Council on Medical Student Education in Pediatrics


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Miscommunication about mistreatment
When the Learning Environment is Suboptimal: Exploring Medical Students' Perceptions of "Mistreatment"
Gan R & Snell L. Academic Medicine 2014; 89(4): 608-617.
Reviewed by Karen Forbes

What was the study question?
How do students perceive mistreatment in the context of the learning environment? What is the range of what students mean by the term mistreatment?

How was the study done?
Final year medical students at McGill University were invited to participate in focus groups to obtain their perspectives about the learning environment. In particular, researchers sought to characterize students' perspectives of "suboptimal learning experience" and "mistreatment." Inductive thematic analysis of focus group transcripts was undertaken to explore the qualitative data to develop conceptual frameworks of student perceptions of mistreatment and of a suboptimal learning experience, and how those concepts intersect.

What were the results?
Students described mistreatment as lack of respect or attack directed toward the person and suboptimal learning environment as situations where learning is compromised. Within each of these constructs, students described a range of situations from the more obvious "incident-based" situations to the more subtle, often repeated "environment-based" incidents. As such, student views regarding what they considered to be mistreatment were divergent, with some considering environment-based incidents as being mistreatment and others considering them as negative learning environments. The authors identified several key factors that appeared to influence whether students perceived negative environments as "mistreatment" or a "suboptimal learning environment."

What are the implications of these findings?
Despite deliberate efforts to reduce student mistreatment, ongoing high rates are reported. This study demonstrates that mistreatment is a complex phenomenon, with incidents falling along a spectrum. In particular, environment-based incidents may be perceived as mistreatment and are often more distressing to students who may not feel supported to report these issues. In order for medical schools to address ongoing issues with medical student mistreatment, it is imperative to understand the range of what is considered mistreatment, and to target strategies to those recurrent, subtle incidents which may include improving the learning environment.

Editor's note: This study reminds us that we all need to be speaking the same language in order to understand what we mean and to react appropriately (SLB). High-fidelity simulation may help

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