Raising Awareness of Mistreatment Policies and Reporting Procedures Using a Novel Medical Student Mobile Application.

BACKGROUND: Reports of mistreatment are an important first step to improving medical students' learning environment. Students may not report mistreatment due to a lack of awareness of institutional policies, reporting procedures, or for fear of reprisal. AIM: We sought to determine if a medical school cross-platform mobile application (app) could be used to improve students' awareness of mistreatment policies and procedures. SETTING AND PARTICIPANTS: Participants in this intervention included Drexel University College of Medicine (DUCOM) medical students, faculty, and Student Affairs Deans. PROGRAM DESCRIPTION: We created the DUCOMpass© app to make mistreatment policies and procedures more readily available and to ease mistreatment reporting for medical students. PROGRAM EVALUATION: To determine the efficacy of the app at raising mistreatment awareness, we analyzed our institutional Graduation Questionnaire data before and after the introduction of the app (from 2016 to 2023) as compared with the national average. We verified our students' self-reported data with app usage data. DISCUSSION: To our knowledge, this is the first instance of a medical school mobile app being implemented to successfully address medical student mistreatment awareness and reporting. We found that reaching students in a familiar and easily accessible mode(s) of communication is a catalyst for lasting change. NIH TRIAL REGISTRY: Not applicable.

Examining medical students' experience of gender-based discrimination and sexual harassment from clinical teachers at a UK medical school.

PURPOSE OF THE ARTICLE: To quantify the prevalence and characterise the nature of gender-based discrimination (GBD) and sexual harassment (SH) arising from clinical teachers towards medical students at one UK medical school. MATERIALS AND METHODS: A mixed quantitative and qualitative survey of medical students. Chi-squared analysis and logistic regression was performed on quantitative data, while an inductive thematic analysis of qualitative data was undertaken. These findings were compared to look for common patterns. RESULTS: Females were significantly more likely to report experiencing both GBD (χ2 = 38.61, p < 0.0001) and SH (χ2 = 19.53, p < 0.0001) than males (OR = 10.45 (CI 4.84 - 22.56, p < 0.0001)). These behaviours were more likely to be reported in specific surgical placements than medical placements (χ2 = 15.06, p < 0.001 and χ2 = 5.90, p < 0.05). Perpetrators were more commonly male, and more commonly consultants. Exposure to GBD or SH was significantly more likely to affect the choice of specialty in females compared to males (χ2 = 11.17, p < 0.001). Students noted a casual use of sexist language, inappropriate sexual advances, and gender-based microaggressions which create a pervasive discrepancy in educational opportunities between genders. Participants reported that concerns regarding anonymity, questioning the severity of the incident, and an ingrained medical hierarchy prevented students reporting these incidents. CONCLUSIONS: The rate of GBD and SH from clinical teachers to medical students remains high, affecting female students more than male students. This study highlights key areas that must be improved to achieve a more equitable teaching experience in UK medical schools. Developing robust reporting and support systems is an important step in eradicating these behaviours.

A model of influences on the clinical learning environment: the case for change at one U.S. medical school.

BACKGROUND: The learning environment within a school of medicine influences medical students' values and their professional development. Despite national requirements to monitor the learning environment, mistreatment of medical students persists. METHODS: We designed a program called WE SMILE: We can Eradicate Student Mistreatment In the Learning Environment with a vision to enhance trainee and faculty awareness and ultimately eliminate medical student mistreatment. We provide a description of our program and early outcomes. RESULTS: The program has enhanced student awareness of what constitutes mistreatment and how to report it. Faculty members are also aware of the formal processes and procedures for review of such incidents. Our proposed model of influences on the learning environment and the clinical workforce informs the quality of trainee education and safety of patient care. Institutional leadership and culture play a prominent role in this model. Our integrated institutional response to learning environment concerns is offered as a strategy to improve policy awareness, reporting and management of student mistreatment concerns. CONCLUSIONS: Our WE SMILE program was developed to enhance education and awareness of what constitutes mistreatment and to provide multiple pathways for student reporting, with clear responsibilities for review, adjudication and enforcement. The program is demonstrating several signs of early success and is offered as a strategy for other schools to adopt or adapt. We have recognized a delicate balance between preserving student anonymity and informing them of specific actions taken. Providing students and other stakeholders with clear evidence of institutional response and accountability remains a key challenge. Multiple methods of reporting have been advantageous in eliciting information on learning environment infringements. These routes and types of reporting have enhanced our understanding of student perceptions and the specific contexts in which mistreatment occurs, allowing for targeted interventions. A common platform across the healthcare professions to report and review concerns has afforded us opportunities to deal with interprofessional issues in a respectful and trustworthy manner. We offer a model of learning environment influences with leadership and institutional culture at the helm, as a way to frame a comprehensive perspective on this challenging and complex concern.

Medical student mistreatment by patients in the clinical environment: prevalence and management.

INTRODUCTION: Medical students rely on patients and their families as teachers during the learning journey. However, ill patients and their families may not welcome having students participating in their care, and anecdotal instances of abuse against clinical medical students are not uncommon. We aimed to determine the prevalence of medical student mistreatment by patients and their families and describe students' self-reported responses to such incidents. METHODS: An email link to an anonymised electronic survey form was sent to all clinical students (n = 184) at a Singapore medical school. The first part of the survey sought information on whether the student had previous experiences of mistreatment by patients and their families. If so, the frequency of mistreatment, circumstances when mistreatment happened and students' reactions were collected. In the second part, the students were asked if they knew how to handle such mistreatment incidents. RESULTS: There were a total of 91 respondents, 14.3% of whom had experienced mistreatment by patients and their families in our institution. One-third of the affected students felt fearful or humiliated. However, the majority chose to be passive by saying nothing or moving away. Less than half of the students knew how to handle such incidents or where to seek help. CONCLUSION: Incidents of mistreatment in our school are not uncommon. Our study revealed a need for more clarity and guidance about how students can manage such situations. This is an important topic because such mistreatment is known to inflict emotional disturbance in students. We proposed a workflow to help students deal with mistreatment.

Medical student mistreatment: understanding 'public humiliation'.

INTRODUCTION: Mistreatment in medical school is an enduring problem in medical education. Little is known about the concept of 'public humiliation,' one of the most common forms of mistreatment as identified on the AAMC Graduation Questionnaire. The objective of this study was to further investigate 'public humiliation' and to understand the underpinnings and realities of 'public humiliation' in medical education. METHOD: Focus groups of medical students on clinical rotation at the University of Washington School of Medicine were conducted over one and a half years. Qualitative analysis of responses identified emergent themes. RESULTS: Study results included responses from 28 third year and one fourth-year medical student obtained over five different focus groups. Participants defined the term 'public humiliation' as negatively, purposefully induced embarrassment. Risk factors for the experience of public humiliation in educational settings were found to include the perceived intent and tone of the teacher, as well as situations being 'public' to patients and taking place during a medical or surgical procedure. Socratic teaching or 'pimping' was not found to be a risk factor as long as learners were properly oriented to the teaching practice. DISCUSSION: This study investigated and defined 'public humiliation' in the setting of medical student mistreatment. More subtle forms of mistreatment, like public humiliation, may be amenable to interventions focused on teaching educators about the importance of orientation and clear communication of intent during the teaching process.

Why We Need a Single Definition of Disruptive Behavior.

Disruptive behavior is known to produce a wide range of negative effects in healthcare, such as impacting patient safety, lowering employee morale, and decreasing employee retention. Healthcare organizations have worked towards eliminating disruptive behavior; however, despite countless interventions, the issue continues to be a problem today. Why then does the issue of disruptive behavior persist? We argue that one reason is the multiple ways disruptive behavior can be described, henceforth defined as the "plurality of terms", which can make it difficult to collect relevant data by doing a simple literature search. Hence, we believe having a single definition for "disruptive behavior" will improve the meta-analysis on disruptive behavior research.

Medical student mistreatment by patients in the clinical environment: prevalence and management

INTRODUCTION@#Medical students rely on patients and their families as teachers during the learning journey. However, ill patients and their families may not welcome having students participating in their care, and anecdotal instances of abuse against clinical medical students are not uncommon. We aimed to determine the prevalence of medical student mistreatment by patients and their families and describe students' self-reported responses to such incidents.@*METHODS@#An email link to an anonymised electronic survey form was sent to all clinical students (n = 184) at a Singapore medical school. The first part of the survey sought information on whether the student had previous experiences of mistreatment by patients and their families. If so, the frequency of mistreatment, circumstances when mistreatment happened and students' reactions were collected. In the second part, the students were asked if they knew how to handle such mistreatment incidents.@*RESULTS@#There were a total of 91 respondents, 14.3% of whom had experienced mistreatment by patients and their families in our institution. One-third of the affected students felt fearful or humiliated. However, the majority chose to be passive by saying nothing or moving away. Less than half of the students knew how to handle such incidents or where to seek help.@*CONCLUSION@#Incidents of mistreatment in our school are not uncommon. Our study revealed a need for more clarity and guidance about how students can manage such situations. This is an important topic because such mistreatment is known to inflict emotional disturbance in students. We proposed a workflow to help students deal with mistreatment.