The development of a theoretical framework can help prevent the pervasive abuse, harassment, discrimination, and mistreatment of medical trainees and support positive changes in academic medical culture, according to a study published in the JAMA Network Open.

Investigators conducted a systemic review seeking to investigate the programmatic and curricular attempts to decrease or prevent the incidence of mistreatment of medical trainees, including students, interns, residents, and clinical fellows.

The authors searched all peer-reviewed publications and curricula through October 2017, including digital resources such as PubMed, Scopus, ERIC, the Cochrane Library, PsycINFO, and MedEdPORTAL, for citations on the mistreatment and abuse of medical trainees. Citations were analyzed for descriptive reviews of mistreatment programs designed to reduce abuse, harassment, discrimination, and mistreatment of trainees. Studies reporting on mistreatment without sufficient outcome data or that described programs that were never implemented were excluded from the study.

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In this review, 3347 citations of mistreatment were identified, of which 38 demonstrated potentially relevant articles that were part of the full-text review. Ten programs met the final inclusion criteria: 7 academic medical centers in the United States, 1 in Canada, 1 in the United Kingdom, and 1 in Australia. The studies were reviewed in 3 sections: mistreatment programs and definitions, outcomes, and quality of medical education reporting. MedEdPORTAL curricula was reviewed independently and identified 5 mistreatment programs with 2 reporting outcome data.

Specific mistreatment interventions were diverse in format but commonly included seminars, workshops, and lectures; many of the programs included mechanisms for reporting mistreatment. Outcome measures were mostly limited to participant survey data and reports of mistreatment. All studies evaluated participant satisfaction, and 7 reported on the frequency of mistreatment reports. Participant satisfaction was high across the board, and frequency of mistreatment reports did not change. In addressing quality, only 1 study had an explicitly stated conceptual framework used to assess methodology, and most studies were designed with a single-group pretest and posttest.

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Limitations of the study included the possibility of omissions in the database search because the diversity of terms for mistreatment are too vast. Another limitation is potential publication bias in the reporting of mistreatment programs with negative outcomes. Only the mistreatment of trainees was examined, and further studies should examine the abuse and harassment affecting other professionals in a hospital setting.

The authors of this systemic review identified gaps in existing literature on the mistreatment of medical trainees and recommend a theoretical framework for mistreatment programs that can ensure a shared understanding of the problem and how to prevent it. Reducing the mistreatment of medical trainees not only improves confidence and clinical ability, but it can lead to better outcomes for patients.


Mazer LM, Bereknyei Merrell S, Hasty BN, Stave C, Lau JN. Assessment of programs aimed to decrease or prevent mistreatment of medical trainees [published online July 27, 2018]. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2018.0870.