A sad state of affairs
Frequency and negative impact of medical student mistreatment based on specialty choice: A longitudinal study. Oser TK et al. Academic Medicine 2014;89:755-761.
Reviewed by Ginny Randall
What was the study question?
This study examined student surveys regarding mistreatment during third year clerkships to determine whether mistreatment could be related to student specialty interest and if career choices were affected.
How was the study done?
A survey was administered to students at the end of each of their third-year clerkships from 2003-2010. Respondents were divided into two groups based on their interest in either primary care or a subspecialty. Differences in patterns of mistreatment, perpetrators, and whether the mistreatment affected the students’ choices of career path were examined.
What were the results?
76% of surveys were returned. The most common type of mistreatment involved students being told directly or overhearing negative comments about their specialty choice, leading to students being less than honest when discussing those choices. Mistreatment occurred most frequently on the surgery clerkship, followed by ob-gyn and internal medicine. Residents were twice as likely as any other group to be the source of the mistreatment. A small number of students identified the negative remarks as causing them to change their choice of career path.
What are the implications of these findings?
While this study did not report the frequency of mistreatment originating in pediatric clerkships, students interested in pediatrics are most certainly on the receiving end of the reported mistreatment including negative remarks from other clerkships should the student voice an interest in primary care. These negative remarks may include comments about intellect needed, potential for income, and lifestyle choice, among others. When we are advising our students, we need to be mindful of the mistreatment they may be experiencing, openly discuss the effect on their career choice, and support them in their personal aspirations.
Editor’s comment: It is discouraging to see documentation of the kind of comments that we all hear about, but hope are not the norm… physicians in one area of medicine badmouthing their colleagues in other specialties. Students are particularly vulnerable to those comments, being developmentally in a place where they are highly influenced by strong role models, and residents making these comments might make an especially strong impression since they spend so much time together and are so close to students in their level of training. It is incumbent on us not only to remain strong supporters of our students, no matter what career paths they choose, but also to use this topic as an important professionalism issue to address with residents across specialties in order to decrease this career path-based mistreatment (LL).