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The Prevalence of Medical Student Mistreatment and Its Association With Burnout

Cook, Alyssa F. MD, MPH; Arora, Vineet M. MD, MAPP; Rasinski, Kenneth A. PhD; Curlin, Farr A. MD; Yoon, John D. MD

doi: 10.1097/ACM.0000000000000204
Research Reports

Purpose Medical student mistreatment has been recognized for decades and is known to adversely impact students personally and professionally. Similarly, burnout has been shown to negatively impact students. This study assesses the prevalence of student mistreatment across multiple medical schools and characterizes the association between mistreatment and burnout.

Method In 2011, the authors surveyed a nation ally representative sample of third-year medical students. Students reported the frequency of experiencing mistreatment by attending faculty and residents since the beginning of their clinical rotations. Burnout was measured using a validated two-item version of the Maslach Burnout Inventory.

Results Of 960 potential respondents from 24 different medical schools, 605 (63%) completed the survey, but 41 were excluded because they were not currently in their third year of medical school. Of the eligible students, the majority reported experiencing at least one incident of mistreatment by faculty (64% [361/562]) and by residents (76% [426/562]). A minority of students reported experiencing recurrent mistreatment, defined as occurring “several” or “numerous” times: 10% [59/562] by faculty and 13% [71/562] by residents. Recurrent mistreatment (compared with no or infrequent mistreatment) was associated with high burnout: 57% versus 33% (P < .01) for recurrent mistreatment by faculty and 49% versus 32% (P < .01) for recurrent mistreatment by residents.

Conclusions Medical student mistreatment remains prevalent. Recurrent mistreatment by faculty and residents is associated with medical student burnout. Although further investigation is needed to assess causality, these data provide impetus for medical schools to address student mistreatment to mitigate its adverse consequences.

Dr. Cook was, at the time of this research, fellow, Medical Education Research, Innovation, Teaching, and Scholarship Program, University of Chicago, Chicago, Illinois, and she is currently core faculty, Internal Medicine Residency Program, MedStar Franklin Square Medical Center, Baltimore, Maryland.

Dr. Arora is associate professor, Department of Medicine, assistant dean, Scholarship and Discovery Program, and associate program director, Internal Medicine Residency Program, University of Chicago, Chicago, Illinois.

Dr. Rasinski was, at the time of this research, assistant professor, Department of Medicine, and he is currently survey manager, Chicago Consortium for School Research, University of Chicago, Chicago, Illinois.

Dr. Curlin was, at the time of this research, associate professor, Department of Medicine, codirector, Program of Medicine and Religion, and associate faculty, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois. He is currently Trent Professor of Medical Humanities, Trent Center for Bioethics, Humanities and History of Medicine, Duke University, Durham, North Carolina.

Dr. Yoon is assistant professor, Department of Medicine, and associate faculty, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois.

Please see the end of this article for information about the authors.

Funding/Support: This project was supported by A New Science of Virtues, the Arete Initiative at the University of Chicago through a grant from the John Templeton Foundation as well as a grant from the Center of Health Administration Studies and a pilot award from the Clinical and Translational Science Award–Institute for Translational Medicine (no. UL1 RR024999).

Other disclosures: None.

Ethical approval: This study was approved by the University of Chicago Social and Behavioral Sciences institutional review board.

Previous presentations: An abstract with these data was presented at the Research in Medical Education Conference during the annual meeting of the Association of American Medical Colleges, November 5, 2012, San Francisco, California, and at the Academic Internal Medicine Week, October 12, 2012, Phoenix, Arizona.

Correspondence should be addressed to Dr. Cook, University of Chicago, 5841 S. Maryland Ave., MC 2007, AMB W216, Chicago, IL 60637; telephone: (773) 702-8157; e-mail: alyssakfcook@gmail.com.

© 2014 by the Association of American Medical Colleges