BMJ, doi: 10.1136/bmj.38924.722037.7C, (Published 6 September 2006)

RESEARCH

Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey

Erica Frank ^1*, Jennifer S Carrera ¹, Terry Stratton ², Janet Bickel ³, Lois Margaret Nora ⁴

¹ Emory University School of Medicine, Department of Family and Preventive Medicine, Atlanta, GA 30303, USA
² Office of Medicine Academic Affairs, University of Kentucky College of Medicine, KY, USA
³ Faculty Career and Diversity, Falls Church, VA, USA
⁴ Northeastern Ohio Universities College of Medicine, Rootstown, OH, USA

^* Correspondence to: erica.frank{at}ubc.ca.

Objective To determine medical students' perceptions of having been harassed or belittled and their correlates, for the purposes of reducing such abuses.

Design Longitudinal survey.

Setting 16 nationally representative US medical schools.

Participants 2884 students from class of 2003.

Main outcome measures Experiences of harassment and belittlement at freshman orientation, at entry to wards, and in senior year by other students, by residents or fellows, by preclinical professors, by clinical professors or attendings, or by patients.

Results 2316 students provided data (response rate 80.3%). Among seniors, 42% (581/1387) reported having experienced harassment and 84% (1166/1393) belittlement during medical school. These types of abuse were caused by other students (11% (158/1389) and 32% (443/1390) of students experienced such harassment or belittlement, respectively). Harassment and belittlement was also caused by residents (27% (374/1387) and 71% (993/1393)), preclinical professors (9% (131/1386) and 29% (398/1385)), clinical professors (21% (285/1386) and 63% (878/1390)), and patients (25% (352/1387) and 43% (592/1388)). Only 13% (181/1385) of students classified any of these experiences as severe. Medical students who reported having been harassed or belittled did not differ significantly from those not reporting such experiences by sex, ethnicity, political orientation, or religion. They did differ significantly by chosen specialty and were significantly more likely to be stressed, depressed, and suicidal, to drink alcohol or to binge drink, and to state that their faculty did not care about medical students. They were also significantly less likely to be glad they trained to become a doctor.

Conclusion Most medical students in the United States report having been harassed or belittled during their training. Although few students characterised the harassment or belittlement as severe, poor mental health and low career satisfaction were significantly correlated with these experiences.

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(Accepted 3 July 2006)
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