Structures and Interventions to Address Trainee Mistreatment in Graduate Medical Education: A Scoping Review

Area of Science:

• Medical Education Research
• Graduate Medical Education
• Health Professions Education

Background:

• Mistreatment of trainees in graduate medical education (GME) continues despite accreditation standards.
• This mistreatment disproportionately impacts minoritized trainees, affecting their well-being and patient care.
• Existing structures to address mistreatment often focus on post-harm coping rather than prevention.

Purpose of the Study:

• To conduct a scoping review identifying educational/training interventions and programs/policies to mitigate harm from and address perpetrators of mistreatment.
• To map existing gaps in practice and research concerning trainee mistreatment.
• To guide future interventions and policies for preventing and addressing mistreatment in GME.

Main Methods:

• A comprehensive scoping review of US-based, English-language studies published between January 2015 and July 2025.
• Searches were conducted in PubMed and Embase, with independent, duplicate screening of references.
• Included studies focused on educational/training interventions, programs/policies, or structural approaches to addressing trainee mistreatment.

Main Results:

• 71 studies were included, with 56 focusing on education/training and 15 on programs/policies.
• Trainings were often single-session, utilized case-based discussions, role-play, and simulation, and relied on immediate self-report for assessment.
• Programs and policies included reporting tools, communication campaigns, and task forces, primarily addressing mistreatment after it occurred.

Conclusions:

• A significant gap exists in proactively preventing trainee mistreatment, with an overemphasis on post-harm coping strategies.
• Future interventions should include perpetrator-focused training, longitudinal reinforcement, transparent measurement, and a continuous quality improvement approach.
• Addressing mistreatment requires institutional policies and equity-informed structures focused on prevention at its source, shifting from resilience to proactive measures.