title: Perceptions of mistreatment among trainees vary at different stages of clinical training.
abstract: BACKGROUND
  Mistreatment of trainees remains a frequently reported phenomenon in medical education. One barrier to creating an educational culture of respect and professionalism may be a lack of alignment in the perceptions of mistreatment among different learners. Through the use of clinical vignettes, our aim was to assess the perceptions of trainees toward themes of potential mistreatment at different stages of training.
  
  
  METHODS
  Based on observations from external experts embedded in the clinical learning environment, six thematic areas of potential mistreatment were identified: verbal abuse, specialty-choice discrimination, non-educational tasks, withholding/denying learning opportunities, neglect and gender/racial insensitivity. Corresponding clinical vignettes were created and distributed to 1) medical students, 2) incoming interns, 3) residents/fellows. Perceptions of the appropriateness of the interactions depicted in the vignettes were measured on a 5-point Likert scale. Scores were categorized into neutral or appropriate (≤3) or inappropriate (i.e. mistreatment) (>3) and compared using chi-squared tests.
  
  
  RESULTS
  Four hundred twenty seven trainees participated (182 students, 120 interns, 125 residents/fellows). Proportions of students perceiving mistreatment differed significantly from those of interns and residents/fellows in domains of verbal abuse, specialty discrimination and gender/racial insensitivity (p < 0.05). In scenarios comparing interns to residents/fellows, no significant differences were noted in perceptions of mistreatment in the domains of non-educational tasks, withholding learning and neglect.
  
  
  CONCLUSIONS
  Perceptions of mistreatment differ at different developmental stages of medical training. After exposure to the clinical learning environment, perceptions of incoming interns did not differ from those of residents/fellows, implicating clinical rotations as a key period in indoctrinating students into the prevailing culture. More longitudinal studies are needed to confirm or better examine this phenomenon.
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, P.O. Box 850, 500 University Drive, H137, Hershey, PA, 17033-0850, USA.
authors.forename: Afif N
authors.initials: AN
authors.lastname: Kulaylat
authors.affiliation: School of Labor and Employment Relations, The Pennsylvania State University, University Park, PA, USA.
authors.forename: Danni
authors.initials: D
authors.lastname: Qin
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, P.O. Box 850, 500 University Drive, H137, Hershey, PA, 17033-0850, USA.
authors.forename: Susie X
authors.initials: SX
authors.lastname: Sun
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, P.O. Box 850, 500 University Drive, H137, Hershey, PA, 17033-0850, USA.|Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, P.O. Box 850, 500 University Drive, H137, Hershey, PA, 17033-0850, USA.
authors.forename: Jane R
authors.initials: JR
authors.lastname: Schubart
authors.affiliation: School of Labor and Employment Relations, The Pennsylvania State University, University Park, PA, USA.
authors.forename: Antone J
authors.initials: AJ
authors.lastname: Aboud
authors.affiliation: Department of Radiology, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Flemming
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, P.O. Box 850, 500 University Drive, H137, Hershey, PA, 17033-0850, USA.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Dillon
authors.affiliation: Department of Medicine, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Bollard
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, P.O. Box 850, 500 University Drive, H137, Hershey, PA, 17033-0850, USA. dhan@hmc.psu.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Han
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology*; D001291:Attitude of Health Personnel; D002321:Career Choice; D002982:Clinical Clerkship; D004504:Education, Medical, Undergraduate / Q000458:organization & administration; D005260:Female; D006801:Humans; D015994:Incidence; D007400:Interprofessional Relations; D007858:Learning; D008137:Longitudinal Studies; D008297:Male; D020380:Needs Assessment; D011287:Prejudice / Q000523:psychology* / Q000706:statistics & numerical data; D028743:Professional Misconduct / Q000523:psychology / Q000706:statistics & numerical data*; D017406:Sexual Harassment / Q000523:psychology* / Q000706:statistics & numerical data; D012919:Social Behavior; D012931:Social Environment; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: ACGME; Burnout; Clinical learning environment; Core competencies; Hidden curriculum; Milestones; Professionalism