Student mistreatment on the surgery clerkship: where are we now?

Medical student mistreatment is an unwelcome issue on surgery clerkships. Neither a comprehensive description of mistreatment nor best practices in mitigation have been developed. We aimed to explore the perspectives of surgical education leaders about forms of student mistreatment and subsequent mitigation efforts.

A phenomenological approach was used to develop study methodology, including initial snowball recruitment to identify participants and purposive sampling to include a variety of class sizes and geographical regions in the United States. A single interviewer was trained to use a content-expert developed semi-structured script. Via phone or video calls, participants were contacted, consented, and interviewed. Conversations were transcribed (Ottr^®) and independently coded (Dedoose^® 2022) by two research team members to identify emerging themes. The developed codebook was iteratively updated with resolution of disagreements occurring via consensus meetings with all team members.

15 current and recent surgery clerkship directors were contacted and 14 interviewed between July and October 2022 (1 declined participation due to desire for absolute confidentiality). Types of mistreatment were categorized ranging from verbal berating to neglect. A primary theme underpinning participant understanding of student mistreatment was the concept of perspective misalignment: the lack of alignment between students and non-students in perception and understanding of a given interaction. Analysis of participant understanding of solutions revealed two fundamentally different approaches: proactive and reactive. Proactive solutions were more common and involved strategies such as increasing faculty awareness of the problem and empowering and orienting students in the learning environment. Reactive solutions were less common but highly visible and included concepts such as prompt management of complaints and early leadership involvement.

Mistreatment of medical students on surgery clerkships remains a pervasive challenge. This study describes the shared understanding of clerkship directors regarding the importance of perspective misalignment. Existing efforts to mitigate mistreatment have mostly been geared towards proactive strategies, in part designed to diminish this misalignment. Future studies should contrast these findings with student perspectives on this issue and impact of existing solutions.