- Research article
- Open Access
- Open Peer Review
Mistreatment of university students most common during medical studies
© Rautio et al; licensee BioMed Central Ltd. 2005
- Received: 22 June 2005
- Accepted: 18 October 2005
- Published: 18 October 2005
This study concerns the occurrence of various forms of mistreatment by staff and fellow students experienced by students in the Faculty of Medicine and the other four faculties of the University of Oulu, Finland.
A questionnaire with 51 questions on various forms of physical and psychological mistreatment was distributed to 665 students (451 females) after lectures or examinations and filled in and returned. The results were analysed by gender and faculty. The differences between the males and females were assessed statistically using a test for the equality of two proportions. An exact two-sided P value was calculated using a mid-P approach to Fisher's exact test (the null hypothesis being that there is no difference between the two proportions).
About half of the students answering the questionnaire had experienced some form of mistreatment by staff during their university studies, most commonly humiliation and contempt (40%), negative or disparaging remarks (34%), yelling and shouting (23%), sexual harassment and other forms of gender-based mistreatment (17%) and tasks assigned as punishment (13%). The students in the Faculty of Medicine reported every form of mistreatment more commonly than those in the Faculties of Humanities, Education, Science and Technology. Experiences of mistreatment varied, but clear messages regarding its patterns were to be found in each faculty. Female students reported more instances of mistreatment than males and were more disturbed by them. Professors, lecturers and other staff in particular mistreated female students more than they mistreated males. About half of the respondents reported some form of mistreatment by their fellow students.
Students in the Faculty of Medicine reported the greatest amount of mistreatment. If a faculty mistreats its students, its success in the main tasks of universities, research, teaching and learning, will be threatened. The results challenge university teachers, especially in faculties of medicine, to evaluate their ability to create a safe environment conducive to learning.
- Medical Student
- Female Student
- Sexual Harassment
- Fellow Student
- Moral Order
The main tasks of universities are research, teaching and learning. The teaching atmosphere during undergraduate studies is important not only for learning but also for building positive attitudes towards one's professional identity and towards life-long learning. Attitudes, positive or negative, adopted during university studies will have an impact on the values and behaviour of students in their future working lives.
Various forms of mistreatment have been reported to occur in a variety of workplaces, including schools , universities [2–5] and the police force . Mistreatment is a problem on a personal level and on the organisational and societal levels as well. In some cases mistreatment can even lead to alcohol and drug abuse [2, 7]. Exposure to mistreatment has a significant inverse correlation with both job satisfaction and psychological health and well being .
Mistreatment is perceived by undergraduate students in the United States as a major source of stress , and such perceptions and their consequences are more prevalent among medical students than either students or faculty staff believe [3, 4, 10, 11]. More than a third of the students at medical school have considered dropping out, and one fourth report that they would have chosen a different profession had they known in advance about the extent of the mistreatment they would experience in American medical schools . Corresponding results have been obtained in Finland . Also, more generally, high proportions of students who experience mistreatment suffer measurable psychopathological consequences [3, 7]. Perceived mistreatment has been found to be a major source of stress during medical internship , and especially when this is consistent and systematic, it may significantly impair mental health and well-being among both university students and employees and affect their overall satisfaction with their work [2, 4, 7].
Becher  found in the UK and US that mistreatment in the cultures of different university disciplines can vary. Disciplines and departments differ both at the level of epistemic issues and in the quality of social relations and atmospheres and their ways of controlling and punishing students. Becher thinks that it is the moral order that defines the basic beliefs, values, norms and aspirations prevailing in each disciplinary culture. This forms the background ethos for each discipline, determining what is regarded as normal and ordinary and what is impossible, imaginary or extraordinary.
A report from two medical schools in Finland in the early 1990s showed that three out of every four students had experienced some kind of mistreatment by classmates, teachers, hospital staff or patients during their education . The present study was undertaken to evaluate the prevalence of physical and psychological mistreatment among students in all faculties of Oulu University, including the Faculty of Medicine. One special purpose was to see whether there were any differences in the treatment of students between the Faculty of Medicine and the other faculties and whether it would be meaningful to discuss the characteristics in terms of a moral order.
Permission to perform this survey was obtained from the rector of the university and from the chief administrator and chief academic officer of each faculty. The protocol was accepted by the university ethics committee. The work was carried out mainly within a 3-week period.
After briefly explaining the survey and its purpose to the students, we distributed the questionnaire forms (see Additional file 1) to them after a lecture or an examination and continued to be present while they filled them in. The students were not allowed to discuss the questionnaire, but were told that they were to give their own personal, honest answer to each question anonymously.
The questionnaire was modified from that used in 1991 to evaluate two medical schools in Finland , which had in turn been based on that of Sheehan et al.  and Baldwin et al. . In order to keep the questionnaire valid and to be able to compare the present results with those obtained earlier using a similar questionnaire, we kept modification of the questionnaire to an absolute minimum. Since it had originally been used only among students in medical faculties, we modified it to be applicable to students in all faculties by changing few phrasings, e.g. we did not specifically ask about mistreatment by nurses.
Topics addressed in the questionnaire (see Additional file 1).
Number of questions
Mistreatment and harassment
Sexual harassment or mistreatment
Racial, ethnic, religious or age discrimination
Threats to fail or give a low grade
Negative or disparaging remarks on study performance
Immoral, unethical or other unacceptable treatment during studies (open-ended question)
Other forms of mistreatment (open-ended question)
Percentages of female students in the faculties and among the students participating in the survey (n = 662).
Percentage of women
In the faculty %
In the survey %
Numbers of students participating in the survey, by faculty and study year (n = 634; 18 females and 10 males did not report the study year).
Students by years of study Number
Total Number (%)
The data were analysed using SPSS (Statistical Package for Social Sciences, version 7.0) and the differences between the males and females were assessed using a test for the equality of two proportions  in the Arcus Quickstat Biomedical software (Research Solutions). An exact two-sided P value was calculated using a mid-P approach to Fisher's exact test (the null hypothesis being that there is no difference between the two proportions) .
Mistreatment by staff
Total numbers of episodes of mistreatment by staff (range 0–10) and fellow students (range 0–8) reported by students during their university studies.
(N = 193) %
(N = 378) %
(N = 571) %
(N = 205) %
(N = 426) %
(N = 631) %
6 or more times
Frequency (%) of all types of mistreatment by given categories of staff experienced by students.
Research/senior research fellows
Mistreatment by fellow students
Occurrence (%) of mistreatment by staff and fellow students during the 2nd year and during or after the 4th year, as reported by male and female students.
2nd year %
≥4th year %
Number of answer
(M = male, F = female)
M 84 – 86
F 102 – 104
M 85 – 86
F 102 – 104
M 61 – 62
F 184 – 189
F 187 – 191
M 208 – 211
F 433 – 446
M 208 – 211
F 437 – 451
Shouting or yelling
Belittlement or humiliation
Assignment for punishment
Someone else took credit for student's work
Threats to harm
Slapping, pushing etc.
Gender-based harassment or mistreatment
Racial, ethnic harassment or discrimination etc.
Threat to fail or give a low mark
Mistreatment in relation to years of study
The reported occurrence of mistreatment both by staff and fellow students increased with the number of years of study (Table 6). This was especially true of sexual harassment or gender-based mistreatment and threats to fail a student or give a low mark, which were reported 2–4 times as often during or after the 4th year as in the 2nd year both by males and females (Table 6). The same tendency was also observed in mistreatment by fellow students. Female students who had been studying for 4 years or more reported shouting and yelling to be twice as common as those who had been studying for 1 or 2 years (Table 6). Men reported the largest increase in belittlement and humiliation and in some one else taking credit for their work. There was no change in the reported occurrence of sexual harassment by fellow students over the years.
Sexual harassment and other forms of gender-based mistreatment
Reported occurrence (%) of different types of gender-based harassment or mistreatment by staff, by gender of the respondent.
Type of sexual harassment or mistreatment
Males (N = 211) %
Females (N = 451) %
All (N = 662) %
Exchange of rewards for sexual favours
Sexist teaching material
Occurrence of different types of mistreatment by staff, by respondent's gender and faculty.
N = 28–29
N = 106–111
N = 36–38
N = 130–134
N = 11
N = 67–68
N = 90–91
N = 8
N = 40
N = 123–124
Shouting or yelling
Belittlement or humiliation
Assignment for punishment
Threats of harm
Threat to fail or
give a low mark
Immoral, unethical and other unacceptable treatment during studies
Occurrence (%) of immoral, unethical and other unacceptable treatment during studies, as reported by male and female students.
Immoral, unethical treatment
Other unacceptable treatment
Male (N = 203) %
Female (N = 429) %
Male (N = 203) %
Female (N = 425) %
The last question concerned all other types of mistreatment during university studies. This was answered by 91 students, with the female students reporting such things more than the males (p = 0.041). Other unacceptable treatment was reported most often by females in the faculties of Medicine (15.7%), Humanities (17.3%) and Science (17.4%). Most of these comments were concerned with teaching skills, poor teacher-student relations, the atmosphere in a department, nasty behaviour by office secretaries and practical training in teaching. The answers to these open-ended questions reported disagreements within and between faculties, e.g. between dentists and medical students or doctors and nurses, or between students in the Faculty of Technology and either the Faculty of Humanities or the Faculty of Education. Students in the Faculty of Education also reported that teachers gave assignments as a means of punishment, that they threatened students, and that they were lacking in punctuality and were in the habit of cancelling their lectures at the last moment.
Overall estimation of mistreatment in the university
Differences between the faculties
The results suggest that the faculties have their own "typical" modes of mistreatment (Table 8). Belittlement or humiliation were especially often reported by males in the Faculties of Medicine (32.1%) and Science (30.0%), whereas the respective figure in Technology was 13.2%. Among females the highest figures were in Medicine (43.2%), followed by Education (35.3%). Negative or disparaging remarks were reported most often by females (18.9%) and males (13.8%) in Medicine, in contrast to only 3.3% of males (3 out of 90) in Technology. Shouting and yelling was rarely reported by males in the Humanities (2.6%), whereas the females in the same faculty reported this 9 times more often (21.6%). Threats to fail a student or to give a low grade were reported most often by male students of Medicine (17.2%). Assignments given as punishment were evident in the Faculties of Medicine (males 27.6%; females 22.5%) and Education (females 19.1%). The gender that was in the minority in a faculty regularly reported mistreatment more often than the majority gender, e.g. female students in the Faculty of Technology.
Mistreatment appeared to be very common, since about half of the students had experienced some form of mistreatment by staff or faculty members and every fifth student reported at least one instance of mistreatment. This can sometimes be explained by racial, ethnic or social discrimination [17, 18], but that is not the case here, since the social, ethnic and racial backgrounds of our students were very homogeneous. Some students will evidently be taken as victims of extensive mistreatment, as can be seen from the fact that 25 female students (6.6%) and eight male students (4.3%) reported having experienced as many as six or more different types of mistreatment. These high figures demand particular attention. The sense of victimization is a complex issue related to negative identification, the sociological and psychological environment and personality . The reporting of any form of abuse or mistreatment is to some extent subjective and depends on the personality and psycho-social structure of the respondent, and thus vulnerable to over reporting. It is difficult to generalize on results of this kind, but in the light of figures reported also by other authors [3, 5, 7, 15, 20] mistreatment of medical students seems to be very common.
Also, about half of the students reported some form of mistreatment by their fellow students. Belittlement, humiliation and negative remarks were astonishingly common. "Inappropriate comments" by fellow-students were also the major category of harassment identified by White . In our material students seemed not to appreciate each other's fields of study, and the present atmosphere in certain disciplines evidently does not support collaboration. It is important that the teachers should not express attitudes of their own that belittle other faculties or disciplines.
The occurrence of mistreatment generally increased with the number of years of study, as also reported earlier [5, 10, 21, 22]. A significant difference has been reported, for example, between the percentages of second-year and third-year medical students quoting any experience of mistreatment (37% vs. 76%) . Furthermore, in accordance with some other studies [3, 5, 23, 24], the women were treated worse than men and were more seriously disturbed by the treatment. It was surprising that medical students reported mistreatment most often in the present survey, even though Uhari et al.  had also reported high rates of negative experiences, up to 70%, among students in two Finnish faculties of medicine in the early 1990s and a frequency of 37% for sex-based mistreatment. Very similar rates was reported by White  at an Australian medical school, where 37.9% of the students reported some form of sexual harassment (male 24.6%; female 47.9%). The female respondents accounted for 80% of all the events reported, and often reported the same form of harassment more than once.
Twenty-one percent of the female students and 10% of the male students had either personally experienced or observed some form of gender-based mistreatment or discrimination during their studies, the frequency being 2.5-fold among fourth- year students or over by comparison with first-year students. These figures are in accordance with those of White , who reported that sexual harassment at medical school was highly significantly (P < 0.001) more common during the clinical years 4–6 than during the pre-clinical years 1–3. Sexual harassment and other sex-based forms of mistreatment experienced especially by women can be ways of trying to marginalize women in university settings . They can have this effect in practice whether or not they are intended as such, because it is not exhilarating to seek a career in a field where you may be harassed sexually and marginalized . High figures for sexual and gender-related harassment have been reported by Larsson  in Sweden, for example.
The high figures for mistreatment by lecturers and teachers without tenure may point to signs of frustration. Teaching is no longer held in high regard in universities by comparison with research work, which is appreciated and respected far more. Recent changes in the working environment have also resulted in insecurity, which may be reflected in the treatment of students by such categories of staff. These issues nevertheless cannot provide a full explanation for the mistreatment that students encounter while studying at university.
It is possible that the use of aversive methods to make students learn and behave better has been passed down from teacher to learner, i.e. there is a "transgenerational legacy" that leads to future mistreatment of others by those who themselves have been mistreated. Also, to add to the picture, it is possible that the attitudes, forms of behaviour and values that characterise study cultures and atmospheres in faculties may be connected with discipline-based or professional socialisation, or different moral orders, to use the terminology of Becher  discussed at the beginning of this paper. The students' experiences of mistreatment in different faculties gave some messages regarding attitudes and hidden assumptions that can be interpreted as being connected with the kind of discipline-based moral order that Becher discusses . This type of discipline-based mistreatment was most evident in medicine and education, fields in which academic socialisation can be greatly influenced by the norms of socialisation that are traditionally emphasised in the professions for which the students are being educated. These norms can exercise a highly covert influence and form tacit but fundamental assumptions and prejudices .
The forms of mistreatment discussed by the students of medicine were very often connected with the position of the student. In a faculty of medicine, as in a hospital, one's position (doctor, nurse, patient, student) seems to be central, and is based on a clear hierarchy within the system. Sexual harassment can be conceptualized as an institutionally sanctioned display of the power that the harasser believes he/she possesses in relation to the victim . This power is often thought to be obtained and derived either from gender or from formal status in the workplace, but it may also play a role in situations where there is no apparent power over the victim, such as a patient harassing a doctor. In such cases the victim may hold the power but the harasser exercises a contra-power and may cause harassment in spite of the apparent formal power imbalance. This may also be true in the case of harassment by a fellow student.
The position of a student in the hierarchy is not so clear as that of a professional, especially when practising in a hospital. The position of an individual in a hospital is often connected with the work done with patients: e.g. who is in a position to decide about injections, operations etc, whose task is it to perform each action, who is allowed to have a voice in each situation and who is not. In that kind of setting it is easy to understand that the atmosphere can be characterised by a strong measure of position-based control and the punishment and mistreatment connected with it, i.e. the use of power. These issues thus characterise the moral order of the study culture. The treatment of students of education – especially by their teachers – points to different areas of control and punishment from those that apply to medicine, but which also relate to the use of power, since teachers control their pupils' use of time, the nature of the tasks they have to do, etc. Correspondingly, the special topics emphasised by the trainee teachers were the control maintained over their time and attendance. The only comment on an obligation to be present in lectures or exercises in spite of being ill was made by a student of teacher education.
The topic of sexual harassment can also be approached through the concept of moral order. Another study conducted by us  gives more detailed information on the situation in the Faculty of Technology, noting that although the respondents indicated that they had not experienced sexual harassment, some other students claimed to have left that faculty because of the sexually harassing atmosphere they had experienced. It is thus possible to think that the moral order of the Faculty of Technology, or of some of its departments, may include the idea that as a female student you must abide a sexually harassing atmosphere if you wish to study there.
In both the Faculties of Medicine and in that of Education the female students reported mistreatment more often than the males, as if the order were stricter for them. The question of treatment is especially important in these faculties, for several reasons. One is that most of the students in these faculties are female and mistreatment seems to disturb them more than males. On the other hand, the nature of this treatment is an especially important question in the professional areas concerned, as it is a question of how teachers treat the pupils for whom they are responsible and how doctors treat their patients. These aspects need further study.
For most people the vision of universities is that they are peaceful sanctuaries protected from the "real world", where students are taught high-level academic skills, read, write and do research. It is also thought that equity, dignity, respect and justice are emphasized in these environments. But, as earlier [17, 18, 28, 29], the present survey shows that this is not true. Students are not treated equally in our universities.
The main tasks of a university – research, teaching and learning – are seriously threatened if members of staff mistreat their students, and this is especially true where women are concerned. The teaching atmosphere during one's studies is important not only for learning but also for building up a positive professional identity. The attitudes adopted during university studies, positive or negative, will have an impact on graduates' values and behaviour in their future working life. And of course, a university hires its researchers and teachers of tomorrow from today's students. Therefore, it is very important to prevent mistreatment from being transmitted to the next generation, in order to increase professionalism in medicine , as in other disciplines. This may be achieved by various methods, such as role playing  and educational strategies .
Our findings emphasize the need to develop and maintain a good, impartial and supportive atmosphere within medical studies and training in order to develop the personality traits needed to practise as a doctor. Serious discussion is obviously needed on the behaviour and habits of teaching staff. Indeed, some degree of educational intervention is needed in all faculties of a university. Issues of the hidden moral order should also be included in these discussions. Several interesting perspectives for educational interventions have been provided by White  and Heru , for example, and by B Sandler and R Shoop .
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