P.T. Ross is director, Advancing Scholarship, University of Michigan Medical School, Ann Arbor, Michigan; ORICD: http://orcid.org/0000-0001-7751-784X. E. Abdoler is clinical educator fellow, Division of Infectious Diseases, University of California, San Francisco, San Francisco, California. L. Flygt is an intern, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; ORICD: http://orcid.org/0000-0002-4843-6802. R.S. Mangrulkar is Marguerite S. Roll Professor of Medical Education, associate dean for medical student education, and associate professor of internal medicine and learning health sciences, University of Michigan School of Medicine, Ann Arbor, Michigan. S.A. Santen is senior associate dean, Evaluation, Assessment and Scholarship, Virginia Commonwealth School of Medicine, Richmond, Virginia; ORICD: http://orcid.org/0000-0002-8327-8002.
Acad Med. 2018 Apr;93(4):606-611. doi: 10.1097/ACM.0000000000002033.
The proportion of students who experience mistreatment is significantly higher than the proportion of students who report mistreatment. Identifying ways to improve students' reporting of these incidents is one strategy for increasing opportunities to achieve resolution and prevent future occurrences.
The authors applied a modified A3 Lean framework to examine medical student reporting of mistreatment behaviors at the University of Michigan Medical School (UMMS) in 2013-2016. The A3 Lean framework is a stepwise approach that involves outlining the background to establish the context of the problem, describing the current condition, identifying the goal or desired outcome, analyzing causes of the problem, providing proposed countermeasures for improvement, and creating follow-up plans. The authors identified three reasons for the difference between students' experiences and reporting of mistreatment and developed five countermeasures/action plan items to address this difference.
The proportion of students reporting mistreatment at UMMS increased 21.4% between 2013 and 2016. Compared with 2013, more students in 2016 indicated not reporting because the incident did not seem important enough or because they resolved the issue on their own.
The authors have enlisted the support of the health system's human resources department and presented the inaugural grand rounds on improving the learning environment in 2016. Among other things, they are also partnering with this team to add questions about student mistreatment and civility to the annual employee engagement survey distributed to all 20,000 employees.
遭受虐待的学生比例明显高于报告虐待事件的学生比例。确定提高学生报告这些事件的方法是增加解决机会和防止未来发生此类事件的策略之一。
作者在 2013 年至 2016 年期间，应用改良的 A3 精益框架审查密歇根大学医学院（UMMS）的医学生报告虐待行为。A3 精益框架是一种逐步方法，包括概述背景以确定问题的背景，描述现状，确定目标或预期结果，分析问题的原因，提供改进的拟议对策，并制定后续计划。作者确定了学生经历和报告虐待之间差异的三个原因，并制定了五个对策/行动计划项目来解决这一差异。
UMMS 报告虐待事件的学生比例在 2013 年至 2016 年间增加了 21.4%。与 2013 年相比，2016 年更多的学生表示没有报告，因为事件似乎不够重要，或者因为他们自行解决了问题。
作者已经争取到了医疗系统人力资源部门的支持，并于 2016 年举行了关于改善学习环境的首届大巡讲。除此之外，他们还与该团队合作，在向所有 20,000 名员工分发的年度员工敬业度调查中添加了有关学生虐待和文明的问题。
