Are Surgeons Just Mean? A Lean Approach to Examine Student Mistreatment in the Surgery Clerkship

Student mistreatment during surgery clerkships (SCs) is pervasive and linked to burnout. This quality improvement study used Lean methodology to identify root causes of suboptimal student experience within SC and develop targeted interventions.

We conducted a comprehensive analysis of surgical learning environments utilizing thematic analysis of student evaluations, cross-clerkship curriculum review, and stakeholder workshops with educators and students. Lean tools, like process maps and fishbone diagrams, helped identify root causes and guided countermeasures. The primary intervention was a preceptorship model, assigning students to faculty preceptors during their rotation. A survey was distributed to students completing SC between August 2024 and March 2025. Responses were compared using Mann-Whitney U tests (P < 0.05).

Our findings show negative student experiences and mistreatment were primarily driven by structural and system-level factors rather than individual behaviors. Root causes included lack of time, continuity, and inclusion between faculty and students; misaligned expectations; and structural features inherent to surgical practice. A preceptor model was implemented to enhance faculty-student relationships by fostering inclusion and continuity. Among 35 respondents (17 traditional versus 18 preceptorship), students in the preceptor model reported higher attending availability (P = 0.0015), better bedside teaching (P = 0.011), greater comfort in the operating room (P = 0.006), increased respect from surgeons (P = 0.011), and fewer mistreatment experiences (P = 0.011).

Systemic factors, rather than individual behaviors, drive student mistreatment in SC. Process-oriented interventions emphasizing continuity, inclusion, and aligned expectations may better improve learning environments.