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Mamani-Benito O, Rojas-Zegarra ME, Carranza Esteban RF, Caycho-Rodríguez T, Vilca LW, Lingán-Huamán SK. New psychometric evidence for the thesis advisor abuse scale (EMAT) in Peruvian university students based on classic and modern procedures. Heliyon 2024; 10:e28475. [PMID: 38560100 PMCID: PMC10979084 DOI: 10.1016/j.heliyon.2024.e28475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 03/06/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
Although evidence of mistreatment toward university students in the academic field has been reported for several years, its study in the context of the development of undergraduate research is still emerging. For this reason, it is necessary to have valid and reliable measurement instruments that allow assessing the magnitude of this problem. The objective of this study was to evaluate the psychometric properties of the Thesis Advisor Abuse Scale (EMAT, for its acronym in Spanish) in Peruvian university students. A total of 753 university students (women = 57.4%) from the 3 regions of Peru participated. The internal structure was analyzed under an analytical-factorial approach, and the discrimination and difficulty characteristics of the items were evaluated from the perspective of item response theory (IRT). The findings showed evidence supporting the original three-dimensional structure. Furthermore, all the items on the EMAT have good discriminatory power. Additionally, the EMAT proved to be strictly invariant according to sex, and the reliability coefficients reached high magnitudes. It is concluded that the EMAT is an instrument that has adequate psychometric properties to be used as a measure of mistreatment by advisors in the thesis preparation processes in Peruvian university students.
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Affiliation(s)
- Oscar Mamani-Benito
- Facultad de Ciencias de la Salud, Universidad Señor de Sipán, Chiclayo, Perú
| | | | | | | | - Lindsey W. Vilca
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Perú
| | - Susana K. Lingán-Huamán
- Carrera de Psicología, Facultad de Ciencias de la Salud, Universidad San Ignacio de Loyola, Lima, Perú
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Kloos J, Simon E, Sammarco A, El-Nashar S, Bazella C. Neglect as an undefined and overlooked aspect of medical student mistreatment: A systematic review of the literature. MEDICAL TEACHER 2023; 45:1395-1403. [PMID: 37300429 DOI: 10.1080/0142159x.2023.2218982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Although the mistreatment of medical students is a well-researched topic, the scope of mistreatment often leaves out neglect, a subtype for which there is no accepted definition based in the published literature. This review sought to summarize the existing data on the prevalence and descriptors of neglect, identify strategies seen in the literature designed to improve it, and offer a synthesized definition of this phenomenon to guide future research. METHODS Following PRISMA guidelines, a relevant systematic literature search from 2000 to April 2021 was performed to identify literature on neglect in clinical settings within American medical schools. RESULTS Neglect, a poorly defined phenomenon in medical education related to the suboptimal learning environment, is often excluded from research on medical student mistreatment. Neglect is a barrier to a successful learning environment, yet a paucity of data and the heterogeneous nature of the present literature render it difficult to estimate its true prevalence. Studies that include neglect frequently assess it solely as the result of identity discrimination or stated career interests. Recent interventions include promoting longitudinal relationships between students and clinical faculty and establishing teaching expectations. CONCLUSIONS Neglect is the mistreatment of medical students by the medical care team via a lack of meaningful inclusion in the clinical environment such that it has a notable negative impact on learning and student well-being, regardless of intentionality. An established definition that is grounded in the literature is required to create a common point of reference and understand its true prevalence, its associated variables, and the best mitigation strategies, as well as to guide future research, which should examine neglect independently and as a consequence of personal and professional identities.
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Affiliation(s)
- Jacqueline Kloos
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Emily Simon
- University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Anne Sammarco
- Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sherif El-Nashar
- Obstetrics and Gynecology, Mayo Clinic School of Medicine and Science, Jacksonville, FL, USA
| | - Corinne Bazella
- Obstetrics and Gynecology, Case Western Reserve School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Marquardt D, Langdale L, Kim S, Leroux B, Friedrich J, Schreuder AB, Wood DE. Closing the gap: Triangulation of surgeons’ respectful behaviors perceived by medical students, residents, and patients. Surgery 2022; 172:96-101. [DOI: 10.1016/j.surg.2021.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/09/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
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Kendrick M, Kendrick KB, Taylor NF, Leggat SG. A qualitative study of hospital clinical staff perceptions of their interactions with healthcare middle managers. J Health Organ Manag 2021; ahead-of-print. [PMID: 34921600 DOI: 10.1108/jhom-06-2021-0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The authors explored clinical staff perceptions of their interactions with middle management and their experiences of the uncongeniality of their working environment. DESIGN/METHODOLOGY/APPROACH Semi-structured interviews of clinical staff from an Australian public health service's Emergency, Surgery and Psychiatry departments. Volunteer interview transcripts were inductively coded using a reflexive thematic content analysis. FINDINGS Of 73 interviews, 66 participants discussed their interactions with management. Most clinicians considered their interactions with middle management to be negative based on a violation of their expectations of support in the workplace. Collectively, these interactions formed the basis of clinical staff perceptions of management's lack of capacity and fit for the needs of staff to perform their roles. PRACTICAL IMPLICATIONS Strategies to improve management's fit with clinicians' needs may be beneficial for reducing uncongenial workplaces for healthcare staff and enhanced patient care. ORIGINALITY/VALUE This article is among the few papers that discuss interactions with management from the perspective of clinical staff in healthcare. How these perspectives inform the perception of workplace uncongeniality for clinicians contributes greater understanding of the factors contributing to adversarial relationships between clinicians and managers.
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Affiliation(s)
- Madeleine Kendrick
- Public Health, La Trobe University - Bundoora Campus, Melbourne, Australia
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Burney CP, Goldwag JL, Sorensen MJ, Crockett AO. Hopes, fears, and rumors: Medical students and the general surgery clerkship. Am J Surg 2021; 222:687-691. [PMID: 34238588 DOI: 10.1016/j.amjsurg.2021.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgical educators have worked to manage the hopes and fears as well as the recurring rumors that plague the surgical clerkship. It is not known if this has effected change over time. METHODS We gathered information on hopes, fears, and rumors during our clerkship orientations from 2017 to 2019 using anonymous polling software with real-time feedback. We analyzed 468 responses using qualitative content analysis. RESULTS Students hoped for practical skills acquisition, self-improvement, and understanding the surgical profession. They feared lack of time and knowledge, burnout, mistreatment, and subjective evaluation. Rumors included negative perceptions of surgical culture work environment, and fear of mistreatment despite clerkship changes intended to allay these fears. CONCLUSION Students starting surgery clerkships hope to gain surgical and clinical skills but concerns about surgical culture and mistreatment appear to remain unchanged despite structural improvements in the clerkship experience. Surgeons should look beyond the clerkship itself to change these perceptions.
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Affiliation(s)
- Charles P Burney
- Department of Surgery, Dartmouth-Hitchcock Medical Center, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jenaya L Goldwag
- Department of Surgery, Dartmouth-Hitchcock Medical Center, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Meredith J Sorensen
- Department of Surgery, Dartmouth-Hitchcock Medical Center, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Andrew O Crockett
- Department of Surgery, Dartmouth-Hitchcock Medical Center, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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Weiser L, Nnamani Silva ON, Thompson A, Hernandez S, Kelly YM, Kim EH, Campbell AR, Sosa JA, Gosnell J, Alseidi A, Lin MYC, Roman SA. Paying it forward: A pilot program for near-peer support for medical students during the surgery clerkship. Am J Surg 2021; 222:501-503. [PMID: 33741184 DOI: 10.1016/j.amjsurg.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/03/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Lucas Weiser
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Avery Thompson
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Sophia Hernandez
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Yvonne M Kelly
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Edward H Kim
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Andre R Campbell
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Julie Ann Sosa
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Jessica Gosnell
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Adnan Alseidi
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Matthew Y C Lin
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Sanziana A Roman
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA.
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Physician mistreatment and toxic teams: Incivility in clinical learning environments. Am J Surg 2020; 220:274-275. [DOI: 10.1016/j.amjsurg.2020.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022]
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Grover A, Appelbaum N, Santen SA, Lee N, Hemphill RR, Goldberg S. Physician mistreatment in the clinical learning environment. Am J Surg 2020; 220:276-281. [DOI: 10.1016/j.amjsurg.2019.11.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/17/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
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Salehi PP, Jacobs D, Suhail-Sindhu T, Judson BL, Azizzadeh B, Lee YH. Consequences of Medical Hierarchy on Medical Students, Residents, and Medical Education in Otolaryngology. Otolaryngol Head Neck Surg 2020; 163:906-914. [DOI: 10.1177/0194599820926105] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ObjectiveTo (1) review concepts of medical hierarchy; (2) examine the role of medical hierarchy in medical education and resident training; (3) discuss potential negative impacts of dysfunctional hierarchy in medical and surgical training programs, focusing on otolaryngology; and (4) investigate solutions to these issues.Data SourcesOvid Medline, Embase, GoogleScholar, JSTOR, Google, and article reference lists.Review MethodsA literature search was performed to identify articles relating to the objectives of the study using the aforementioned data sources, with subsequent exclusion of articles believed to be outside the scope of the current work. The search was limited to the past 5 years.ConclusionsTwo types of hierarchies exist: “functional” and “dysfunctional.” While functional medical hierarchies aim to optimize patient care through clinical instruction, dysfunctional hierarchies have been linked to negative impacts by creating learning environments that discourage the voicing of concerns, legitimize trainee mistreatment, and create moral distress through ethical dilemmas. Such an environment endangers patient safety, undermines physician empathy, hampers learning, lowers training satisfaction, and amplifies stress, fatigue, and burnout. On the other hand, functional hierarchies may improve resident education and well-being, as well as patient safety.Implications for PracticeOtolaryngology–head and neck surgery programs ought to work toward creating healthy systems of hierarchy that emphasize collaboration and improvement of workplace climate for trainees and faculty. The goal should be to identify aspects of dysfunctional hierarchy in one’s own environment with the ambition of rebuilding a functional hierarchy where learning, personal health, and patient safety are optimized.
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Affiliation(s)
- Parsa P. Salehi
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel Jacobs
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Timur Suhail-Sindhu
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Benjamin L. Judson
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Babak Azizzadeh
- Division of Head and Neck Surgery, Department of Otolaryngology–Head and Neck Surgery, Center for Advanced Facial Plastic Surgery, Beverly Hills, California, USA
- Division of Head and Neck Surgery, Department of Otolaryngology–Head and Neck Surgery, David Geffen School of Medicine at the University of California–Los Angeles, Los Angeles, California, USA
| | - Yan Ho Lee
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Griffith M, Clery MJ, Humbert B, Joyce JM, Perry M, Hemphill RR, Santen SA. Exploring Action Items to Address Resident Mistreatment through an Educational Workshop. West J Emerg Med 2019; 21:42-46. [PMID: 31913817 PMCID: PMC6948710 DOI: 10.5811/westjem.2019.9.44253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/15/2019] [Accepted: 09/23/2019] [Indexed: 11/16/2022] Open
Abstract
Mistreatment of trainees is common in the clinical learning environment. Resident mistreatment is less frequently tracked than medical student mistreatment, but data suggest mistreatment remains prevalent at the resident level. To address resident mistreatment, the authors developed an Educational Advance to engage emergency medicine residents and faculty in understanding and improving their learning environment. The authors designed a small-group session with the following goals: 1) Develop a shared understanding of mistreatment and its magnitude; 2) Recognize the prevalence of resident mistreatment data and identify the most common types of mistreatment; 3) Relate study findings to personal or institutional experiences; and 4) Generate strategies for combating mistreatment and strengthening the clinical learning environment at their home institutions. Design was a combination of presentation, small group discussion, and facilitated discussion. Results were presented to participants from a previously administered survey of resident mistreatment. Public humiliation and sexist remarks were the most commonly reported forms. Faculty were the most frequent perpetrators, followed by residents and nurses. A majority of respondents who experienced mistreatment did not report the incident. Session participants were then asked to brainstorm strategies to combat mistreatment. Participants rated the session as effective in raising awareness about resident mistreatment and helping departments develop methods to improve the learning environment. Action items proposed by the group included coaching residents about how to respond to mistreatment, displaying signage in support of a positive learning environment, zero tolerance for mistreatment, clear instructions for reporting, and intentionality training to improve behavior.
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Affiliation(s)
- Max Griffith
- Michigan Medicine/St. Joseph Mercy Ann Arbor, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Michael J. Clery
- Emory University School of Medicine, Grady Memorial Hospital, Department of Emergency Medicine, Atlanta, Georgia
| | - Butch Humbert
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - J. Michael Joyce
- Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, Virginia
| | - Marcia Perry
- Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Robin R. Hemphill
- Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, Virginia
| | - Sally A. Santen
- Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, Virginia
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Sergesketter AR, Lubkin DT, Shammas RL, Krucoff KB, Peskoe SB, Risoli T, Endres K, Hollenbeck ST. The Impact of Ergonomics on Recruitment to Surgical Fields: A Multi-Institutional Survey Study. J Surg Res 2018; 236:238-246. [PMID: 30694762 DOI: 10.1016/j.jss.2018.11.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/17/2018] [Accepted: 11/20/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Awareness of ergonomics in surgery is growing, but whether musculoskeletal (MSK) injuries in surgery influence trainee career choices remains unknown. This study aimed to characterize medical students' MSK pain during surgical rotations and determine whether ergonomics influence student interest in surgical fields. METHODS An online survey was administered to medical students in North Carolina. Students were asked about specialty interest, MSK pain on surgical rotations, and deterrents from surgical fields. Students were exposed to literature about ergonomics in surgery then queried again about relative specialty interest (medical versus surgical). Differences in specialty interest before and after the exposure were compared using a Wilcoxon signed-rank test. RESULTS Of 243 participants, 44.0% were interested in pursuing a surgical specialty. Overall, 75.3% reported MSK pain during their surgical rotation, with the average daily pain score highest during surgery rotations compared to all other clinical rotations. The worst pain was reported in the feet and low back while "standing in the operating room" (81.2%) or "retracting" (59.4%). Among students initially interested in surgery but whose interest changed to a medical specialty during medical school, "physical demands of the field" was a common deterrent (36.4%). After exposure to literature regarding the incidence of MSK injuries in surgery, student interest in surgical fields on a 10-point scale significantly decreased (average -0.5 points; P < 0.01). CONCLUSIONS High incidence of MSK injury among surgeons may be one factor deterring medical students from surgical careers. Ergonomic interventions may be important both to improve surgeon longevity and maintain the surgical workforce.
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Affiliation(s)
| | - David T Lubkin
- Duke University School of Medicine, Durham, North Carolina
| | - Ronnie L Shammas
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kate B Krucoff
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Medical Center, Durham, North Carolina
| | - Sarah B Peskoe
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Thomas Risoli
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Kyle Endres
- Duke Social Science Research Institute, Initiative on Survey Methodology, Durham, North Carolina
| | - Scott T Hollenbeck
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Medical Center, Durham, North Carolina.
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Mazer LM, Bereknyei Merrell S, Hasty BN, Stave C, Lau JN. Assessment of Programs Aimed to Decrease or Prevent Mistreatment of Medical Trainees. JAMA Netw Open 2018; 1:e180870. [PMID: 30646041 PMCID: PMC6324298 DOI: 10.1001/jamanetworkopen.2018.0870] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Mistreatment of medical students is pervasive and has negative effects on performance, well-being, and patient care. OBJECTIVE To document the published programmatic and curricular attempts to decrease the incidence of mistreatment. DATA SOURCES PubMed, Scopus, ERIC, the Cochrane Library, PsycINFO, and MedEdPORTAL were searched. Comprehensive searches were run on "mistreatment" and "abuse of medical trainees" on all peer-reviewed publications until November 1, 2017. STUDY SELECTION Citations were reviewed for descriptions of programs to decrease the incidence of mistreatment in a medical school or hospital with program evaluation data. A mistreatment program was defined as an educational effort to reduce the abuse, mistreatment, harassment, or discrimination of trainees. Studies of the incidence of mistreatment without description of a program, references to a mistreatment program without outcome data, or a program that has never been implemented were excluded. DATA EXTRACTION AND SYNTHESIS Authors independently reviewed all retrieved citations. Articles that any author found to meet inclusion criteria were included in a full-text review. The data extraction form was developed based on the guidelines for Best Evidence in Medical Education. An assessment of the study quality was conducted using a conceptual framework of 6 elements essential to the reporting of experimental studies in medical education. MAIN OUTCOMES AND MEASURES A descriptive review of the interventions and outcomes is presented along with an analysis of the methodological quality of the studies. A separate review of the MedEdPORTAL mistreatment curricula was conducted. RESULTS Of 3347 citations identified, 10 studies met inclusion criteria. Of the programs included in the 10 studies, all were implemented in academic medical centers. Seven programs were in the United States, 1 in Canada, 1 in the United Kingdom, and 1 in Australia. The most common format was a combination of lectures, workshops, and seminars over a variable time period. Overall, quality of included studies was low and only 1 study included a conceptual framework. Outcomes were most often limited to participant survey data. The program outcome evaluations consisted primarily of surveys and reports of mistreatment. All of the included studies evaluated participant satisfaction, which was mostly qualitative. Seven studies also included the frequency of mistreatment reports; either surveys to assess perception of the frequency of mistreatment or the frequency of reports via official reporting channels. Five mistreatment program curricula from MedEdPORTAL were also identified; of these, only 2 presented outcome data. CONCLUSIONS AND RELEVANCE There are very few published programs attempting to address mistreatment of medical trainees. This review identifies a gap in the literature and provides advice for reporting on mistreatment programs.
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Affiliation(s)
- Laura M. Mazer
- Goodman Surgical Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Sylvia Bereknyei Merrell
- Goodman Surgical Education Center, Stanford–Surgery Policy Improvement Research & Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Brittany N. Hasty
- Goodman Surgical Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Christopher Stave
- Lane Medical Library, Stanford University School of Medicine, Stanford, California
| | - James N. Lau
- Goodman Surgical Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
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