A Mixed-Methods Analysis of a Novel Mistreatment Program for the Surgery Core Clerkship

Purpose: A little less than half of all medical students report mistreatment during clerkship rotations and this is particularly prevalent on surgical ones. We report the impact of a program targeted at medical students for improving the clinical learning environment on the surgery clerkship at one academic institution. Method: We implemented a dual-modality, video- and discussion-based mistreatment program in the surgery core clerkship to empower students to address potential mistreatment. We compared counts and mistreatment types reports from one year prior to the start of the program and for two years during the program’s incorporation. Students also completed end-of-clerkship questionnaires and written reflections that we inductively analyzed to identify themes. Results: One hundred and sixty-four (164) students, enrolled in the general surgery clerkship between March 2014 and December 2015 and completed the mistreatment program, 141 completed surveys and 47 provided written reflections. On our clerkship surveys, 77% of students rated the program ‘excellent’ or ‘outstanding’. In the qualitative analysis, respondents valued the program in: establishing expectations; allowing for shared experiences; raising awareness of resources to address mistreatment; and providing emotional support. Students felt that the learning environment and rotation culture was improved and that interest in surgery as a career would increase. There were 14 mistreatment reports on the surgery clerkship the year preceding the program, 9 reports in the program’s first year, and 4 the second year. Conclusions: A rotation-specific mistreatment program, focused on creating shared understanding about mistreatment, decreased mistreatment reports and was universally well received among core clerkship students in surgery.