Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal surveyBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38924.722037.7C (Published 28 September 2006) Cite this as: BMJ 2006;333:682
- Erica Frank (), Professor1,
- Jennifer S Carrera, consultant1,
- Terry Stratton, assistant dean2,
- Janet Bickel, consultant3,
- Lois Margaret Nora, dean4
- 1 Emory University School of Medicine, Department of Family and Preventive Medicine, Atlanta, GA 30303, USA,
- 2Office of Medicine Academic Affairs, University of Kentucky College of Medicine, KY, USA,
- 3Faculty Career and Diversity, Falls Church, VA, USA,
- 4Northeastern Ohio Universities College of Medicine, Rootstown, OH, USA
- Correspondence to: E Frank, Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, V6T 2K9
- Accepted 3 July 2006
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.
References w1-w21 are on bmj.com
Contributors EF (principle investigator) conceived the study, conceived of and had primary responsibility for structuring the analyses, and wrote the first and final drafts of most of the sections besides the methods. JSC conceived of and had primary responsibility for carrying out the analyses, wrote the first drafts of most of the methods section, and helped edit the manuscript. EF and JSC are guarantors. TS helped structure the analyses, wrote the first drafts of substantive components of the discussion section, and helped edit the manuscript. JB helped structure the analyses, contributed components of the discussion section, and helped edit the manuscript. LMN helped structure the analyses, contributed components of the discussion section, and helped edit the manuscript.
Competing interests None declared.
Ethical approval This study was approved by the Emory University institutional review board.