Dr. Kevin O’Brien of the University of South Florida Morsani College of Medicine introduces a definition of medical student mistreatment. When exactly mistreatment is occurring in a medical situation is not always clear to everyone involved.
BOSTON—An interactive session devoted to thinking about medical student mistreatment — how to identify it, address it, and prevent it — drew a full room and much conversation during the AAMC Annual Meeting in Boston on Nov. 6, 2017. The Gold Humanism Honor Society, which has more than 140 chapters in medical schools and 30,000 members, sponsored the session.
“How to define mistreatment of underlings by those in positions of power and what to do to prevent it and punish repeat offenders could not be a more timely conversation than it is today,” said Dr. Dorothy Levine, director of the Gold Humanism Honor Society. “The field of medicine, like business, and politics and entertainment, is not immune to abuses of power of all sorts. A cultural change is needed, and these prescient physician researchers began their study well before Hollywood and Congress did. ”
Student mistreatment is often a symptom of perpetrator’s burnout, depression, anxiety, or a manifestation of a prior event that happened to the perpetrator. The culture that allows medical student mistreatment is handed down from one generation to the next, and is a significant contributor to ongoing burnout, lack of empathy, substance misuse and even suicide.
Identifying the behavior of mistreatment by those who witness it and/or use it is critical to breaking the cycle.
Three presenters brought deep knowledge of the how mistreatment of medical students manifests:
- Dr. Alex J. Mechaber is the Bernard J. Fogel Chair in Medical Education, Senior Associate Dean for Undergraduate Medical Education and Professor of Medicine at University of Miami Leonard M. Miller School of Medicine.
- Dr. Cynthia Ledford is Professor of Internal Medicine and of Pediatrics, Assistant Dean for Curriculum Design and Innovation, and Associate Vice Chair for Education at The Ohio State University College of Medicine.
- Dr. Kevin O’Brien is Associate Professor of Medicine, Clerkship Director of Adult Inpatient Medicine, and Director of UME, Department of Internal Medicine, at University of South Florida Morsani College of Medicine.
Together, they are leading a project around medical student mistreatment that involved showing videos of scenarios to prompt discussion. The project is now being tested in nine medical schools with more 1,000 participants. They brought their project to Boston to share with AAMC attendees, who included medical students, residents, faculty, deans and many other leaders in medical education.
Dr. O’Brien kicked off the AAMC session with interactive polling. Audience members could text their responses to questions that appeared on the screen: “Were you mistreated in medical school?”
The answers appeared in real time on the screen, an enlightening and often surprising set of responses that elicited buzz in the room. More than 50% of those audience members who answered said “Yes,” they were mistreated in medical school.
Dr. O’Brien then asked, “Did you report the episode of event?” About 15% of the audience answered “Yes,” 15%, which is a little lower than the rates of around 31% that has been reported in the academic literature.
Then presenters then shared several short, 3- to 4-minute videos of scenarios involving medical students and physicians. To best be able to discuss what medical student mistreatment is, “videos are critical,” said Dr. O’Brien.
After watching each scenario, the audience voted by text: “Was that medical student mistreatment or not?” There was not a consensus, and that sparked a lively discussion.
To really combat medical student mistreatment, an institution-wide approach is crucial, said Dr. Mechaber.
Dr. Ledford noted that it is unclear when mistreatment occurs, and for that reason, she often advises medical students to feel free to talk about any time they feel uncomfortable. Lowering the bar helps ensure a safe environment, she said.
After the session, many participants reached out to the presenters to inquire how their own institution might get involved to help end this scourge.
“We are proud to have helped bring this excellent work to light. We hope that the AAMC, ACGME and other medical schools do what they can to further their efforts to prevent the burnout, anxiety and depression that can result from a culture of belittlement and disrespect,” Dr. Levine said.
For more information, please contact Dr. Kevin O’Brien at kobrien@health.usf.edu.
