About half of internal medicine residents experience mistreatment
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Nearly half of internal medicine residents surveyed in the U.S. and Puerto Rico reported experiencing mistreatment, according to results published in JAMA Internal Medicine.
“Mistreatment can lead to burnout, depression and decreased self-confidence,” Kathleen Mary Finn, MD, the inpatient associate program director for the internal medicine residency program at Massachusetts General Hospital, told Healio. “These in turn can affect residents’ career choices and advancement by influencing decisions about fellowships, accepting jobs and taking advantage of career opportunities.”
Finn and colleagues conducted a national survey of internal medicine residents in August 2019. They administered an anonymous, five-question, optional survey to internal medicine residents after they completed the ACP Internal Medicine In-Training Examination.
In total, 21,931 residents completed the survey; 43.3% of respondents were women, 62.2% were medical graduates in the U.S., and 71.4% reported English as their primary language.
Prevalence of mistreatment
Overall, 48.3% of residents reported experiencing mistreatment and 62.4% reported witnessing mistreatment during their residency, according to Finn and colleagues. Also, 57.4% of residents reported that their programs “assessed trainees about mistreatment.”
Women experienced mistreatment more often than men during residency (64% vs. 36.2%; P < .001). They also reported witnessing mistreatment more than men (71.6% vs. 55.3%; P < .001).
The sources of mistreatment reported by residents were most often patients (51.3%), patients’ families (37.9%), nurses (20%) and faculty (16.1%). In general, women, graduates of U.S. medical schools and native English speakers were more likely to report mistreatment, regardless of source.
“A large percentage of mistreatment came from patients and families who likely hold beliefs about who should be a physician and may feel it’s fine to comment on women’s appearances,” Finn said.
The proportion of residents reporting mistreatment has not significantly changed during the last 3 decades, according to Finn.
“Residency programs should provide formal training for both residents and physicians about mistreatment, including what is considered mistreatment and how to manage and discuss it in real time,” she said. “They should also continue to monitor residents to evaluate which initiatives are making a difference. Institutions need policies about disrespectful patient behavior and to provide bystander training for all medical staff.”
Adopting a ‘zero-tolerance policy’
In a related commentary, Natalie L. Richmond, MD, of the department of internal medicine at the University of California, San Francisco, and Lara Goitein, MD, a critical care medicine specialist at Mountain Air Pulmonary Medicine in Santa Fe, New Mexico, contextualized the survey results.
“Increasing tensions during the COVID-19 pandemic” may be exacerbating preexisting mistreatment experienced by physicians and trainees, according to Richmond and Goitein.
While mistreatment by other residents and faculty has declined, mistreatment by patients and families has increased. Institutions should equip their residents and faculty with the tools and training needed to respond to mistreatment and bias, they added.
“As part of a zero-tolerance policy, any mistreatment of internal medicine residents and trainees should promptly be addressed,” Richmond and Goitein wrote.
References:
Finn KM, et al. JAMA Intern Med. 2022;doi:10.1001/jamainternmed.2022.0051.
Richmond NL, Goitein L. JAMA Intern Med. 2022;doi:10.1001/jamainternmed.2022.0055.