Clerkship-Specific Medical Student Mistreatment
Sally A. Santen
International Association of Medical Science Educators 2018
Background Few meaningful changes have been made to reduce medical student mistreatment despite years of interventions
undertaken based on data regarding mistreatment gathered annually in the Association of American Medical College’s (AAMC)
Medical School Graduation Questionnaire (GQ). No studies to date have compared clerkship-specific mistreatment to identify
problems unique to individual learning environments. The purpose of this study was to investigate medical student mistreatment
during third-year clerkships at a university-based medical school and to evaluate specific mistreatment patterns by clerkship.
Methods In the 2012–2013 academic year, 122 third-year medical students were surveyed using the AAMC GQ questions on
mistreatment behaviors witnessed or experienced during medical school. During each of their clerkships, students were asked to
report mistreatment and to specify the individuals responsible for it.
Results Public humiliation was the most commonly reported form of mistreatment. This was more prominent on Surgery
(23.8%), Obstetrics and Gynecology (15.2%), and Internal Medicine (12.4%) versus Neurology (4.8%), Psychiatry (4.3%),
Pediatrics (2.1%), and Family Medicine (0%). Faculty (36–64%) and residents (29–50%) were primarily responsible for mis-
treatment. Students identified many instances of mistreatment in the operating room. More students reported being denied
opportunities based solely on gender during Obstetrics and Gynecology than all other clerkships (12 versus 0–2%).
Conclusions Students reported higher incidences of mistreatment on Surgery, Obstetrics and Gynecology, and Internal Medicine.
Operating room culture may contribute to medical student mistreatment. Gender-specific mistreatment occurs during the Obstetrics
and Gynecology clerkship, which may affect the educational experience of male students. We recommend a clerkship-specific
approach to evaluate mistreatment to successfully identify and address mistreatment across learning environments.
Keywords Medical student
The clinical learning environment is influenced by student in-
teractions with patients and their families, nurses, residents,
attending physicians, peers, and other medical staff .
Ideally, these interactions are civil and professional while en-
hancing student education and development. Unfortunately,
however, these interactions sometimes invoke fear, stress, and
discomfort in students, and in extreme cases may include ha-
rassment, discrimination, or abuse.
Silver first speculated 35 years ago that the transition of
students from eager and enthusiastic at the time of admission
to frustrated and cynical near graduation was a result of mis-
treatment that occurred during their medical school education
. In 1990, the Association of American Medical Colleges
(AAMC) added questions about harassment and discrimina-
tion to their annual Graduation Questionnaire (GQ). The phe-
nomenon of medical student mistreatment has since been well
studied over the years. Fried et al. described that despite one
institution’s 13-year multi-pronged approach to eradicating
medical student mistreatment, such practices persisted rela-
tively unchanged . The AAMC GQ has continued to show
that about 40% of students in the USA report mistreatment
* Bethany Skinner
University of Michigan Medical School, 1301 Catherine St., Ann
Arbor, MI 48109, USA
Present address: University of Colorado School of Medicine, 13001
E 17th Place, Aurora, CO 80045, USA
Department of Obstetrics and Gynecology, L 4100 Women’s
Hospital SPC 5276, 1500 E Medical Center Dr, Ann
Arbor 48109, MI, USA
Present address: University of Rochester School of Medicine and
Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA
Medical Science Educator