Special Feature

One in five medical school grads report mistreatment; AMA taking action

About 17 to 20 percent of medical students report that they have experienced mistreatment, according to the Graduation Questionnaire (GQ) of the Association of American Medical Colleges. The AMA is taking action to address this problem at its roots and improve the medical education learning environment.

At its Annual Meeting in Chicago in June, the AMA reviewed an informational report on the medical education learning environment that calls for developing a working definition of medical student and resident mistreatment; identifying tools that can ascertain whether mistreatment is occurring; and developing strategies to prevent and address mistreatment.

In addition, during its June meeting the AMA held an education program, "Optimizing the Learning Environment: Exploring the Issue of Medical Student Mistreatment," that outlined the scope of the problem and suggested potential solutions. Cosponsored by the AMA Section on Medical Schools, Council on Medical Education, and Medical Student Section, the event brought together the perspectives of medical school deans, resident physicians, and medical students.

Key issues explored by the presenters included the difficulty of defining mistreatment and issues of reporting, confidentiality, and adjudication. The 2011 GQ notes that mistreatment includes "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."

Data from the GQ over the last three years suggest that belittlement and humiliation are the most pervasive forms of mistreatment (85 percent of mistreated students), followed by requests for personal services (24 percent), offensive remarks of a sexual nature (22 percent), and lower evaluations (21 percent).

The most prevalent sources of mistreatment (reflecting data over the last 11 years) were residents (68 percent), clinical faculty (66 percent), nurses (39 percent), patients (28 percent), and even fellow students (17 percent). 

It is clear that a culture in which mistreatment is ignored or implicitly condoned is toxic for learner, teacher, and patient alike. A recent Archives of Surgery commentary cites the epidemic levels of harassment, belittlement and abuse of students and trainees and suggests that surgeons are "trained to be rude."

In December, the AMA will hold a small invitational meeting to further discuss medical student mistreatment and ways to address the problem. This work is directly related to the AMA's Innovative Strategies for Transforming the Education of Physicians (ISTEP) program, which seeks to evaluate medical education processes and outcomes; develop physicians who are knowledgeable, competent and compassionate; and ultimately improve the care of patients.