"A morning since eight of just pure grill": a multischool qualitative study of student abuse

Abstract

Purpose: Previous medical student abuse research employed quantitative surveys that failed to explore factors thought to contribute to abuse and students' actions in the face of abuse. This study examined medical student abuse narratives to identify types of perceived abuse, factors cited by students as contributing to abuse, and students' actions at the time of abuse.

Method: A qualitative design was adopted employing 22 individual and 32 group interviews to elicit narratives of professionalism dilemmas from 200 medical students at two 5-year undergraduate programs and one 4-year graduate entry program (England, Wales, and Australia) between 2007 and 2009. Thematic analysis of abuse narratives was conducted.

Results: Of 833 professionalism dilemma narratives, 86 (10%) involved perceived medical student abuse. Within these narratives, students reported mostly covert, status-related abuse, direct verbal abuse, and sexual harassment and discrimination. Some narrators described multiple factors contributing to abuse (individual, work, and/or organization); most cited factors focusing on individuals. Despite the abuse typically recounted with negative emotion, few participants reported resisting at the time of abuse by challenging or reporting the perpetrator. Participants gave a variety of reasons for this inaction (e.g., anxiety about receiving bad marks from the perpetrator) and for resisting (e.g., the abuse was affecting their education negatively).

Conclusions: Although narratives focused predominantly on individual factors contributing to abuse and responses to abuse, educators should focus on the dynamic interplay between individual and organizational factors to combat abuse. Several opportunities to mitigate this continuing blight on the conscience of the profession are described.