Residents' Insight on Student Mistreatment: What We Learned From Our First Action Research Cycle

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Abstract

BACKGROUND:

The medical student mistreatment literature focuses on prevalence, risk factors, and mistreatment sources. Studies describe interventions to improve learning culture, however many students continue to report mistreatment. We initiated a project to engage residents to construct knowledge of the mistreatment phenomenon, plan, and evaluate actions to address this problem.

METHODS:

Action research (AR) is a repetitive, cyclical, participatory research process. We used the method of Group Level Assessment (GLA) to organize our first AR cycle. In a group setting, residents responded individually to 22 theoretically-derived prompts. Residents viewed all responses, performed first-cut qualitative analysis, and planned actions from group discussion. Secondary qualitative analysis was performed to understand mistreatment characteristics, contributing factors, responses and outcomes, and interventions.

RESULTS:

Twenty-three residents participated. Factors identified that contributed to student mistreatment included different medical specialty paths, unprepared students, poorly defined expectations, hierarchy, poor communications, and residents' need for patience, time and inspiration to teach. Residents acknowledged both negative and positive outcomes from humiliation, including loss of focus, learner withdrawal, positive resilience traits, motivation to learn, and attention to details. Solutions spanned clinical and educational interventions to needed gains in personal insight and improved behaviors.

DISCUSSION:

Our findings confirm the influence of previously described factors contributing to medical student mistreatment. Most importantly, we gained significant insight into local factors contributing to this phenomenon. Residents are now organizational change-makers, an AR principle. As a result, we are implementing resident-inspired interventions and moving forward with our next AR cycle.

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