title: Mistreatment and the learning environment for medical students on general surgery clerkship rotations: What do key stakeholders think?
abstract: BACKGROUND
  Mistreatment has potential downstream effects on students. General surgery rotations tend to have a higher incidence of mistreatment reports. This study was undertaken to identify dominant themes contributing to a negative learning environment.
  
  
  METHODS
  A qualitative study was performed using Delphi consensus technique to develop a discussion guide. Four focus groups were performed (n = 30 participants) with medical students, residents, nurses, and attending surgeons. Participants were selected using purposive-stratified criterion-based sampling.
  
  
  RESULTS
  Multiple themes emerged: 1) unclear expectations for medical students; 2) passive mistreatment (neglect); 3) failure to integrate students into surgical team; 4) witnessed or experienced active mistreatment, 5) negative attitude of residents towards medical students' lack of knowledge.
  
  
  CONCLUSIONS
  Medical student mistreatment persists and is a threat to the learning environment and individual learning process. Passive mistreatment (neglect) represents the most distressing component of mistreatment. These findings suggest a need for education aimed at surgical residents and others in the learning environment.
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Lowry Medical Office Building, Boston, MA 02215, USA. Electronic address: macastil@bidmc.harvard.edu.
authors.forename: Manuel
authors.initials: M
authors.lastname: Castillo-Angeles
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Lowry Medical Office Building, Boston, MA 02215, USA. Electronic address: aawatkin@bidmc.harvard.edu.
authors.forename: Ammara A
authors.initials: AA
authors.lastname: Watkins
authors.affiliation: Department of Obstetrics & Gynecology, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY 11219, USA. Electronic address: daniloe25@gmail.com.
authors.forename: Danilo
authors.initials: D
authors.lastname: Acosta
authors.affiliation: Department of Internal Medicine, New York University School of Medicine, 550 First Ave, New York, NY 10016, USA. Electronic address: frydman.julia@gmail.com.
authors.forename: Julia L
authors.initials: JL
authors.lastname: Frydman
authors.affiliation: Department of Internal Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Deaconess Building, Suite 306, Boston, MA 02215, USA. Electronic address: lydia.flier@gmail.com.
authors.forename: Lydia
authors.initials: L
authors.lastname: Flier
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Lowry Medical Office Building, Boston, MA 02215, USA. Electronic address: agarces@bidmc.harvard.edu.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Garces-Descovich
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Lowry Medical Office Building, Boston, MA 02215, USA. Electronic address: mcahalan@bidmc.harvard.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cahalane
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Lowry Medical Office Building, Boston, MA 02215, USA. Electronic address: sgangadh@bidmc.harvard.edu.
authors.forename: Sidharta P
authors.initials: SP
authors.lastname: Gangadharan
authors.affiliation: Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: katkins@bidmc.harvard.edu.
authors.forename: Katharyn M
authors.initials: KM
authors.lastname: Atkins
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Lowry Medical Office Building, Boston, MA 02215, USA. Electronic address: tkent@bidmc.harvard.edu.
authors.forename: Tara S
authors.initials: TS
authors.lastname: Kent
mesh_terms: D001291:Attitude of Health Personnel; D002982:Clinical Clerkship; D003697:Delphi Technique; D004504:Education, Medical, Undergraduate; D005180:Faculty, Medical; D017144:Focus Groups; D013502:General Surgery / Q000193:education; D006801:Humans; D007396:Internship and Residency; D007398:Interpersonal Relations; D008404:Massachusetts; D015279:Organizational Culture; D036301:Qualitative Research; D012919:Social Behavior; D013337:Students, Medical / Q000523:psychology*; D013663:Teaching
keywords: Clerkship; Medical student; Mistreatment; Neglect; Surgery