OBJECTIVE: To assess the prevalence of medical student abuse during clinical clerkships in Japan.
DESIGN: A cross-sectional questionnaire survey.
SETTING: Six medical schools in Japan.
PARTICIPANTS: Final year (sixth-year) and fifth-year medical students in the period from September 2003 to January 2004. From a total of 559 students solicited, 304 (54.4%) returned the questionnaire, and 276 (49.4%: 178 male and 98 female) completed it.
MEASUREMENTS: Prevalence of medical student abuse in 5 categories: verbal abuse, physical abuse, academic abuse, sexual harassment, and gender discrimination; differences in abusive experience between male and female students; types of alleged abusers; reporting abusive experiences to authorities; and emotional effects of abusive experiences.
RESULTS: Medical student abuse was reported by 68.5% of the respondents. Verbal abuse was the most frequently experienced abuse (male students 52.8%, female students 63.3%). Sexual harassment was experienced significantly more often (P<.001) by female students (54.1%) than by male students (14.6%). Faculty members were most often reported as abusers (45.2% of cases). Abuse occurred most frequently during surgical rotations (42.0% of cases), followed by internal medicine (25.1%) and anesthesia rotations (21.8%). Very few abused students reported their abusive experiences to authorities (8.5%). The most frequent emotional response to abuse was anger (27.1% of cases).
CONCLUSIONS: Although experience of abuse during clinical clerkships is common among medical students in Japan, the concept of “medical student abuse” is not yet familiar to Japanese. To improve the learning environment, medical educators need to take action to resolve this serious issue.
clerkships education Japan medical student abuse questionnaire sexual harassment
Richman JA, Flaherty JA, Rospenda KM, Christensen ML. Mental health consequences and correlates of reported medical student abuse. JAMA. 1992;267:692–4.CrossRefPubMedGoogle Scholar
Sheehan KH, Sheehan DV, White K, Leibowitz A, Baldwin DC Jr. A pilot study of medical student ‘abuse.’ Student perceptions of mistreatment and misconduct in medical school. JAMA. 1990;263:533–7.CrossRefPubMedGoogle Scholar
Rosenberg DA, Silver HK. Medical student abuse. An unnecessary and preventable cause of stress. JAMA. 1984;251:739–42.CrossRefPubMedGoogle Scholar
Maida AM, Vasquez A, Herskovic V, et al. A report on student abuse during medical training. Med Teacher. 2003;25:497–501.CrossRefGoogle Scholar
Katz LA, Sarnacki RE, Schimpfhauser F. The role of negative factors in changes in career selection by medical students. J Med Educ. 1984;59:285–90.PubMedGoogle Scholar
Paiva RE, Kienzler LM, Anderson MB. Preparation for the teaching role in residencies: an elective for medical students. J Med Educ. 1982;57:792–4.PubMedGoogle Scholar
Baldwin DC Jr., Daugherty SR, Eckenfels EJ. Student perceptions of mistreatment and harassment during medical school. A survey of ten United States schools. West J Med. 1991;155:140–5.PubMedGoogle Scholar
Uhari M, Kokkonen J, Nuutinen M, et al. Medical student abuse: an international phenomenon. JAMA. 1994;271:1049–51.CrossRefPubMedGoogle Scholar
Henry P. Relationship between academic achievement and measured career interest: examination of Holland’s theory. Psychol Rep. 1989;64:35–40.PubMedGoogle Scholar
Elnicki DM, Curry RH, Fagan M, et al. Medical students’ perspectives on and responses to abuse during the internal medicine clerkship. Teaching Learn Med. 2002;14:92–7.CrossRefGoogle Scholar
Ministry of Education, Culture, Sports, and Technology. 1999, a guideline for preventing sexual harassment. Available at: http://www.mext.go.jp/b_menu/houdou/11/03/990305.htm#top. Accessed May 15, 2005 (in Japanese).Google Scholar
Ministry of Education, Culture, Sports, and Technology. Statistical abstract. Available at: http://www.mext.go.jp/b_menu/shingi/chukyo/chukyo4/gijiroku/009/04111201/005/001.htm. Accessed May 15, 2005 (in Japanese).Google Scholar
1.Department of General Medicine and Clinical EpidemiologyKyoto University Graduate School of MedicineKyotoJapan
2.Department of Healthcare Economics and Quality ManagementKyoto University Graduate School of MedicineKyotoJapan
3.Department of Community and General Medicine Graduate School of Medicine, Program of Community Health and Comprehensive Medicine, Division of Community and Comprehensive Medicine, Clinical EpidemiologySapporo Medical University School of MedicineHokkaidoJapan
4.Department of Medical EducationYokohama City University School of MedicineKanagawaJapan
5.Office of Educational Developmentthe Jikei University School of MedicineTokyoJapan
6.Department of MedicineFujita Health University School of MedicineAichiJapan
7.Department of General MedicineSaga University HospitalSagaJapan
8.Department of Bioethics, Faculty of Medical and Pharmaceutical ScienceKumamoto UniversityKumamotoJapan