prevalence of neglect reported on clinical rotations. DATA SOURCES: EMBASE and Ovid MEDLINE were searched using these terms: lack of appreciation, lack of guidance, ignored, passed over, unintentional mistreat, unintentional mistreatment, missed learning opportunity, environment-based mistreatment, insidious mistreatment, marginalized learner, neglect, social dominance, medical education, undergraduate medical education, medical student. METHODS OF STUDY SELECTION: Non-English language articles, editorials, commentaries, and letters were excluded using search filters or by hand. Publications were selected for full-text review if they commented on medical students’ perceptions of being ignored, neglected, mistreated, or experiencing an unwelcoming learning environment. Further screening of 1,698 identified only three that focused specifically on neglect. Three additional studies were identified from reference lists or findings of prior literature searches. TABULATION, INTEGRATION AND RESULTS: The six publications included in the review reported the results of three qualitative and three cross-sectional studies. Medical Education Research Study Quality Instrument scores for the cross-sectional studies were low due to limitations in study design: single institution, no comparison group, and unknown validity of evaluation instruments. A discrete definition of neglect was not found, but several authors described a spectrum including “covert, status related abuse” and “environment-based mistreatment” to describe this phenomenon. CONCLUSION: Poor study quality and missing or inconsistent definitions and measures limit the validity of efforts to estimate the prevalence of neglect on different clinical rotations for medical students.