Study | Study Population | Quantitative—Qualitative | Types of incivility | Outcomes reported |
---|---|---|---|---|
Power day: Addressing the use and abuse of power in medical training (Angoff et al. 2016, 203–213) [19] | Medical students | Qualitative | Power-based | • Positive and negative examples of uses of power |
Professionalism in the teacher-learner relationship in medical schools: mistreatment(Antonelli 2009, 88–89) [20] | Medical students | Quantitative | Verbal, sexual and gender-based | • Perpetrators by professional role • Reasons for not reporting student mistreatment |
Awareness of Bullying in Residency: Results of a National Survey of Internal Medicine Program Directors (Ayyala et al. 2018, 209–213) [21] | Residents | Quantitative | Less than 1/3 respondents reported bullying, with verbal > physical abuse | • Decreased performance and depression |
Perceived Bullying Among Internal Medicine Residents (Ayyala, Rios, and Wright 2019, 576–578) [22] | Residents | Quantitative | Bullying and verbal abuse | •Concerns about burnout, decreased performance, depression, weight change/nutrition |
"I'm too used to it": a longitudinal qualitative study of third year female medical students' experiences of gendered encounters in medical education(Babaria et al. 2012, 1013–1020) [23] | Medical students | Qualitative | Sexual and gender-based | •Perpetrators via student-patient and student-supervisor relationships •Impact on student self-image •Students’ adaptations to managing inappropriate behavior |
The learning environment in the obstetrics and gynecology clerkship: an exploratory study of students' perceptions before and after the clerkship (Baecher-Lind, Chang, and Blanco 2015, 27,273) [24] | Medical students | Qualitative | Verbal, sexual, physical | •Perceptions of mistreatment pre-clerkship and post-clerkship |
Underlying mechanisms of mistreatment in the surgical learning environment: A thematic analysis of medical student perceptions (Brandford et al. 2018, 227–232) [25] | Medical students | Qualitative | Exclusion form medical team, obstruction of student learning, not being fair or respectful, exploiting student vulnerability, assigning non-educational tasks | •Students need to be encouraged to report mistreatment |
Clerkship-Specific Medical Student Mistreatment (Breed et al. 2018, 477–482) [26] | Medical students | Quantitative | Public humiliation, gender discrimination | • Occurs more often in the operating room • Surgery > Ob > Internal Medicine |
Sexual Harassment in Ophthalmology: A Survey Study (Cabrera et al. 2019, 172–174) [27] | Faculty and residents | Quantitative | Sexual harassment | • Interfered with the ability to work • 15% changed jobs and/or careers • American Academy of Ophthalmology has established zero tolerance policy for sexual harassment |
Sexual Harassment in Radiology (Camargo, Liu, and Yousem 2017, 1094–1099) [28] | Faculty and residents | Quantitative | Sexual harassment | • Needs to be transparency of reporting • Females less likely to report • Females > males |
A "ton of feathers": Gender discrimination in academic medical careers and how to manage it (Carr et al. 2003, 1009–1018) [29] | Faculty | Qualitative Quantitative | Gender-based | • Effect of gender discrimination on academic medicine career |
Mistreatment and the learning environment for medical students on general surgery clerkship rotations: What do key stakeholders think? (Castillo-Angeles et al. 2017, 307–312) [30] | Medical students | Qualitative | Mistreatment, neglect, unclear expectations, not integrating into the team, negative attitudes about lack of knowledge, humiliation, sexual harassment | • Focus on learning environment |
Bullying in the American graduate medical education system: A national cross-sectional survey (Chadaga, Villines, and Krikorian 2016, e0150246) [31] | Residents | Quantitative | Verbal | • Most common types of bullying and association of personal attributes with risk of bullying • Perpetrators by professional role • Impact on health |
Workplace Bullying of Urology Residents: Implications for the Patient and Provider (Chowdhury, Husainat, and Suson 2019, 30–35) [32] | Residents | Quantitative | 98% reported bullying | • Perceptions is that this had negative effects on personal behavior and patient care |
Intraoperative Disruptive Behavior: The Medical Student's Perspective (Chrouser and Partin 2019, 1231–1240) [33] | Medical students | Qualitative | Verbal abuse in the operating room | • Personal and team consequences with a result of decreased work |
Exploring medical students' barriers to reporting mistreatment during clerkships: a qualitative study (Chung et al. 2018, 1478170) [34] | Medical students | Qualitative | Mistreatment, verbal and physical abuse | • Barriers to reporting: fear of reprisal, perceptions that medical culture includes mistreatment, the difficulty of reporting subtler forms of mistreatment, can damage teacher-students relationship, reporting process cumbersome and is reporting beneficial |
The prevalence of medical student mistreatment and its association with burnout (Cook et al. 2014, 749–754) [14] | Medical students | Quantitative | Mistreatment | • Frequency of mistreatment by faculty and residents • Prevalence of burnout in medical students by degree of reported mistreatment |
A Survey Study of Resident Experiences of Sexual Harassment during Dermatology Training (DeWane et al. 2019) [35] | Residents | Quantitative | Sexual harassment by patients, faculty and fellow residents | • Greater in females than males • Sexist hostility and gender harassment |
Feedback matters: the impact of an intervention by the dean on unprofessional faculty at one medical school (Dorsey, Roberts, and Wold 2014, 1032–1037) [36] | Medical students | Quantitative | Verbal | • Unprofessional faculty behaviors most frequently mentioned by graduating medical students |
An Empirical National Assessment of the Learning Environment and Factors Associated with Program Culture (Ellis et al. 2019, 585–592) [37] | Residents | Quantitative | Verbal and physical abuse, gender discrimination, sexual harassment, burnout | • Wellness inversely proportional to duty hours • Program culture determined by wellness and negative exposures |
Medical student abuse from multiple perspectives (Elnicki, Ogden, and Wu 2007, 153–158) [38] | Medical students Residents Faculty Nurses | Quantitative | Verbal, ethnic, sexual | • Agreement regarding if scenarios represented abuse and if type of behavior should be reported |
Screening for Harassment, Abuse, and Discrimination among Surgery Residents: An EAST Multicenter Trial (Fitzgerald et al. 2019, 456–461) [39] | Residents | Quantitative | Sexual harassment | • Impact on learning climate, promoting anger, frustration and embarrassment |
Eradicating medical student mistreatment: a longitudinal study of one institution's efforts (Fried et al. 2012, 1191-1198) [40] | Medical students | Quantitative | Verbal, power-based, sexual, ethnic, physical | • Types of mistreatment before and after adoption of ‘Statement Supporting an Abuse-Free Academic Community’ • Perpetrators by professional role including patients |
Association Between Perceived Medical School Diversity Climate and Change in Depressive Symptoms Among Medical Students: A Report from the Medical Student CHANGE Study (Hardeman et al. 2016, 225–235) [41] | Medical students | Quantitative | Negative role modeling, mistreatment, negative racial climate, ignored, humiliated | • Increased depressive symptoms related to negative behavior • Call for creating an institutional climate that is inclusive, fair and equitable |
Formation of medical student professional identity: categorizing lapses of professionalism, and the learning environment (Hendelman and Byszewski 2014, 139) [42] | Medical students | Quantitative | Verbal, power-based, cultural or religious, sexual | • Types of professionalism lapses witnessed by pre-clerkship and clerkship medical students • Prevalence of witnessing professionalism lapse during medical school • Perpetrators of professional lapses during pre-clerkship and clerkship |
'Am I being over-sensitive?' Women's experience of sexual harassment during medical training (Hinze 2004, 101–127) [43] | Residents | Quantitative Qualitative | Sexual | • Experiences of and discomfort with specific sexist treatment variables • Settings by specialty |
Patterns of Disrespectful Physician Behavior at an Academic Medical Center: Implications for Training, Prevention, and Remediation (Hopkins et al. 2018, 1679–1685) [44] | Medical staff | Quantitative | Disrespectful behavior | • For faculty, this was highest in the operating room; for trainees this was highest on the med/surg units • Higher in procedural areas than non-procedural • Males > females, medicine > surgery |
Tracking Student Mistreatment Data to Improve the Emergency Medicine Clerkship Learning Environment (House et al. 2018, 18–22) [45] | Medical students | Qualitative | Ignored or marginalized, treated unprofessionally | • Need for data over time and faculty development to confront issue |
Professionalism in plastic surgery: attitudes, knowledge, and behaviors in medical students compared to surgeons in training and practice–one, but not the same (Hultman and Wagner 2015, S247-54) [46] | Medical students Faculty | Quantitative | Verbal, physical, sexual | • Types of unprofessional behavior witnessed by medical students and faculty • Prevalence of observation of unprofessional behavior by health care personnel |
Impact of a program to diminish gender insensitivity and sexual harassment at a medical school (Jacobs, Bergen, and Korn 2000, 464–469) [47] | Faculty | Quantitative | Sexual | • Prevalence of sexually harassing behaviors during multi-year program to educate faculty on gender issues and diminish sexual harassment |
Sexual harassment and discrimination experiences of academic medical faculty (Jagsi et al. 2016, 2120–2121) [48] | Faculty | Quantitative | Sexual, gender-based | • Types of sexual harassment experienced • Prevalence of gender-based bias or advantage and sexual harassment • Effect of gender-based bias on professional advancement |
Identifying Medical Student Mistreatment in the Obstetrics and Gynecology Clerkship (Kappy et al. 2019) [49] | Medical students | Quantitative Qualitative | Treated as ‘stupid’; Discouraged from asking questions; ignored; marginalized; nonprofessional behavior | • Students reported a high rate of mistreatment • Conclusion is to improve the learning environment |
Reported Mistreatment During the Surgery Clerkship Varies by Student Career Choice (Kemp et al. 2018, 918–923) [50] | Faculty and residents | Quantitative | Verbal/physical abuse, negative physician attitudes, sexual harassment, gender discrimination, public humiliation | • Mistreatment appears to be improving • Career choice of students correlated with perceptions of mistreatment |
Verbal aggressiveness among physicians and trainees (Lazarus et al. 2016, 756–760) [51] | Medical students Residents Faculty | Quantitative | Verbal, physical | • Prevalence bullying in medical school • Sources of trainee bullying • Settings • Association of Infante Verbal Aggressiveness Scale (IVAS) with specialties, attending and trainee characteristics |
Post-traumatic Stress Disorder in Resident Physicians (Lo et al. 2019, e4816) [52] | Residents | Quantitative | Bullying, violence | • Concerns about post-traumatic stress disorder |
Medical student mistreatment: understanding 'public humiliation' (Markman et al. 2019) [53] | Medical students | Qualitative | Public humiliation | • May be amenable to intervention through teaching faculty the importance of orientation and clear communication of intent |
Learning about medical student mistreatment from responses to the medical school graduation questionnaire (Mavis et al. 2014, 705–711) [16] | Medical students | Quantitative | Verbal, physical, sexual, racial/ethnic, sexual orientation | • Prevalence of types of mistreatment • Perpetrators of mistreatment • Awareness regarding school policies; reporting practices |
Perception of Shame in otolaryngology-head and neck surgery training (McMains et al. 2015, 786–790) [54] | Residents Faculty | Quantitative | Shaming | • Prevalence of shaming • Sources of shaming • Settings • Effects of shaming on individual |
The Culture of Academic Medicine: Faculty Behaviors Impacting the Learning Environment (Moutier et al. 2016, 912–918) [55] | Faculty | Quantitative | Derogatory behavior, anger, hostile email and verbal communication, bullying, sexual harassment | • Decreased work production, jeopardized patient care • Strategies should be directed to improve the learning climate |
Interns' experiences of disruptive behavior in an academic medical center (Mullan, Shapiro, and McMahon 2013, 25–30) [56] | Residents | Quantitative | Verbal, gender-based, racial, physical | • Types of disruptive behavior • Perpetrators of disruptive behavior |
A qualitative study of gender differences in the experiences of general surgery trainees (Myers et al. 2018, 127–134) [57] | Residents | Qualitative | Lewd remarks, interpreting other’s behavior as aggressive Females affected more than males | • Women perceive lack of mentorship, discomfort, pressure to accept/participate in unprofessional behavior, difficulty completing tasks, more barriers during training that interfere with self-identification as surgeons versus men |
Medical students' perception of lesbian, gay, bisexual, and transgender (LGBT) discrimination in their learning environment and their self-reported comfort level for caring for LGBT patients: a survey study (Nama et al. 2017, 1368850) [58] | Medical students | Quantitative | Negative comments about sexual orientation, jokes rumors, bullying, harassment | • This is peer-on-peer incivility and based on perceptions • Anti-LGBT discrimination and heterosexism noted by peers, although not affecting the care of LGBT patients • This discrimination presents a difficult learning environment for these students |
Gender discrimination and sexual harassment in medical education: perspectives gained by a 14-school study (Nora et al. 2002, 1226–1234) [59] | Medical students | Quantitative | Sexual, gender-based | • Prevalence of gender discrimination/sexual harassment • Settings by specialty |
Faculty self-reported experience with racial and ethnic discrimination in academic medicine (Peterson et al. 2004, 259–265) [60] | Faculty | Quantitative | Racial/ethnic | • Prevalence by race • Effect on career satisfaction, job stability, professional confidence |
Sexual Harassment of Canadian Medical Students: A National Survey (Phillips et al. 2019, 15–20) [61] | Medical students | Quantitative | Sexual harassment | • Predominantly by patients, then fellow students and faculty • Perpetrators all male and 98% victims female • Resulted in shame and self-blame of victims • Silence to this problem not acceptable |
To the point: undergraduate medical education learner mistreatment issues on the learning environment in the United States (Pradhan et al. 2019) [62] | Medical students | Quantitative | Public humiliation, sexual remarks | • Resulted in negative learning climate • Remedies need to be directed to faculty, residents and students with a zero tolerance policy |
Supervisor-trainee relationship boundaries in medical education (Recupero et al. 2005, 484–488) [63] | Residents | Quantitative | Supervisor-trainee boundaries, sexual | • Types of boundary violations • Perpetrators by supervisory role |
Patterns and predictions of resident misbehavior–a 10-year retrospective look (Resnick et al. 2006, 418–425) [64] | Residents | Quantitative | Verbal, physical | • Types of mistreatment • Victims • Perpetrators by surgical specialty, |
Impact and implications of disruptive behavior in the perioperative arena (Rosenstein and O'Daniel 2006, 96–105) [65] | Residents Faculty Nurses and other perioperative staff | Quantitative | Verbal, physical | • Types of disruptive behavior • Perpetrators by professional role • Effect on individual and clinical care |
Workplace bullying of general surgery residents by nurses (Schlitzkus et al. 2014, e149-54) [66] | Residents | Quantitative | Verbal | • Types of bullying |
Workplace violence and harassment against emergency medicine residents (Schnapp et al. 2016, 567–573) [67] | Residents | Quantitative | Physical abuse and verbal harassment by patients, sexual harassment | • 75% felt safe at work • Need to understand the prevalence of workplace violence for prevention |
Training-related harassment and drinking outcomes in medical residents versus graduate students (Shinsako, Richman, and Rospenda 2001, 2043–2063) [68] | Residents | Quantitative | Verbal, sexual | • Types of harassment • Victims’ gender and Michigan Alcoholism Screening Test (MAST) scores |
Mistreatment of medical students in the third year may not be the problem (Slavin and Chibnall 2017, 891–893) [69] | Medical students | Quantitative | Working with unhappy residents and attending physicians, ignored, feeling incompetent, unfair evaluations | • Assess underlying reasons why attending physicians and residents are unhappy, leading to burnout |
Does students' exposure to gender discrimination and sexual harassment in medical school affect specialty choice and residency program selection? (Stratton et al. 2005, 400–408) [70] | Medical students | Quantitative | Gender-based, sexual | • Setting by specialty • Influence on specialty choice and residency rankings |
Emergency medicine resident wellness: Lessons learned from a national survey (Taher et al. 2018, 721–724) [71] | Residents | Quantitative | Verbal harassment | • Results were falling asleep at the wheel, motor vehicle accidents, stress, fatigue, mood swings, suicidal ideation • Call for more investigation with validated tools for stakeholders |
Prevalence of Horizontal Violence Among Emergency Attending Physicians, Residents, and Physician Assistants (Volz et al. 2017, 213–218) [72] | Faculty, residents, physician assistants | Quantitative | Verbal aggression, demeaning remarks, not respected re: professional decisions, subject of rumors, isolation | • 9% stated this impacted their health and the care of their patients |
Gender-based discrimination is prevalent in the integrated vascular trainee experience and serves as a predictor of burnout (Wang et al. 2019) [73] | Residents | Quantitative | Public humiliation, others taking credit for one’s work, assigned tasks as punishment, physical violence, gender/race/ethnicity mistreatment, sexual harassment | • Negative workplace experience • Affected relationships with staff, women > men |
Resident bullying in diagnostic radiology (Wolfman and Parikh 2019, 47–52) [74] | Residents | Quantitative | Bullying | • 28% experienced bullying and 33% witnessed bullying |