Know the Difference: Teaching or Mistreating

Mistreatment as defined by the AAMC:

Mistreatment occurs when behavior shows disrespect for the dignity of others and unreasonably interferes with the learning process. Examples of mistreatment include sexual harassment; discrimination or harassment based on race, religion, ethnicity, gender, or sexual orientation; humiliation, psychological or physical punishment; and the use of grading and other forms of assessment in a punitive manner.

The occurrence, either intentional or unintentional, of such incidents results in a disruption of the spirit of learning and a breach in the integrity and trust between teacher and learner.

Examples of mistreatment include, but are not limited to:

  • Public belittlement or humiliation
  • Requiring performance of tasks intended to belittle or humiliate
  • Conduct intended to insult or stigmatize a student
  • Intentional neglect
  • Verbally abusive language
  • Inappropriate anger
  • Offensive remarks based on gender, race/ethnicity or sexual orientation
  • Threats of physical harm or actual physical punishment (e.g. hitting, slapping, kicking)
  • Requirements to perform personal services (e.g. shopping, babysitting)
  • Being denied training opportunities based on discrimination (gender, race/ethnicity, religion, sexual orientation, age, disability)
  • Unwanted sexual advances
  • Use of professional position to engage in romantic or sexual relationships
  • Asking for sexual favors in exchange for grades
  • Giving lower grades based on discrimination (gender, race/ethnicity, religion, sexual orientation, age, disability)

In the context of the multiple challenges posed by medical school training, it is sometimes difficult to distinguish between what constitutes mistreatment, and what does not.

The Pritzker School of Medicine* has developed the following set of examples to help students and faculty better understand what constitutes inappropriate behaviour or mistreatment.


   
Not Mistreatment
Mistreatment

M

Malicious Intent

On the first day of third year, the ward clerk says to the students, “I can tell you guys are newbies,” then offers to help the students find a computer station.

Resident purposely gives student misinformation before rounds. Student overhears resident laughing about messing him over.

I

Intimidation on Purpose

Student working with the chairman of surgery says he feels nervous about operating with him since the chairman can "make or break" his career.

Resident tells a student that they intend to make them cry before the rotation is over. 

S

Sexual harassment

Male student asked not to go into a room because a female patient only wants a female to examine her.

Student subjected to offensive sexist remarks or names.

T
 

Threatening verbal or physical behaviour
 

A student is yelled at to "get out of the way" by a nurse as a patient is about to be shocked during resuscitation.

An attending grabs the student's finger with a clamp OR tells them they are an "idiot" after they could not answer a question.

R

Racism or excessive discrimination

Attending gives student feedback on how to improve performance.

Student subjected to racist or ethically offensive remarks or names.

E
 

Excessive or unrealistic expectations
 

Student is asked by an attending to review an article and present it on rounds to the team.

A resident tells a student that it is their job to perform rectal exams (necessary or not) on all the patients admitted to the service.

A

Abusive favors

A student is asked to get coffee for themselves and for the team prior to rounds since the resident did it yesterday. The team gives the student money.

A student is asked to pick up an attending’s dry cleaning. 

T

Trading for grades

A resident tells a student that they can review and present a topic to the team as a way to enhance their grade.

A student is told that if they help a resident move that they will get honors.


Ref. *The Pritzker School of Medicine 


Mistreatment or unprofessionalism?

Mistreatment is always unprofessional.

Unprofessionalism does not necessarily involve mistreatment.

Consider the Declaration of Professionalism, which establishes a set of core values by which medical students, faculty, residents, allied health care professionals and staff are expected to live.  These include: 

  • Honesty and Integrity
  • Altruism and Respect
  • Responsibility and Accountability
  • Compassion and Empathy
  • Dedication and Self-improvement

Not all of these core values of professionalism involve mistreatment.  For example, if a professor repeatedly cancels a lecture at last minute, it is seen as unprofessional. Similarly, recurring tardiness constitutes unprofessional behavior.  These examples are not illustrative of mistreatment, but do put into question the professional conduct of an individual.

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