Medical students’ perception of behaviors in the clinical learning environment evolve with increasing clinical exposure as measured with situational video vignettes

Abstract

This cross-sectional study involved matriculating, mid-level and graduating medical students (n = 723) who participated in specific transition courses in our medical school curriculum between August 2016 and March 2019. We used a mixed-methods approach (survey and analysis of narrative comments) to study the evolution in perception of the learning environment by medical students with increasing clinical exposure using four different video vignettes. Differences in student perceptions of mistreatment exists at various levels of training. Compared to graduating students, matriculating students were more likely to perceive reprimanding a student on being late as appropriate behavior (80.5% vs 53.3%, p = 0.001), whereas a significantly higher proportion of the graduating students (15.3%, p = 0.001) perceived it as mistreatment. A majority of the matriculating students (84%, p = 0.001) considered the case of an eager student as mistreatment, while a significantly higher proportion of the graduating students (59.5%, p = 0.001) did not think it was mistreatment. Qualitative analysis of comments from students at different stages of training displayed an increased appreciation of their professional responsibilities and nuanced appreciation of body language and tone as contributing factors in determining whether a situation represented inappropriate behavior. Our results demonstrate that students’ perceptions of inappropriate behaviors evolve with increased clinical exposure.

Keywords:

• Education environment
• professionalism
• undergraduate
• medicine
• clinical

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Notes on contributors

Howard B. Fleit

Howard B. Fleit, PhD, is an Assistant Dean for Curriculum and Vice Chair for Education in the Pathology department at the Renaissance School of Medicine at Stony Brook University, Stony Brook, NY.

Wei-Hsin Lu

Wei-Hsin Lu, PhD, is the Director of Assessment and Evaluation and Research Assistant Professor of Family, Population and Preventive Medicine at the Renaissance School of Medicine at Stony Brook, Stony Brook, NY.

Doreen M. Olvet

Doreen M. Olvet, PhD, was a Research Project Manager at the Stony Brook School of Medicine. Her current position is Medical Education Research Manager at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.

Latha Chandran

Latha Chandran, MD, MPH, is Vice Dean for Academic and Faculty Affairs, Miriam and David Donoho Distinguished Teaching Professor, SUNY Distinguished Teaching Professor, and Founding Director, Donoho Academy of Clinical and Educational Scholars at the Renaissance School of Medicine at Stony Brook University, Stony Brook, NY.