Department of Surgery, University of New Mexico, Albuquerque, NM.
Department of Surgery, University of New Mexico, Albuquerque, NM.
J Am Coll Surg. 2020 Jul;231(1):112-121.e2. doi: 10.1016/j.jamcollsurg.2020.03.029. Epub 2020 Apr 10.
Despite decades of reporting, rates of medical student mistreatment on the surgical clerkship remains a national issue. To understand whether misaligned perceptions about what constitutes mistreatment were leading to the high rates of reported mistreatment at our institution, we implemented an intervention designed to educate students about the unique challenges of the surgical environment and to build consensus around the definition of mistreatment.
Medical students were recruited from the surgery clerkship to participate in a video vignette-based curriculum accompanied by a facilitated discussion. Participants completed a survey before and after the educational intervention to assess their understanding of mistreatment and their perceptions of the surgical learning environment. At the end of each clerkship block students who participated in the intervention, as well as students who did not participate, were asked to complete a questionnaire about their experiences during the clerkship.
During 6 clerkship blocks, 53 students participated in the intervention (51% of the third-year student cohort). Students who participated in the intervention were more likely to report experiencing mistreatment or witnessing mistreatment during the clerkship. Students who participated in the intervention also reported experiencing neglect more frequently than students who did not participate.
We found that using an educational intervention designed to align perceptions of what constitutes mistreatment in the surgical learning environment did not decrease rates of mistreatment reporting on the surgical clerkship at our institution. Students who participated in the intervention reported increased confidence in their ability to define and recognize mistreatment after the intervention, as well as increased comfort reporting mistreatment and turning to faculty with concerns about mistreatment.
尽管已有数十年的报道，但医学生在外科实习期间受到虐待的问题仍然是一个全国性问题。为了了解对虐待行为的看法是否不一致，导致我们机构报告的虐待率很高，我们实施了一项干预措施，旨在教育学生了解外科环境的独特挑战，并就虐待行为的定义达成共识。
从外科实习中招募医学生参加基于视频小插曲的课程，并进行小组讨论。参与者在教育干预前后完成一项调查，以评估他们对虐待的理解以及对手术学习环境的看法。在每个实习块结束时，参加干预的学生以及未参加干预的学生都被要求完成一份关于他们在实习期间经历的问卷。
在 6 个实习块中，有 53 名学生参加了干预（占三年级学生的 51%）。参加干预的学生更有可能报告在实习期间受到虐待或目睹虐待。参加干预的学生比未参加干预的学生更频繁地报告被忽视。
我们发现，使用旨在使外科学习环境中对虐待行为的看法一致的教育干预措施，并不能降低我们机构外科实习期间虐待行为的报告率。参加干预的学生在干预后报告对自己定义和识别虐待的能力更有信心，并且更愿意报告虐待行为，并向教职员工报告对虐待的担忧。
