title: Under the knife: medical student perceptions of intimidation and mistreatment.
abstract: BACKGROUND
  The progression from classroom to clinical setting can be a difficult transition for medical students. Experience in the operating room is anticipated as one of the most challenging environments for a novel medical learner. We sought to identify common concerns before exposure in this learning environment and examine the experience of final-year medical students on their surgical clerkship rotation in an effort to identify areas where improvements can be made.
  
  
  METHODS
  A 20-question survey was developed after a focus group met to identify potential issues that medical students encounter during their surgical clerkship. Personal and anecdotal experiences guided the development of the survey. It was distributed to final-year medical students and recent graduates (350 individuals) using SurveyMonkey. A quality improvement ethics application was completed before the commencement of the survey, as were participant consent forms. Responses were grouped and common themes were identified in the experiences reported by 2 investigators.
  
  
  RESULTS
  A total of 72 individuals responded to the survey, providing a 21% response rate. Subjects were asked how confident they were in their understanding of what was expected during a surgical rotation. Of them, 52 (72%) responded that they were "unsure" or "very unsure," whereas only 12 and 3 felt "somewhat confident" and "very confident," respectively. Most of the learners felt nervous (96%) and feared appearing incompetent (89%). Common concerns included insufficient knowledge and technical skill, anticipated negative experiences, and feelings of uncertainty regarding medical student expectations.
  
  
  CONCLUSIONS
  We present common themes stemming from medical student experiences during their surgical clerkship. We comment on perception of intimidation and abuse, the rationalization behind such behavior, and perceived lack of guidance. The intention of this analysis was to identify weaknesses in our surgical training so that a quality improvement plan can be implemented.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Canada. Electronic address: Claire.Temple-Oberle@albertahealthservices.ca.
authors.forename: Jill P
authors.initials: JP
authors.lastname: Stone
authors.affiliation: Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Jacob H
authors.initials: JH
authors.lastname: Charette
authors.affiliation: Cumming School of Medicine, University of Calgary, Calgary, Canada; Section of Pediatric Surgery, Division of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Canada.
authors.forename: Donald F
authors.initials: DF
authors.lastname: McPhalen
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Canada; Division of Surgical Oncology, Department of Surgery, University of Calgary, Calgary, Canada.
authors.forename: Claire
authors.initials: C
authors.lastname: Temple-Oberle
mesh_terms: D004504:Education, Medical, Undergraduate; D013502:General Surgery / Q000193:education*; D006801:Humans; D007400:Interprofessional Relations; D009873:Operating Rooms; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Interpersonal and Communication Skills; Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; clerkship; intimidation; medical education; surgical education; teaching