Who Bears the Brunt of Medical Student Mistreatment?

A new study finds that female and minority medical students face significantly higher rates of mistreatment compared to male and white students.

Women, racial and ethnic minorities, and sexual minorities bear a disproportionate share of medical student mistreatment, new research shows.

In medical school, mistreatment of students includes a range of actions such as assault, discrimination, sexual harassment, and verbal abuse. Mistreatment has been linked to several negative consequences, including alcohol abuse, burnout, depression, and medical student attrition.

The new research, published today in JAMA Internal Medicine, suggests that mistreatment of women, racial and ethnic minorities, and sexual minorities in medical school impacts not only the quality of education but also efforts to boost diversity among physicians. "This differential burden of mistreatment may have substantial implications for the medical school learning environment and the diversity of the physician workforce," the research co-authors wrote.

The research is based on data collected from the 2016 and 2017 Association of American Medical Colleges Graduation Questionnaire. The AAMC Graduation Questionnaire is administered annually to all 140 accredited allopathic medical schools in the country.

The researchers analyzed 27,500 graduation questionnaires, which represents 72.1% of medical school graduates in 2016 and 2017. More than one-third of survey respondents reported experiencing at least one type of mistreatment. The most common form of mistreatment was public humiliation, which was reported by 21.1% of survey respondents.

Student mistreatment data

The JAMA Internal Medicine study generated several key data points.

1. Mistreatment by sex:

• More female students reported at least one episode of mistreatment compared to male students (40.9% vs. 25.2%)
   
• More female students reported public humiliation compared to male students (22.9% vs. 19.5%)
   
• More female students reported unwanted sexual advances compared to male students (6.8% vs. 1.3%)
   
• More female students reported a higher rate of gender-based discrimination compared to male students (28.2% vs. 9.4%), including being denied training opportunities and receiving lower evaluations

2. Mistreatment by race or ethnicity:

• Among white students, 24.0% reported experiencing mistreatment. Reported rates of mistreatment were higher for Asian (31.9%), underrepresented minority (38.0%), and multiracial (32.9%) students.
   
• Among white students, 3.8% reported discrimination based on race or ethnicity. Reported discrimination rates were higher for Asian (15.7%), underrepresented minority (23.3%), and multiracial (11.8%) students.
   
• Among white students, 0.7% reported receiving low evaluations because of race or ethnicity. Reported rates of low evaluations because of race or ethnicity were higher for Asians (5.0%), underrepresented minorities (9.6%), and multiracial (3.4%) students.

3. Mistreatment by sexual orientation:

• Nearly twice as many lesbian, gay, or bi-sexual (LGB) students reported an episode of mistreatment compared to heterosexual students (43.5% vs. 23.6%)
   
• More LGB students reported being publicly humiliated than heterosexual students (27.1% vs. 20.7%)
   
• More LGB students reported being subjected to unwanted sexual advances than heterosexual students (7.7% vs. 3.7%)
   
• More LGB students reported discrimination based on sexual orientation than heterosexual students (23.1% vs. 1.0%)
   
• More LGB students reported receiving lower evaluations based on sexual orientation than heterosexual students (4.0% vs. 0.3%)

Data interpretations and implications

The study's data reveals trends in the mistreatment of medical school students, the co-authors wrote. "The major findings of our national study include not only a high prevalence of medical student mistreatment but also differences in the prevalence of mistreatment by student sex, race/ethnicity, and sexual orientation," they wrote.

The data also demonstrate that several inappropriate behaviors are common in medical school, the co-authors wrote.

"These reported behaviors include, but are not limited to, unwanted sexual advances (6.8% of female students and 7.7% of LGB students), lower evaluations secondary to bias and discrimination (6.8% of female students and 9.6% of underrepresented minority students), and being subjected to sexist or bigoted comments (24.3% of female students, 18.9% of underrepresented minority students, and 21.8% of LGB students)."

The data indicate several disturbing implications, they wrote.

"The differential treatment reported by medical students in this study suggests a noninclusive learning environment, which could have profound implications for the well-being and academic success of students. … Another concerning negative experience reported by students was missed opportunities or lower grades because of discrimination. These experiences may have incremental consequences as trainees advance through their medical careers."

Medical schools can take actions to combat mistreatment of students, the co-authors wrote. "Potential interventions include implicit bias and bystander intervention training, better protections for individuals who have been subjected to and report instances of bias and discrimination, and greater transparency in policies for reporting and remediating instances of bias and discrimination."