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    1 Comment for this article
    We need to do better
    Frederick Rivara, MD, MPH | University of Washington

    In our institution, we conduct a survey of 4th year medical students. It has shown that mistreatment of trainees unfortunately is not uncommon. This nice study underlines the need to develop effective programs for preventing this occurring. Emphasizing professionalism is obviously important, but may just not be enough.

    CONFLICT OF INTEREST: Editor in Chief, JAMA Network Open
    Original Investigation
    Medical Education
    July 27, 2018

    Assessment of Programs Aimed to Decrease or Prevent Mistreatment of Medical Trainees

    Author Affiliations
    • 1Goodman Surgical Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
    • 2Goodman Surgical Education Center, Stanford–Surgery Policy Improvement Research & Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
    • 3Lane Medical Library, Stanford University School of Medicine, Stanford, California
    JAMA Netw Open. 2018;1(3):e180870. doi:10.1001/jamanetworkopen.2018.0870
    Key Points español 中文 (chinese)

    Question  What programmatic and curricular attempts have been reported to decrease the incidence of mistreatment of medical trainees?

    Findings  After a systematic review of more than 3300 articles, only 10 peer-reviewed studies presented outcomes from an implemented program to prevent mistreatment. Overall, quality of included studies was low, and few studies reported any outcome data.

    Meaning  There are very few published descriptions of programs attempting to decrease mistreatment of medical trainees, and there is a need for improved quantity and quality of such reports.


    Importance  Mistreatment of medical students is pervasive and has negative effects on performance, well-being, and patient care.

    Objective  To document the published programmatic and curricular attempts to decrease the incidence of mistreatment.

    Data Sources  PubMed, Scopus, ERIC, the Cochrane Library, PsycINFO, and MedEdPORTAL were searched. Comprehensive searches were run on “mistreatment” and “abuse of medical trainees” on all peer-reviewed publications until November 1, 2017.

    Study Selection  Citations were reviewed for descriptions of programs to decrease the incidence of mistreatment in a medical school or hospital with program evaluation data. A mistreatment program was defined as an educational effort to reduce the abuse, mistreatment, harassment, or discrimination of trainees. Studies of the incidence of mistreatment without description of a program, references to a mistreatment program without outcome data, or a program that has never been implemented were excluded.

    Data Extraction and Synthesis  Authors independently reviewed all retrieved citations. Articles that any author found to meet inclusion criteria were included in a full-text review. The data extraction form was developed based on the guidelines for Best Evidence in Medical Education. An assessment of the study quality was conducted using a conceptual framework of 6 elements essential to the reporting of experimental studies in medical education.

    Main Outcomes and Measures  A descriptive review of the interventions and outcomes is presented along with an analysis of the methodological quality of the studies. A separate review of the MedEdPORTAL mistreatment curricula was conducted.

    Results  Of 3347 citations identified, 10 studies met inclusion criteria. Of the programs included in the 10 studies, all were implemented in academic medical centers. Seven programs were in the United States, 1 in Canada, 1 in the United Kingdom, and 1 in Australia. The most common format was a combination of lectures, workshops, and seminars over a variable time period. Overall, quality of included studies was low and only 1 study included a conceptual framework. Outcomes were most often limited to participant survey data. The program outcome evaluations consisted primarily of surveys and reports of mistreatment. All of the included studies evaluated participant satisfaction, which was mostly qualitative. Seven studies also included the frequency of mistreatment reports; either surveys to assess perception of the frequency of mistreatment or the frequency of reports via official reporting channels. Five mistreatment program curricula from MedEdPORTAL were also identified; of these, only 2 presented outcome data.

    Conclusions and Relevance  There are very few published programs attempting to address mistreatment of medical trainees. This review identifies a gap in the literature and provides advice for reporting on mistreatment programs.