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An Internal Perspective: the Psychological Impact of Mistreatment

  • Empirical Report
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Abstract

Objectives

Student mistreatment remains a prominent issue in medical education. Mistreatment has been linked to negative mental health outcomes, including depression, anxiety, and burnout. Continued challenges in this arena include difficulties in identifying mistreatment and underreporting. The objective of this study was to better understand the nuances of individual students’ reactions to mistreatment.

Methods

Medical students, who had experienced mistreatment, were invited to participate in this study. Individual, semi-structured, peer-to-peer interviews were conducted with 21 students. Interview transcriptions were coded using grounded theory and inductive analysis, and themes were extracted.

Results

The interviews generated 34 unique mistreatment incidents. Four major themes arose in students’ reactions to mistreatment. (1) Descriptions—the student described the incident as inappropriate, unusual, or unnecessary. (2) Recognition—most students did not immediately recognize the incident as mistreatment. (3) Emotions—the student described negative emotions (negative self-views, anger, powerlessness, shock, discomfort) associated with the mistreatment incident. (4) Coping mechanisms—the student utilized avoidance and rationalization to process their mistreatment.

Conclusions

Mistreatment generates complex emotions and coping mechanisms that impair the learning process. These complex emotions and coping mechanisms also make it difficult for trainees to identify mistreatment and to feel safe to report. Increasing understanding of the psychological impact of mistreatment can help peers and educators better screen for mistreatment in trainees and guide them in reporting decisions.

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Acknowledgments:

Thank you to Alvin Chen for assistance with RedCap and processing the codebook. Thank you to Michelle Ghebranious, Shelley Burge, Andrew Gerber, Tasia Isbell, Isabelle Mulder, Margaret O’Brien, Tiffany Robles, David Wideman, and Victoria Lehrmann for assistance with study recruitment and interview transcription. Thank you to the McGovern Medical School Office of Admissions and Student Affairs and Office of Educational Programs for their support and commitment to combating student mistreatment.

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Authors and Affiliations

  1. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Bernice N. Yau

  2. Yale School of Medicine, New Haven, CT, USA

    Alissa S. Chen

  3. McGovern Medical School, Houston, TX, USA

    Kelsey B. Montgomery, Nicole Dubuque & Dana M. McDowelle

Authors
  1. Bernice N. Yau
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  2. Alissa S. Chen
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Correspondence to Bernice N. Yau.

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Yau, B.N., Chen, A.S., Montgomery, K.B. et al. An Internal Perspective: the Psychological Impact of Mistreatment. Acad Psychiatry 45, 308–314 (2021). https://doi.org/10.1007/s40596-021-01430-1

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  • DOI: https://doi.org/10.1007/s40596-021-01430-1

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