Neglect as an undefined and overlooked aspect of medical student mistreatment: A systematic review of the literature

Abstract

Purpose

Although the mistreatment of medical students is a well-researched topic, the scope of mistreatment often leaves out neglect, a subtype for which there is no accepted definition based in the published literature. This review sought to summarize the existing data on the prevalence and descriptors of neglect, identify strategies seen in the literature designed to improve it, and offer a synthesized definition of this phenomenon to guide future research.

Methods

Following PRISMA guidelines, a relevant systematic literature search from 2000 to April 2021 was performed to identify literature on neglect in clinical settings within American medical schools.

Results

Neglect, a poorly defined phenomenon in medical education related to the suboptimal learning environment, is often excluded from research on medical student mistreatment. Neglect is a barrier to a successful learning environment, yet a paucity of data and the heterogeneous nature of the present literature render it difficult to estimate its true prevalence. Studies that include neglect frequently assess it solely as the result of identity discrimination or stated career interests. Recent interventions include promoting longitudinal relationships between students and clinical faculty and establishing teaching expectations.

Conclusions

Neglect is the mistreatment of medical students by the medical care team via a lack of meaningful inclusion in the clinical environment such that it has a notable negative impact on learning and student well-being, regardless of intentionality. An established definition that is grounded in the literature is required to create a common point of reference and understand its true prevalence, its associated variables, and the best mitigation strategies, as well as to guide future research, which should examine neglect independently and as a consequence of personal and professional identities.

Keywords:

• Neglect
• mistreatment
• learning environment
• medical student
• medical education

Ethics statement

An ethics statement is not applicable because this study is based exclusively on published literature.

Acknowledgments

We thank Amber Stout, MLIS (University Hospitals, Cleveland, OH) for developing the search terminology used to identify relevant literature.

Disclosure statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the cited articles and their supplementary materials.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Jacqueline Kloos

Jacqueline Kloos is a medical student at Case Western Reserve University School of Medicine.

Emily Simon

Emily Simon, MD is a general surgery resident at University Hospitals/Case Western Reserve University.

Anne Sammarco

Anne Sammarco, MD is a Urogynecologist and Female Pelvic Medicine and Reconstructive Surgeon at University Hospitals Cleveland Medical Center, Assistant Professor of Obstetrics and Gynecology.

Sherif El-Nashar

Sherif A. El-Nashar, MD is a Urogynecologist and Female Pelvic Reconstructive Surgeon at Mayo Clinic in Jacksonville Florida and Associate Professor of Obstetrics and Gynecology at Mayo Clinic School of Medicine and Science.

Corinne Bazella

Corinne Bazella, MD, is an Obstetrician Gynecologist at University Hospitals Cleveland Medical Center, Associate Professor of Obstetrics and Gynecology at Case Western Reserve School of Medicine.