Abstract
Objective
To determine if perception of mistreatment and severity in each of the professional videotaped vignettes was similar between participants of differing professional status (Ob/Gyn attending physicians, resident physicians, and medical students), previous mistreatment status, ethnic minority status, and gender.
Methods
Three video vignettes were filmed portraying possible medical student mistreatment during an obstetrics and gynecology clerkship. Prior to watching the videos, all participants were asked to complete a questionnaire related to their prior experience with mistreatment as a medical student along with other demographic details. After viewing each video, participants were asked to rate the video as representing mistreatment (yes/no) and, if yes, the severity of medical student mistreatment.
Results
Eight attending physicians, ten resident physicians, and ten medical students participated in this study. Professional status, previous mistreatment status, ethnic minority status, and gender did not affect how participants perceived mistreatment or the severity of the video vignettes. Fifty percent (14/28) of participants reported previous mistreatment as a medical student, all of which occurred during their third year of medical school.
Conclusion
Medical students, resident physicians, and attending physicians generally agreed which video vignettes represented medical student mistreatment and the level of severity of the event.
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Funding
This project was funded in the amount of $15,000 by the Association of Professors of Gynecology and Obstetrics (APGO) Medical Education Endowment Fund in 2016.
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*For the PAMS Investigators (see Appendix for more info)
Précis
This convenience sample (n=28) of attending and resident obstetrician/gynecologists and medical students on the Ob-Gyn clerkship at one institution agree on what constitutes mistreatment, and on the severity of medical student mistreatment in professional videotaped vignettes.
Appendix
Appendix
The PAMS Investigators
Narratives of the 3 Vignettes
Student Mistreatment Scenario 1: Inappropriate Tasks
Setting: Common workspace area, like a resident or student workroom with a bank of computers. Several female Ob/Gyn residents are charting on their patients on computers facing away from the two medical students. This team of residents and medical students are on call during a night shift.
Resident #1: “Hey! I’m getting really hungry. We should totally order from Burrito Brothers on 7th Street. I love their chicken chimichangas and nachos.”
Resident #2: “Yeah. Their burrito bowl with black beans and rice is so yummy. But, they don’t deliver to the hospital anymore.” (Makes pouty face and then turns to face the two medical students). “Labor and delivery and triage aren’t that busy right now. How about you go pick up the take out order from Burrito Brothers for the team tonight?”
Student #1: “Oh. Okay. I can go I guess …”.
Student #2: “Yeah! The two of us can go together!” (student #1 looks at student #2 with a confused face as he/she says this).
Resident #1: “Are you two sure?”
Resident #2 (before the students can answer): “Thanks guys! That would be great! Here let us all write our order on this piece of paper” (scribbles on a piece of paper and passes it around to all the residents).
Student #2 (whispering to student #1 while the residents write their orders): “This is great! They will love us now and give us perfect evaluations. Plus, we can take our time and just say there was a long line at the restaurant, that way we can get out of doing even more work. I am exhausted and can really use this break.”
Student #1 (hesitant, nodding back and whispering): “Sure, yeah that makes sense.”
Resident #2 (handing over the piece of paper): “Thanks again guys, here’s our order. Just add on whatever you want – I seriously recommend the burrito bowl.”
Student #2 (accepts the piece of paper and smiles): “Perfect! We’ll be right back!”
Student #1 (wringing fingers): “Should we, uh … In terms of payment, how should we ….”
Resident #2: “Oh! I almost forgot! (Digs in white coat and pulls out credit card) Dinner is on me!”
Student #2: “Sweet! Thank you! You are the best resident ever!”
Resident #2: “Do not worry about it! Hurry back before it gets cold!”
End
Student Mistreatment Scenario 2: Ethnic/Racial Insensitivity
Setting: Outside the operating room entrance where the scrub hats and masks are located. Two residents (at least one male resident) are putting on scrub shoe covers, hats, and masks. A Muslim female medical student approaches with a hijab on her head/neck.
Student: “I’ve been assigned to scrub this C-section. I am super excited! I have never seen a baby born this way.” She starts to don the shoe covers.
Resident #1: (to the student) “You know you cannot wear that scarf into the operating room, right?”
Student: “I wear my hijab for religious reasons. I am uncomfortable removing it front of men. I can try to cover the scarf with a scrub hat.”
Resident #1: “This hospital doesn’t have a hat that will fully cover that thing. You will contaminate the surgical field and can’t come in the OR wearing that.” (Pointing to the head scarf) “You are going to have to go back to the workroom and find us another student to scrub this section. This patient is super fat and we are going to need all the help with retraction that we can get. Send Jim back to the OR. He’s big and tall.”
Student: “I was really hoping to be able to learn from this experience. Is there another option I can try?”
Resident #1: “Unless you take the scarf off, no. It’s seriously not that big of a deal, you know. You can put it back on after the surgery. Plus, no one is going to be looking at you during the surgery anyway; everyone will be focused on the patient.”
Student: “I am sorry, but that is not something I am comfortable with.”
Resident #1: “Then I am sorry too, but there is no other option.”
Resident #2: “Actually, I have heard about special covers used for men with beards that cover the head and neck. (Looking at resident #1) Perhaps that could work?”
Resident #1: “I do not think those work very well. Plus they are not readily available and we would have to go and find them – I’m not sure how much longer this patient can wait, we need to get in the OR now. I think we are better off with another student this time. (Looking at the student) You understand right?”
Student nods back quietly.
Resident #1 (to student): “I knew you would understand. It’s not personal at all, some of my good friends are Muslim. But we need to be sterile for these procedures and we are really tight on time right now. Go and get Jim and tell him to hurry.”
Student turns and walks away.
Resident #1 (to resident #2): “It is such a shame how some students put their religion above their education. This is a once in a lifetime experience for most students – if they don’t go in to OB they will probably never help to deliver a baby again. She should have just taken the scarf off.”
End
Student Mistreatment Scenario 3: Sexual Harassment/Inappropriate Humor
Setting: An office for residents and medical students to present their patients to an attending physician. This team of residents and medical students are paired together and seeing patients in an outpatient Ob/Gyn clinic. A resident and a medical student are approaching another resident and medical student outside the door to this office where an attending is seated at a computer. This conversation happens out of earshot of the attending in the hallway.
Resident #1 (to resident #2): “I just finished seeing this 16 year old gravida 2 para 1 for her first Ob visit. She wouldn’t even relax enough for the pelvic exam. I mean, really? She’s had Chlamydia and herpes so I know much bigger things have been in there.”
Resident #2: “I got a better one … my patient’s BMI is 96! I mean- Your BMI isn’t a math test. 100 isn’t a perfect score. She’s so obese that she can’t be examined on our exam tables. The table’s weight limit is 400 pounds! How do you let yourself get like that? She is still sexually active with her boyfriend somehow. I don’t even want to think about the mechanics involved with that activity.”
Resident #1: “I don’t even know my patient’s EDC since she hasn’t bothered to have any prenatal care. Her fundal height measures near 30 cm. She should’ve had her “baby daddy” drive her to the clinic earlier in this pregnancy.”
Resident #2: “Maybe I can sign my patient up for the show My 600 pound Life on TLC. I’ll be famous! Right?” (while looking at the students).
Both the students look measurably uncomfortable and do not respond …
Resident #1 (to the students): “Don’t worry! We’ve had a really rough week on labor and delivery. We hardly ever speak about our patients this way. Humor really makes the job bearable.”
Both residents enter the office with the medical students to present their patients.
Resident #1 (to the attending): “I have a 16 year-old gravida 2 para 1-zero-zero-1 who presents for her initial Ob visit with an unknown LMP. She reports her EDC is 3/1/2016 based on an ultrasound done at St. Joe’s 2 weeks ago, but we don’t have that report yet. Her pregnancy is complicated by teen pregnancy, a history of Chlamydia and herpes diagnosed in her last pregnancy. Her exam is consistent with 30 weeks estimated gestational age …”.
End
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Holmström, S.W., Klocksieben, F.A., Forrester, L.D. et al. Medical Student Mistreatment—an Obstetrics and Gynecology Perspective: a Pilot Study. Med.Sci.Educ. 29, 787–794 (2019). https://doi.org/10.1007/s40670-019-00740-2
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DOI: https://doi.org/10.1007/s40670-019-00740-2