How medical learners and educators decide what counts as mistreatment: A qualitative study

Area of Science:

• Medical Education
• Healthcare Professional Development
• Learner Well-being

Background:

• Mistreatment of medical learners is a documented global issue with existing research on prevalence and interventions.
• Learners often perceive mistreatment differently than researchers and administrators, leading to definitional ambiguity.
• This ambiguity complicates efforts to understand and effectively address maltreatment in clinical settings.

Purpose of the Study:

• To explore how medical learners and educators interpret negative interactions in clinical environments.
• To identify factors influencing the perception of these interactions as mistreatment.
• To address the definitional ambiguity surrounding learner mistreatment.

Main Methods:

• Constructivist grounded theory approach utilized.
• Interviews conducted with 49 participants: 16 medical students, 15 residents/fellows, and 18 educators.
• Constant comparative analysis of experiences categorized as 'definitely,' 'maybe,' or 'definitely not' mistreatment.

Main Results:

• Participants found it challenging to classify negative interpersonal interactions, except in severe cases.
• Individual sense-making processes, considering interaction, initiator, and recipient factors, were consistently used to interpret experiences.
• Significant variation existed in categorizing similar experiences, yet consistent elements informed their judgments.

Conclusions:

• Only the most severe behaviors are universally recognized as mistreatment.
• A complex, individual sense-making process is necessary to evaluate interaction acceptability.
• Discrepancies in judging interactions present opportunities for administrative, research, and faculty development interventions.