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A distressing tale. Fried J et al. Eradicating Medical Student Mistreatment: A Longitudinal Study of One Institution’s Efforts. Academic Medicine 2012;87(9):1191-1198.

Reviewed by Makia Powers

What was the study question?
Did institutional policies designed to decrease student mistreatment lead to a decrease in the prevalence or severity of perceived medical student mistreatment?

How was the study done?
Medical students at the David Geffen School of Medicine at UCLA completed an anonymous survey at the end of their third year clerkships from 1996-2008. The questionnaire asked students to report any verbal, sexual, physical, ethnic or power mistreatments and who committed it. Data were analyzed in four time periods, coinciding with the introduction of key initiatives in the school's multi-pronged program to decrease student mistreatment. Quantitative and qualitative analysis were performed on the data collected. Mistreatments were categorized in mild, moderate, and severe categories.

What were the results?
Data were collected from 1946 third-year medical students over 13 years. Incidence of mistreatment during clerkships was highest in years prior to any institutional interventions (75%) and decreased to 57% across the years. The drop in overall incidence of mistreatment after the adoption of the statement on supporting an abuse-free academic community was due to a decline in incidence of verbal and power mistreatment. Other initiatives had no effect on the incidence of sexual harassment or physical mistreatment. There were no gender differences in reported physical mistreatment, but females reported more verbal mistreatment and sexual harassment. The main sources of mistreatment were residents (40%) and clinical faculty (36%). The incidence of "severe" mistreatments did not decline over the study period.

What are the implications of these findings?
There remains much work to be done to create a culture in which medical students are not mistreated.

Editor's note: That this school's multi-faceted program – consisting of committees, policies, websites, offices, support structures, and mandatory teaching sessions – did little to decrease student mistreatment is distressing. The authors remain committed to the cause and intent on tackling this by addressing the "hidden curriculum". Further, that this degree of student mistreatment is occurring at the clerks' crucial time of professional identity is particularly worrisome. The authors remain committed to the cause, though, and intent on tackling this by addressing the "hidden curriculum" (SLB).

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