Why do few medical students report their experiences of mistreatment to administration?

Introduction Over 50% of medical students worldwide report experiencing mistreatment and abuse during their clinical education, yet only a small proportion of students report these concerns to administration. It is unknown how medical students make sense of their experiences of mistreatment and come to decide whether to formally report these experiences. Improved understanding of this phenomenon will facilitate changes at the administrative and institutional levels to better support students. Methods Using Constructivist Grounded Theory, we interviewed 19 current and former medical students from one institution about their experiences with mistreatment and reporting. Data were analysed in an iterative fashion, using focused and theoretical forms of coding. Results The decision of whether to report mistreatment is only one phase in the process that students report experiencing when encountering mistreatment. This process can be understood as a journey consisting of five phases: Situating, Experiencing and Appraising, Reacting, Deciding and Moving Forward. Students move through these phases as they come to understand their position as medical learners and their ability to trust and be safe within this institution. Each experience of mistreatment causes students to react to what has happened to them, decide if they will share their experiences and reach out for support. They choose if they are going to report the mistreatment, at what cost and for what outcomes. Students continue through their training while incorporating their experiences into their understanding of the culture in which they are learning and continually resituating themselves within the institution. Discussion Student perceptions of trust or mistrust in their educational institution are highly influential when it comes to reporting mistreatment. Interventions designed to support students and decrease exposure to mistreatment may be best focused on increasing organisational trust between students and the medical school.

Automated summary

Research suggests that whether medical students choose to report mistreatment is part of a larger process, involving five phases: Situating, Experiencing and Appraising, Reacting, Deciding, and Moving Forward. Students react to mistreatment, decide whether to share their experiences and seek support, ultimately choosing whether to report mistreatment, and for what outcomes. They continue through their training, integrating their experiences into their understanding of the culture and continually repositioning themselves within the institution. Factors such as trust in the educational institution play a significant role in students' decision-making process regarding reporting mistreatment. Improving organizational trust between students and the medical school may be key in supporting students and reducing mistreatment.