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Moving from medical student mistreatment to a culture of respect

Attention to the issue of medical student mistreatment is growing, particularly in light of new data from the Association of American Medical Colleges (AAMC) Graduation Questionnaire showing that 47 percent of graduating medical students are reporting mistreatment. In comparison, about one student in five reported mistreatment in the past (the questionnaire was revised this year to be more explicit and to denote specific behaviors).

Mistreatment and similar behaviors "compromise the learning environments of medical students and residents," says Darrell G. Kirch, MD, AAMC President and CEO, in the latest issue of the AAMC Reporter. "Tomorrow's doctors must be able to learn in a safe and supportive culture that fosters the respectful, compassionate behavior we expect them to show their future patients. Though . . . unprofessional scenarios tend to be the exception rather than the rule, the results of the 2012 Graduation Questionnaire (GQ) tell us we still have work to do."

Part of this work is to better define mistreatment. "What is humiliation, and what is really trying to push people to be their very best?" asks Marsha Rappley, MD, dean of Michigan State University College of Human Medicine, in another AAMC Reporter article. "There will always be experiences, as a teacher, where I'm asking an important question, and the student doesn't know the answer. I need to let them know it's a problem that they don't know the answer."

Defining mistreatment is one thing; eradicating it is another, as evidenced by a recent study from the University of California, Los Angeles, David Geffen School of Medicine, in the September issue of Academic Medicine. The study's authors found no evidence of a culture change at the institution, despite a 13-year program with "informal and formal mechanisms of reporting and resolving incidents of mistreatment, providing education for students, residents, and faculty, and promoting the open discussion of this topic at all levels." They noted that the "hidden curriculum" may be undermining efforts to stop mistreatment.

"The concept of eradicating student mistreatment needs to be embraced at the highest levels of leadership," said Joyce M. Fried, assistant dean at UCLA, who led the study. "If you're really going to change the culture, it has to come from the top."

The AMA is working to address this issue. At its meeting in Honolulu, Hawaii, Nov. 9-10, the AMA Section on Medical Schools meeting will feature an educational session, "Medical student mistreatment: The graduate medical education connection."

Register now for the SMS meeting, held in conjunction with the Interim Meeting of the AMA House of Delegates. Registration is free of charge.

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American Medical Association designates this live activity for a maximum of 3.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In addition, the AMA-convened Learning Environment Study Consortium encompasses 28 participating schools from the U.S. and Canada, with data on approximately 5,500 medical students. The longitudinal study, now in its third year, is examining how students' personal characteristics and the institution's formal curriculum interact to impact the development of medical professionalism among students.