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Original Investigation
Physician Work Environment and Well-Being
February 24, 2020

Assessment of the Prevalence of Medical Student Mistreatment by Sex, Race/Ethnicity, and Sexual Orientation

Author Affiliations
  • 1Yale School of Medicine, New Haven, Connecticut
  • 2Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
  • 3Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
  • 4National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
  • 5Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
  • 6Department of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, California
  • 7Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
  • 8Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
JAMA Intern Med. 2020;180(5):653-665. doi:10.1001/jamainternmed.2020.0030
Key Points

Question  Does the self-reported prevalence of medical student mistreatment vary based on student sex, race/ethnicity, and sexual orientation?

Findings  In this cohort study of 27 504 graduating medical students, the following students reported a higher prevalence of mistreatment than male, white, and heterosexual students: female students; Asian, underrepresented minority, and multiracial students; and lesbian, gay, or bisexual students.

Meaning  These findings suggest that there is a differential burden of mistreatment that must be addressed to improve the medical school learning environment.

Abstract

Importance  Previous studies have shown that medical student mistreatment is common. However, few data exist to date describing how the prevalence of medical student mistreatment varies by student sex, race/ethnicity, and sexual orientation.

Objective  To examine the association between mistreatment and medical student sex, race/ethnicity, and sexual orientation.

Design, Setting, and Participants  This cohort study analyzed data from the 2016 and 2017 Association of American Medical Colleges Graduation Questionnaire. The questionnaire annually surveys graduating students at all 140 accredited allopathic US medical schools. Participants were graduates from allopathic US medical schools in 2016 and 2017. Data were analyzed between April 1 and December 31, 2019.

Main Outcomes and Measures  Prevalence of self-reported medical student mistreatment by sex, race/ethnicity, and sexual orientation.

Results  A total of 27 504 unique student surveys were analyzed, representing 72.1% of graduating US medical students in 2016 and 2017. The sample included the following: 13 351 female respondents (48.5%), 16 521 white (60.1%), 5641 Asian (20.5%), 2433 underrepresented minority (URM) (8.8%), and 2376 multiracial respondents (8.6%); and 25 763 heterosexual (93.7%) and 1463 lesbian, gay, or bisexual (LGB) respondents (5.3%). At least 1 episode of mistreatment was reported by a greater proportion of female students compared with male students (40.9% vs 25.2%, P < .001); Asian, URM, and multiracial students compared with white students (31.9%, 38.0%, 32.9%, and 24.0%, respectively; P < .001); and LGB students compared with heterosexual students (43.5% vs 23.6%, P < .001). A higher percentage of female students compared with male students reported discrimination based on gender (28.2% vs 9.4%, P < .001); a greater proportion of Asian, URM, and multiracial students compared with white students reported discrimination based on race/ethnicity (15.7%, 23.3%, 11.8%, and 3.8%, respectively; P < .001), and LGB students reported a higher prevalence of discrimination based on sexual orientation than heterosexual students (23.1% vs 1.0%, P < .001). Moreover, higher proportions of female (17.8% vs 7.0%), URM, Asian, and multiracial (4.9% white, 10.7% Asian, 16.3% URM, and 11.3% multiracial), and LGB (16.4% vs 3.6%) students reported 2 or more types of mistreatment compared with their male, white, and heterosexual counterparts (P < .001).

Conclusions and Relevance  Female, URM, Asian, multiracial, and LGB students seem to bear a disproportionate burden of the mistreatment reported in medical schools. It appears that addressing the disparate mistreatment reported will be an important step to promote diversity, equity, and inclusion in medical education.

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