Medical student mistreatment remains common in US allopathic institutions. Women, underrepresented minority (URMs), and lesbian, gay, or bisexual (LGB) respondents most frequently reported mistreatment, according to study data published in JAMA Internal Medicine.

Investigators abstracted respondent data from the 2016 and 2017 iterations of the American Medical Colleges Graduation Questionnaire (AAMC-GQ). The AAMC-GQ is administered annually to students graduating from all 140 allopathic US medical institutions. The AAMC-GQ captures student demographics, including age, sex, race/ethnicity, sexual orientation, and socioeconomic status. The questionnaire also assesses whether respondents have had negative experiences with medical school faculty, residents, interns, and nurses. Negative experiences were defined as general negative behaviors, gender-based discrimination, race/ethnicity-based discrimination, and sexual orientation-based discrimination. Response choices for all questions regarding negative behavior used a 4-point Likert scale for frequency of maltreatment: “never,” “once,” “occasionally,” and “frequently.” Chi-squared and Fisher exact tests were used to compare prevalence rates of mistreatment by demographic characteristics.

Data from 27,504 unique respondents representing 72.1% of the 38,160 total medical school graduates between 2016 and 2017 were used in analyses. The sample was comprised of 13,351 women (48.5%), 16,521 white students (60.1%), 5641 Asian students (20.5%), 2433 URM students (8.8%), 2376 multiracial students (8.6%), and 1463 LGB students (5.3%). More than a third (35.4%) of all respondents reported experiencing at least 1 type of mistreatment. The most commonly reported maltreatment type was public humiliation, reported by 21.1% of respondents. Overall, 18.5% reported discrimination secondary to gender, 8.8% reported discrimination secondary to race/ethnicity, and 2.3% reported discrimination secondary to sexual orientation. A greater percentage of women reported at least 1 episode of maltreatment compared with men (40.9% vs 25.2%; P <.001). Similarly, greater numbers of Asian (31.9%), URM (38.0%), and multiracial (32.9%) students reported ≥1 episode of mistreatment compared with white students (24.0%; P <.001). In addition, LGB students more frequently reported episodes of negative behavior compared with their heterosexual peers (43.5% vs 23.6%; P <.001). A greater percentage of female vs male students (17.8% vs 7.0%), Asian (10.7%), URM (16.3%), multiracial (11.3%) vs white students (4.9%), and LGB (16.4%) vs heterosexual students (3.6%) reported experiencing 2 or more types of mistreatment.

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These data illustrate the disproportionate burden of mistreatment experienced by female and minority medical students in the United States. This mistreatment has documented effects on student burnout, performance, and workplace satisfaction. “[A]ddressing the disparate mistreatment…will be an important step to promote diversity, equity, and inclusion in medical education,” the investigators wrote.


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Disclosure: One study author declared affiliations with the pharmaceutical industry.

Please see the original reference for a full list of authors’ disclosures.

Reference

Hill KA, Samuels EA, Gross CP, et al. Assessment of the prevalence of medical student mistreatment by sex, race/ethnicity, and sexual orientation [published online February 24, 2020]. JAMA Intern Med. doi:10.1001/jamainternmed.2020.0030