Resident and Medical Student Mistreatment

A growing problem or a more visible problem? By Megan Gayeski, MD, Co-chair, CMS Resident and Fellow Section

The situation is common—medical students whispering about the feared attending who has reportedly thrown objects in the operating room when someone answers a question incorrectly. Or some residents who say they fudge their work hours out of fear their institution might get in trouble. At almost every institution in the country, there is talk behind closed doors about the darker side of our profession, with specific examples of poor behavior. While mistreatment occurs in all walks of life and even among us students and residents, the culture of medicine has its own particular brand.

What is considered mistreatment of medical professionals, as opposed to someone being short with another person after another stressful day? What can we do to bring this discussion to the forefront of our profession? And what can we do to change patterns of bad behavior?

In fall 2011, the LCME, ACGME, and AMA held a joint meeting on the subject of medical student and resident mistreatment. Interestingly, it was almost impossible for everyone in the room to agree on what exactly mistreatment was. While there were some obvious answers (physical and sexual abuse, for example), other examples were not as clear. It also became obvious that medical students, residents, and physicians have different definitions and different ways of dealing with mistreatment.

Because the stakes are so high in undergraduate and graduate medical training, we fear that reporting what happens may have potential repercussions. As medical students, we worry about getting a dreaded pass or even a failing grade in a rotation we need to graduate, much less landing a spot in our desired residency program. As residents, we are afraid of jeopardizing our relations with our institution and possibly our residency program. While most medical schools and residency programs are now publicizing different ways to report mistreatment, many of us believe that a culture of intimidation is preventing an honest conversation on this topic.

Defining Mistreatment
As a direct result of the joint meeting, the Graduation Questionnaire, which is sent to every graduating medical student by the Association of American Medical Colleges, was revised. Instead of first asking if students had been victims of mistreatment and then asking them to define mistreatment, students were asked if they had ever experienced situations that would be defined by most of us as mistreatment. By asking about specific behaviors or incidents, nearly 50%, or half of this year’s intern class, reported at least one mistreatment incident during their medical school career. In the past, less than 20% of students indicated that they had been mistreated.

With this recent data has come a flurry of exposés on the culture of medicine. When released at the beginning of August, practically every medical student and resident read Dr. Pauline Chen’s “The Bullying Culture of Medical School,” which detailed new initiatives at the University of California-Los Angeles to change the culture of medicine.

However, the conversation has been mostly focused on medical students, who make up the undergraduate medical population, and not on residents. Yet last April, KevinMD blogged that Chinese factory workers have better mistreatment policies than residents. Are statements like that really true? In an attempt to sort things out, the Medical School Section will be holding a session during the AMA Interim Meeting this November on the treatment of students and residents.

How to Help?
As individuals, what can we do to help change the situation? First, it helps to be educated. Schools and residencies are now required to publish instructions for reporting unacceptable behavior. There is concern, though, that many medical students or residents won’t know where to find this information or what to do. One emerging technique allows students and residents to anonymously report incidents or behavior directed at themselves or others. Another allows them to report mistreatment when it occurs, but does not release the incident report until the person has completed a particular rotation or their entire schooling. Still another technique allows individuals to report to someone hired by the university or institution but still entirely removed from medicine and with the power to conduct an investigation.

Second, for change to occur we have to speak up. When we feel we have been mistreated, we need to do more than report our experiences on the Graduation Questionnaire or in memoirs.

Finally, we must encourage other students and residents not to mistreat others. Possibly the most surprising piece of information gleaned from the Graduation Questionnaire is the fact that many students feel they are being mistreated by their own classmates. If we can’t even play well together among our peers, how on earth can we expect those around us to behave differently?

The Golden Rule tells us to treat others as we wish to be treated.  It should guide the interactions of all members of the health care team.