Mullins Clarence, Callahan Edward, Hageman Heather, Chen Herbert, Lindeman Brenessa
From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Mullins, Chen, Lindeman).
School of Medicine, University of California at Davis, Sacramento, CA (Callahan).
J Am Coll Surg. 2022 Apr 1;234(4):701-707. doi: 10.1097/XCS.0000000000000092.
Nearly 1 in 5 medical students reports at least 1 incident of mistreatment, with many occurring in the perioperative environment. We aimed to further define the types of mistreatment occurring perioperatively in a national data set by using a mixed-methods approach.
A sample of 2,224 responses to the general public humiliation free-text question on the 2015 Association of American Medical College's Graduation Questionnaire were analyzed. Using grounded theory methodology, 4 raters independently created and refined the coding schema. Final coding was determined by majority rating. Descriptive statistics, interrater reliability, and chi-square analysis were performed where appropriate.
Among responses, 2,411 events were identified. Interrater reliability was moderate (>0.41) on 94% of variables. Events occurring in a specific setting implicated the surgery clerkship and the operating room 53.2% and 21.8% of the time, respectively. Perioperative events accounted for nearly one-third of verbal abuse reports (30.5%, 324/1059), and almost half of events described yelling (47.0%, 178/379). Mistreatment involving physical contact was significantly more likely to occur in the operating room (59% vs 41%, p < 0.001). Events coded as possibly routine education (n = 379) were significantly less common perioperatively than nonsurgical settings (20.5% vs 79.4%, p = 0.007).
A significant proportion of medical student mistreatment events occur in the context of surgery. Surgeons and trainees must play active roles in leading and instituting needed changes to improve the learning environment to support medical students and recruit a sufficient future surgical workforce.
近五分之一的医学生报告至少经历过1次虐待事件，其中许多发生在围手术期环境中。我们旨在通过采用混合方法，在全国数据集中进一步明确围手术期发生的虐待类型。
对2015年美国医学院协会毕业调查问卷中关于公众羞辱的自由文本问题的2224份回复样本进行了分析。采用扎根理论方法，4名评分者独立创建并完善了编码方案。最终编码由多数评分确定。在适当的情况下进行描述性统计、评分者间信度和卡方分析。
在回复中，共识别出2411起事件。94%的变量评分者间信度为中等（>0.41）。在特定环境中发生的事件分别有53.2%和21.8%发生在外科实习和手术室。围手术期事件占言语虐待报告的近三分之一（30.5%，324/1059），几乎一半的事件描述为大喊大叫（47.0%，178/379）。涉及身体接触的虐待在手术室发生的可能性显著更高（59%对41%，p<0.001）。编码为可能是常规教育的事件（n=379）在围手术期比非手术环境中明显更少（20.5%对79.4%，p=0.007）。
相当一部分医学生虐待事件发生在手术背景下。外科医生和实习生必须在引领和实施必要变革方面发挥积极作用，以改善学习环境，支持医学生并招募足够的未来外科劳动力。
