Underlying mechanisms of mistreatment in the surgical learning environment: A thematic analysis of medical student perceptions

• Published in: The American journal of surgery Vol. 215; no. 2; pp. 227 - 232
• Main Authors: Brandford, Elena, Hasty, Brittany, Bruce, Janine S., Bereknyei Merrell, Sylvia, Shipper, Edward S., Lin, Dana T., Lau, James N.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2018; Elsevier Limited
• Subjects: Adult; Behavior; Clinical Clerkship; Content analysis; Curricula; Education; Exploitation; Female; General Surgery - education; Graduate students; Humans; Interpersonal Relations; Learning; Male; Medical personnel; Medical residencies; Medical schools; Medical students; Physicians; Polls & surveys; Qualitative Research; Questionnaires; School environment; Social Discrimination; Social Perception; Stress, Psychological - etiology; Student attitudes; Students; Students, Medical - psychology; Studies; Surgery; United States; United States; United States > US
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2017.10.042

Medical students experience more psychological distress than the general population. One contributing factor is mistreatment. This study aims to understand the mechanisms of mistreatment as perceived by medical students. Students completed anonymous surveys during the first and last didactic session of their surgery clerkship in which they defined and gave examples of mistreatment. Team-based thematic analysis was performed on responses. Between January 2014 and June 2016, 240 students participated in the surgery clerkship. Eighty-nine percent of students completed a survey. Themes observed included (1) Obstruction of Students' Learning, (2) Exploitation of Student Vulnerability, (3) Exclusion from the Medical Team, and (4) Contextual Amplifiers of Mistreatment Severity. The themes observed in this study improve our understanding of the students' perspective on mistreatment as it relates to their role in the clinical learning context, which can serve as a starting point for interventions that ultimately improve students' experiences in the clinical setting. Mistreatment remains common and has many negative effects on medical students. This study aims to understand how medical students perceive mistreatment through a qualitative analysis of open-ended survey responses collected during a core surgery clerkship. Thematic analysis yielded the following themes categorizing mistreatment: (1) Obstruction of Students' Learning, (2) Exploitation of Student Vulnerability, (3) Exclusion from the Medical Team, (4) Contextual Amplifiers of Mistreatment Severity.