E. Brandford1, D. Hoang1, B. Hasty1, E. Shipper1, S. Merrell1, D. Lin1, J. Lau1 1Stanford University,General Surgery,Palo Alto, CA, USA
Introduction:
Mistreatment has many negative effects on medical students including increased burnout, post-traumatic stress, depressive symptoms, drinking for escape, and decreased confidence in clinical skills. Mistreatment is reported at high rates during surgery clerkships, and may result in a decreased interest in pursuing a surgical residency. Despite the consensus that mistreatment is a problem that needs to be addressed, there exists no uniform definition of medical student mistreatment. Definitions used by medical institutions typically includes a small number of specific acts but are not necessarily based on medical student experiences. Without first defining mistreatment, we cannot develop interventions to prevent it. Our purpose was to characterize student generated definition(s) of mistreatment.
Methods:
An anonymous survey was distributed to medical students during both the first and last didactic session of their 8-week required surgery clerkship. Open ended survey questions asked students to define mistreatment generally, within the context of a surgery rotation, and to give examples of medical student mistreatment (real or hypothetical). Survey responses were qualitatively analyzed using content and thematic analysis to determine the components of mistreatment.
Results:
Between January 2014 and June 2016 a total of 219 medical students participated in the general surgery clerkship. 197 (90%) of students completed the pre-clerkship survey, and 183 (84%) completed the post clerkship survey, generating a total of 380 responses. Preliminary data analysis suggests that the features of mistreatment, as defined by medical students, can be described by four major categories: 1) perceived intent of the educator, 2) acts of mistreatment, 3) outcome of the action for the student and the educational environment, and 4) setting in which mistreatment takes place. The acts of mistreatment in the medical student generated definitions included examples not represented by traditional definitions of mistreatment, which are often limited to verbal abuse, physical abuse, discrimination and embarrassment. In addition, medical student definitions included subtler actions such as neglect and exclusion from learning.
Conclusion:
Our qualitative analysis demonstrates that a wide breadth of factors constitute mistreatment in surgical clerkships that is not captured by official definitions often used by medical institutions. While traditional acts of mistreatment were represented, student generated definitions also emphasized the context in which those actions took place, including the setting, the intent of the educator, and the final impact on the student. This delineation of mistreatment paves the way for the development of interventions to target the expanded range of actions, intents, and outcomes that students report as constituting mistreatment.