Mistreatment of medical graduates affects professional identity
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Key takeaways:
- Most medical students reported experiencing at least one mistreatment incident during the study period.
- Low professional identity scores commonly occurred among students who reported experiencing mistreatment.
The prevalence of perceived mistreatment appeared high among medical students in China and correlated with students’ reported professional identity, according to study results published in JAMA Network Open.
The findings indicate the need for additional research on the topic so that medical schools will provide supportive and respectful learning environments, researchers concluded.
Image: Adobe Stock.
‘A common experience’
“Mistreatment is a common experience among medical students, with various negative consequences of such perceived mistreatment reported,” Xuanxuan Ma, MPH, of Peking University’s School of Public Health in Beijing, China, and colleagues wrote. “However, few large-scale studies have investigated the association between perceived mistreatment and the formation of medical students’ professional identities.”
Researchers used the China Medical Student Survey to measure perceived mistreatment among 94,153 medical students (57.2% women; 88.7% Han ethnicity) who graduated between 2019 and 2022 across 135 medical schools in China. They then assessed the association between perceived mistreatment and professional identity among students.
Researchers used a validated seven-item scale adapted from the Macleod Clark Professional Identity Scale to assess professional identity and determined the link between perceived mistreatment and medical students’ professional identity by using multivariate linear regression.
Reported mistreatment
Overall, 84.5% of medical students reported experiencing at least one mistreatment incident, including being required to perform personal service (61%), mistreatment by patients (71.6%), public humiliation (25.9%), unjust treatment (38.2%) and deliberate harassment (48.9%).
Researchers observed a negative association and saturation effect between the degree of mistreatment and medical students’ professional identity scores.
For example, lower professional identity scores occurred more commonly among students who reported single (95% CI, ‒0.33 to ‒0.28), moderate (95% CI, ‒0.69 to ‒0.63) and high (95% CI, ‒0.65 to ‒0.58) frequency of mistreatment vs. those who reported no mistreatment. Of note, the association between lower personal identity scores and reported mistreatment persisted but attenuated after adjusting for students’ sociodemographic characteristics and remained consistent across all mistreatment types, according to the researchers.
“The overall degree of mistreatment found in this study accords with that reported in a previous longitudinal project, but much higher than the Association of American Medical Colleges (AAMC) Graduation Questionnaire (GQ) 2016-2017 data,” the researchers wrote.
“While these differences may be due to differences in measurement methods, our comparison of similar mistreatment items revealed that the prevalence of mistreatment in China was higher than in GQ data, as was the case for being required to perform personal services and public humiliation. While these varying findings suggest apparent variability in cultures and learning environments across countries, it is also possible that because the average age of the graduates in this study was approximately 4 years younger than that of graduates in the U.S., this made them more likely to perceive and find it challenging to confront mistreatment during medical training.”
Researchers additionally noted study limitations, including possible reporting bias because the study relied on “medical students’ self-reported experiences of mistreatment during undergraduate medical education, and definitions of negative behaviors constituting mistreatment may vary among medical students.”
Creating a better environment
“To our knowledge, this is the first comprehensive study to investigate Chinese medical graduates’ experience of mistreatment and the association between perceived mistreatment and professional identity,” the researchers wrote.
“Our findings suggest that creating a supportive and nurturing learning environment is essential for promoting professional identity among medical students,” they added. “Theoretically, students acquire the values that will be basic to their professional way of life and learn to play the role of a physician through the process of socialization within the community of practice, including observing and evaluating the behavior of their supervisors and exchanging experiences and ideas with peers, patients, and other members of the health system.”
Ma and colleagues concluded that institutional- and individual-level solutions are needed for effective strategies to create supportive and respectful learning environments.
Perspective
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My colleagues and I have conducted extensive research on the treatment of health care professionals in the United States, particularly the challenges and abuse faced by women. We often examine the cultural shifts within medicine — acknowledging how, historically, the environment for trainees and students was far more toxic.
During the past several decades, however, significant strides have been made in the U.S. to address these issues and foster a more supportive and positive learning environment.
While we recognize that there is still much work to be done, the efforts made by the U.S. health care system demonstrate a commitment to identifying and addressing these cultural problems. I’m not suggesting that the U.S. system is perfect or superior, but rather emphasizing the importance of recognizing these issues as systemic challenges that require continuous attention and improvement.
The study we are discussing focuses on the mistreatment of medical students in China and its association with professional identity — a critical and fascinating area of investigation. What makes this study particularly compelling is its exploration of the ripple effects of mistreatment. It goes beyond simply identifying the prevalence of negative behaviors and delves into how these experiences shape a student’s sense of professional identity.
The findings reveal a clear negative correlation: Students who reported mistreatment also reported a diminished sense of professional identity. While this may seem intuitive, having data to substantiate this relationship is vital for developing actionable solutions.
The study highlights how mistreatment is not just a short-term issue — it can have lasting consequences on how medical students approach their roles as future physicians.
This research is crucial for several reasons. First, it underscores the need for systemic change to address and prevent mistreatment. Creating supportive, respectful learning environments isn’t just about improving student well-being — it’s about ensuring we are cultivating the next generation of compassionate, effective health care providers. Second, the study’s findings remind us of the broader implications of a toxic educational culture. Negative experiences during medical training don’t exist in isolation; they influence how these students will practice medicine as residents, physicians and leaders in health care.
The prevalence of mistreatment identified in this study is concerning, and I hope it catalyzes action to implement strategies that foster positive reinforcement, respect and support within medical education. Research consistently shows that such environments not only improve mental health and morale but also lead to better-trained physicians and, ultimately, better patient care.
This study is a poignant reminder of the importance of global collaboration and shared learning in addressing challenges within medical education. By working together, we can create systems that support students and empower them to become the best possible versions of themselves as health care professionals.
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