The "Invisible Student": Neglect as a Form of Medical Student Mistreatment, a Call to Action

Examining How Black Women Medical Students Rate Their Experiences with Medical School Mistreatment on the Aamc Graduate Questionnaire

Introduction

Few researchers have examined how medical student mistreatment varies by race/ethnicity and gender, specifically highlighting Black women's experiences. Moreover, researchers often fail to use theoretical frameworks when examining the experiences of minoritized populations. The purpose of this study was to examine the frequency of mistreatment US Black women medical students experience and how this compared to other students underrepresented in medicine (URiM) using intersectionality as a theoretical framework.

Methods

We used the Association of American Medical Colleges Graduate Questionnaire (GQ) as the data source for examining descriptive statistics and frequencies. We examined differences between US Black women (N = 2,537) and other URiM students (N = 7,863) with Mann-Whitney U tests.

Results

The results from this study highlighted that most Black women medical students did not experience mistreatment, yet a higher proportion of these trainees reported experiencing gendered (χ2(1) = 28.59, p < .01) and racially/ethnically (χ2(1) = 2935.15, p < .01) offensive remarks at higher frequency than their URiM counterparts. We also found US Black women medical students infrequently (27.3%) reported mistreatment from a lack of confidence for advocacy on their behalf, fear of reprisal, and seeing the incident as insignificant.

Discussion

A paucity of research exists on Black women medical students and even less using relevant theoretical frameworks such as intersectionality. Failure to extract Black women's experiences exacerbates alienation, invisibility, and inappropriate attention to their mistreatment.

New psychometric evidence for the thesis advisor abuse scale (EMAT) in Peruvian university students based on classic and modern procedures

Although evidence of mistreatment toward university students in the academic field has been reported for several years, its study in the context of the development of undergraduate research is still emerging. For this reason, it is necessary to have valid and reliable measurement instruments that allow assessing the magnitude of this problem. The objective of this study was to evaluate the psychometric properties of the Thesis Advisor Abuse Scale (EMAT, for its acronym in Spanish) in Peruvian university students. A total of 753 university students (women = 57.4%) from the 3 regions of Peru participated. The internal structure was analyzed under an analytical-factorial approach, and the discrimination and difficulty characteristics of the items were evaluated from the perspective of item response theory (IRT). The findings showed evidence supporting the original three-dimensional structure. Furthermore, all the items on the EMAT have good discriminatory power. Additionally, the EMAT proved to be strictly invariant according to sex, and the reliability coefficients reached high magnitudes. It is concluded that the EMAT is an instrument that has adequate psychometric properties to be used as a measure of mistreatment by advisors in the thesis preparation processes in Peruvian university students.

Medical Students' Self-Perceptions of Harassment During Clinical Placement

Objectives

Exploring workplace dynamics during clinical placement is crucial to determine whether medical students are encountering safe and meaningful learning experiences. The aim of this original article is to describe medical students' reported harassment experiences whilst on clinical placement.

Design

Medical students in years 4 to 6 were invited to participate in the survey. In this mixed-methods study, data collection included demographic information, responses to the Generalized Workplace Harassment Questionnaire, and qualitative commentaries.

Results

Two hundred and five students completed the questionnaire. Medical students experienced harassment in areas of verbal aggression, disrespect, isolation/exclusion, threats/bribes, and physical aggression. Concerning levels of occurrence were noted for disrespect, isolation/exclusion, and verbal aggression.

Conclusions

Many medical students in this study reported experiencing harassment during their clinical placements indicating that harassment during clinical placement continues to be of concern in medical education. The findings indicate that further initiatives need to be designed to identify and respond to these cases of workplace harassment and that power imbalance and safe reporting appear to be further issues of concern. It was evident that students need to feel safe enough to be able to report harassment experiences to allow managers and educators to address the full extent of the problem.

Neglect as an undefined and overlooked aspect of medical student mistreatment: A systematic review of the literature

PURPOSE

Although the mistreatment of medical students is a well-researched topic, the scope of mistreatment often leaves out neglect, a subtype for which there is no accepted definition based in the published literature. This review sought to summarize the existing data on the prevalence and descriptors of neglect, identify strategies seen in the literature designed to improve it, and offer a synthesized definition of this phenomenon to guide future research.

METHODS

Following PRISMA guidelines, a relevant systematic literature search from 2000 to April 2021 was performed to identify literature on neglect in clinical settings within American medical schools.

RESULTS

Neglect, a poorly defined phenomenon in medical education related to the suboptimal learning environment, is often excluded from research on medical student mistreatment. Neglect is a barrier to a successful learning environment, yet a paucity of data and the heterogeneous nature of the present literature render it difficult to estimate its true prevalence. Studies that include neglect frequently assess it solely as the result of identity discrimination or stated career interests. Recent interventions include promoting longitudinal relationships between students and clinical faculty and establishing teaching expectations.

CONCLUSIONS

Neglect is the mistreatment of medical students by the medical care team via a lack of meaningful inclusion in the clinical environment such that it has a notable negative impact on learning and student well-being, regardless of intentionality. An established definition that is grounded in the literature is required to create a common point of reference and understand its true prevalence, its associated variables, and the best mitigation strategies, as well as to guide future research, which should examine neglect independently and as a consequence of personal and professional identities.

How medical learners and educators decide what counts as mistreatment: A qualitative study

INTRODUCTION

The mistreatment or abuse (maltreatment) of medical learners by their peers and supervisors has been documented globally for decades, and there is significant research about the prevalence, sequelae and strategies for intervention. However, there is evidence that learners experience maltreatment as being less clear cut than do researchers, educators and administrators. This definitional ambiguity creates problems for understanding and addressing this issue. The objective of this study was to understand how medical learners and educators make sense of less-than-ideal interactions in the clinical learning environment, and to describe which factors influenced their perception that the encounter constituted maltreatment.

METHODS

Using constructivist grounded theory, we interviewed 16 medical students, 15 residents or fellows, and 18 educators associated with a single medical school (n = 49). Data collection began with the most junior learners, iterating with analysis as we progressed through the project. Constant comparative analysis was used to gather and compare stories of 'definitely', 'maybe' and 'definitely not' maltreatment across a variety of axes including experience level, clinical setting and type of interaction.

RESULTS

Our data show that learners and educators have difficulty classifying their experiences of negative interpersonal interaction, except in the most severe and concrete cases. While there was tremendous variation in the way they categorised similar experiences, there was consistency in the elements drawn upon to make sense of those experiences. Participants interpreted negative interpersonal interactions on an individual basis by considering factors related to the interaction, initiator and recipient.

CONCLUSIONS

Only the most negative behaviour is consistently understood as maltreatment; a complex process of individual sense-making is required to determine the acceptability of each interaction. The differences between how individuals judge these interactions highlight an opportunity for administrative, research and faculty development intervention.

Medical Students' Communication Preferences for the Ideal Surgical Educator

OBJECTIVE

Medical students have expectations and preferences for how they are taught by clinical surgical educators. The goal of this study was to (a) determine medical students' prioritizations of ideal teaching behaviors and characteristics for surgical educators, and (b) delineate which teaching behaviors and characteristics were considered to be less important for surgical education.

DESIGN

Using a necessity (low) and luxury (high) budget allocation methodology to build their ideal surgical educator, MSIII and MSIV students (N = 82) completed a survey to prioritize and invest in 10 effective teaching behaviors and characteristics identified in the instructional communication literature (assertiveness, responsiveness, clarity, relevance, competence, character, caring, immediacy, humor, and disclosure).

RESULTS

Repeated-measures ANOVAs indicated MSIII and MSIV students invested significantly more of their teaching budget allocations for their ideal surgical educator into instructor clarity, competence, relevance, responsiveness, and caring, both within a (low) necessity budget (F[5.83, 472.17] = 24.09, p < 0.001, η2p = 0.23) and (high) luxury budget (F(7.65, 619.76) = 67.56, p < 0.001, η2p = 0.46). Using paired t-tests, comparisons of repeated investments in low and high budget allocations revealed that students invested slightly more of a percentage of funds in instructor immediacy (+2.62%; t(81) = 2.90, p = 0.005; d = 0.32) and disclosure (+1.44%; t(81) = 3.26, p = 0.002; d = 0.36), indicating they viewed these teaching behaviors more as luxury components of surgical education rather than necessities, but these behaviors were significantly less important than their ideal prioritizations of instructor clarity, competence, relevance, responsiveness, and caring.

CONCLUSIONS

Results indicated that medical students want a surgical educator who is largely a rhetorical educator; that is, a surgical specialist who clearly communicates expertise and relevant content that students can apply to their careers as future surgeons. However, a relational component was viewed as ideal by students as students also preferred surgical educators to be sensitive and sympathetic to their academic needs.

Safe to speak: Fostering psychological safety among incoming predoctoral dental students

PURPOSE

To describe the implementation and impact of an introductory session on psychological safety for incoming first-year Doctor of Dental Surgery (DDS) learners.

METHODS

In August 2020, first-year DDS students participated in a 2-h online instructional session focused on defining psychological safety, the behaviors that promote and disrupt it, and setting expectations for learner and faculty behavior to foster it. Learners worked in small groups to discuss the various components of psychological safety and document their discussion in a collaborative workspace before a large group debriefs. Participants were requested to complete an electronic survey before and after the session to evaluate their change in knowledge, confidence in performing tasks to foster psychological safety, and perceptions about their level of control. Six months after the session, learners were requested to participate in a focus group for additional feedback and reflections.

RESULTS

Seventy-four participants completed the before and after experience survey. There was a statistically significant increase in knowledge of the components of psychological safety and perceptions of control. In addition, self-reported measures of confidence to perform the tasks increased from an average rating of 36% confident before the session to 86% confident afterward. In the experience, learners were active in their discussion and generated many ideas about behaviors that promote and disrupt psychological safety, which informed the creation of learner and faculty classroom expectations.

CONCLUSION

Engaging learners in discussions about psychological safety can be a useful activity to establish expectations and create group norms that may support collaborative learning environments.

Creating a win-win for the health system and health Profession's education: a direct observation clinical experience with feedback iN real-time (DOCENT) for low acuity patients in the emergency department

BACKGROUND

Clinical education across the professions is challenged by a lack of recognition for faculty and pressure for patient throughput and revenue generation. These pressures may reduce direct observation of patient care provided by students, a requirement for both billing student-involved services and assessing competence. These same pressures may also limit opportunities for interprofessional education and collaboration.

METHODS

An interprofessional group of faculty collaborated in a sequential quality improvement project to identify the best patients and physical location for a student teaching clinic. Patient chief complaint, use of resources, length of stay, estimated severity of illness and student participation and evaluation of the clinic was tracked.

RESULTS

Clinic Optimization and Patient Care: Five hundred and thirty-two emergency department (ED) patients were seen in the first 19 months of the clinic. A clinic located near the ED allowed for patients with higher emergency severity index and greater utilization of imaging. Patients had similar or lower lengths of stay and higher satisfaction than patients who remained in the ED (p < 0.0001). In the second clinic location, from October 2016-June 2019, 644 patients were seen with a total of 667 concerns; the most common concern was musculoskeletal (50.1%). Student Interprofessional Experience: A total of 991 students participated in the clinic: 68.3% (n = 677) medical students, 10.1% (n = 100) physician assistant students, 9.7% (n = 96) undergraduate nursing students, 9.1% (n = 90) physical therapy students, and 2.8% (n = 28) nurse practitioner students. The majority (74.5%, n = 738) of student participants worked with students from other professions. More than 90% of students reported that faculty set a positive learning environment respectful of students. However, 20% of students reported that faculty could improve provision of constructive feedback. Direct Observation: Direct observation of core entrustable professional activities for medical students was possible. Senior medical students were more likely to be observed generating a differential diagnosis or management plan than first year medical students.

CONCLUSIONS

Creation of a DOCENT clinic in the emergency department provided opportunities for interprofessional education and observation of student clinical skills, enriching student experience without compromising patient care.