Purpose: Nearly half of all medical students report mistreatment during clerkship rotations, and this is particularly prevalent in surgery. This is a single academic institution’s report of the impact following the implementation of a curriculum targeted at medical students for improving the surgical learning environment.
Method: Students were interviewed between April and June 2015. The questions asked centered around their impressions and value of the curriculum, their perceptions of mistreatment, and how the curriculum prepared them for the surgery clerkship. Two independent coders identified themes throughout the transcripts, until saturation, using a grounded theory approach. An interrater reliability analysis using the Cohen kappa statistic was performed by the two raters with a result of k =0.76.
Results: Between April and June 2015, 24 medical students were interviewed. All students previously completed the required third year surgical clerkship, including the mistreatment curriculum. Four domain areas emerged from the analysis: Student Characteristics, Faculty/Team, Culture of Surgery, and Curriculum. Under the Curriculum domain, students felt it was valuable to define mistreatment in the surgical learning environment, set expectations for the surgery clerkship, attend weekly check-in/debriefing sessions, and learn strategies that would aid them in the event they experience mistreatment.
Conclusion: Our rotation-specific mistreatment curriculum has shown that providing students an opportunity to define mistreatment, a safe environment for students to debrief, and staff to support and advocate for them has empowered students with the knowledge and skill to effectively cope with what is too often considered part of the hidden curriculum.
