Ending student mistreatment: early successes and continuing challenges

Figures & data

Figure 1. Timeline of interventions and reports of mistreatment from the AAMC Graduation Questionnaire.

• EMTF: Ending Mistreatment Task Force.

• Defining Mistreatment: A document providing definitions and examples to distinguish mistreatment from a sub-optimal learning environment.

• Faculty Accountability Initiatives: Included distribution of a new faculty Code of Professional Behavior, a revised Teacher-Learner Agreement, a Faculty Promise imbedded in annual faculty performance reviews and explicit description of professionalism obligations in letters of offer for new faculty.

• Office of Professionalism: A confidential resource for reporting mistreatment and a means to provide confidential, non-punitive feedback to teachers reported for mistreatment.

• The Office also conducted outreach activities in an effort to promote an institution-wide culture of professionalism and respect.

• 5-Minute Clinical Orientation: A guide for clinical teachers that addressed myths about millennial learners, reinforced students' expectations for hard but respectful questions and recommended ‘best practices’ to help promote a respectful learning and clinical care environment.

• Student Mistreatment Videos: Student-produced videos illustrating examples of mistreatment, including student neglect, humiliating questioning, racial and gender bias toward students and dehumanizing remarks directed at patients or clinical care team members.

• FAQ for Students: A document produced by the Office of Professionalism and the EMTF, describing the procedures for reporting mistreatment and reinforcing the benefits and safety of reporting.

Table 1. Examples of mistreatment defined by the ending mistreatment task force. ^a.

Public belittlement or humiliation; Physical harm or the threat of physical harm; Requests to perform personal services; Being subjected to offensive, sexist remarks, or being subjected to unwanted sexual advances (physical or verbal); Being denied opportunities for training or rewards, or receiving lower evaluations or grades, based solely on gender; Being subjected to racially or ethnically offensive remarks; Being denied opportunities for training or rewards, or receiving lower evaluations or grades, based solely on race or ethnicity; Being subjected to offensive remarks about one’s sexual orientation; Being denied opportunities for training or rewards, or receiving lower evaluations or grades, solely because of sexual orientation; Verbal or emotional harassment through neglect or creating a hostile environment; Inappropriate comments about a student’s appearance; Use of foul language; Retaliation or threats of retaliation against any student who, in good faith, reports mistreatment or unprofessional behavior.

^a Adapted from: Dickstein L SM, Culbert A, Dobbins D, Hall F. Appropriate Treatment in Medicine (ATM): A Compendium on Medical Student Mistreatment. Washington, DC: Association of American Medical Colleges; 2000; and Medical Student Graduate Questionnaire: 2017 All Schools Summary Report Washington, DC: Association of American Medical Colleges; July 2017.

Table 2. Examples of a suboptimal learning environment ^a.

Repeated lack of courtesy toward students, which may leave students feeling ignored or disenfranchised; Lack of courtesy or respect for patients or patient care team members^b; Lack of clear learning objectives Excessive, repetitive “work without education” (the expectation that students perform an excessive number of tasks that are not related to teaching, learning or high-quality patient care or that are not appropriately supervised); Lack of teachers (faculty or residents) or insufficient time to ensure that education takes place during rounds or clinical encounters and that students receive constructive, performance-based feedback. Poor communication between teacher and student; Significant lack of attention paid to teaching and the role of learners, such that students are only allowed to “shadow,” rather than actively participate in patient care activities.

^a Adapted from: Gan R et al. When the learning environment is sub-optimal: exploring medical students perceptions of ‘mistreatment.’ Acad Med. 2014: 89:608–617.

^b May also properly be considered as an example of student mistreatment.

Figure 2. Rates of mistreatment – CU School of Medicine vs all US allopathic medical schools. Source: AAMC Graduation Questionnaire

Figure 3. Rates of public humiliation – CU School of Medicine vs all US allopathic medical schools. Source: AAMC Graduation Questionnaire

Figure 4. Percentage of students who, when asked ‘Why’ they did not report, did not believe that anything would be done if they were to report, CU School of Medicine vs all US allopathic medical schools. Source: AAMC Graduation Questionnaire