Incidence of resident mistreatment in the learning environment across three institutions

Abstract

Introduction

Mistreatment in the learning environment is associated with negative outcomes for trainees. While the Association of American Medical Colleges (AAMC) annual Graduation Questionnaire (GQ) has collected medical student reports of mistreatment for a decade, there is not a similar nationally benchmarked survey for residents. The objective of this study is to explore the prevalence of resident experiences with mistreatment.

Methods

Residents at three academic institutions were surveyed using questions similar to the GQ in 2018. Quantitative data were analyzed based on frequency and Mann-Whitney U tests to detect gender differences.

Results

Nine hundred ninety-six of 2682 residents (37.1%) responded to the survey. Thirty-nine percent of residents reported experiencing at least one incident of mistreatment. The highest reported incidents were public humiliation (23.7%) and subject to offensive sexist remarks/comments (16.0%). Female residents indicated experiencing significantly more incidents of public embarrassment, public humiliation, offensive sexist remarks, lower evaluations based on gender, denied opportunities for training or rewards, and unwanted sexual advances. Faculty were the most frequent instigators of mistreatment (66.4%). Of trainees who reported experiencing mistreatment, less than one-quarter reported the behavior.

Conclusion

Mistreatment in the academic learning environment is a concern in residency programs. There is increased frequency among female residents.

Keywords:

• Education environment
• multiprofessional
• undergraduate
• medicine

Acknowledgments

The researchers are grateful to the students and residents who completed surveys and Meagan Rawls for data management.

Disclosure statement

All three institutions have received funding from Accelerating Change in Medical Education from the American Medical Association that is unrelated to this study. MJC completed this work during his residency.

Site A’s data collection for this study was part of a larger learning environment study that is also looking at well-being and patient and provider mistreatment.

ePoster

Surgical Education Meeting, April 2019, Chicago, IL.

Poster

Group on Women in Medicine and Science Reception, sub-meeting of AAMC Research in Medical Education, November 2018, Austin, TX.

Additional information

Notes on contributors

Maya M. Hammoud

Maya M. Hammoud, MD, MBA, is an associate chair for education, clerkship director and professor, Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI.

Nital P. Appelbaum

Nital P. Appelbaum, PhD, was an assistant professor, office of assessment, evaluation and scholarship, Virginia Commonwealth University School of Medicine at the time of writing, and is now assistant professor, Baylor College of Medicine, Houston, TX.

Paul M. Wallach

Paul M. Wallach, MD, is an executive associate dean for educational affairs and institutional improvement and professor of medicine, Indiana University School of Medicine, Indianapolis, IN.

Heather L. Burrows

Heather L. Burrows, MD, PhD, is an associate chair for education, residency program director and associate professor, Pediatrics, University of Michigan Medical School, Ann Arbor, MI.

Komal Kochhar

Komal Kochhar, MBBS, MHA, is a director for research in medical education and assistant research professor family medicine, Indiana University School Medicine, Indianapolis, IN

Robin R. Hemphill

Robin R. Hemphill, MD, MPH, is a chief quality and safety officer and associate dean for quality and safety, Virginia Commonwealth University School of Medicine, Richmond, VA.

Michelle Daniel

Michelle Daniel, MD, MHPE, is an assistant dean for curriculum and associate professor, Emergency Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI.

Michael J. Clery

Michael J. Clery, MD, MPP, is an assistant professor of emergency medicine, Emory University, Atlanta, GA. Previously, resident, Emergency Medicine, University of Michigan Medical School.

Sally A. Santen

Sally A. Santen, MD, PhD, is a senior associate dean, assessment, evaluation and scholarship and professor, Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA.