Information de reference pour ce titreAccession Number: | 00001888-201405000-00034.
|
Author: | Fnais, Naif MS; Soobiah, Charlene; Chen, Maggie Hong PhD, MSc; Lillie, Erin MSc; Perrier, Laure MLIS; Tashkhandi, Mariam MD; Straus, Sharon E. MD, MSc; Mamdani, Muhammad PharmD, MA, MPH; Al-Omran, Mohammed MD, MSc; Tricco, Andrea C. PhD, MSc
|
Institution: | Mr. Fnais is a medical student, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Ms. Soobiah is research coordinator, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Chen is a biostatistician, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Ms. Lillie is research coordinator, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Ms. Perrier is information specialist, Continuing Education and Professional Development, Faculty of Medicine, University of Toronto, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Tashkhandi is an MSc candidate, Institute of Medical Science, University of Toronto, and associate researcher, Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Straus is professor, Department of Medicine, and director, Division of Geriatric Medicine, University of Toronto Faculty of Medicine, and director, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Mamdani is professor, Department of Health Policy, Management, and Evaluation and Leslie Dan Faculty of Pharmacy, University of Toronto, and director, Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Al-Omran is professor and vascular surgeon, Department of Surgery, University of Toronto Faculty of Medicine, and head, Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Tricco is a scientist, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
|
Title: | |
Source: | Academic Medicine. 89(5):817-827, May 2014.
|
Abstract: | Purpose: Harassment and discrimination include a wide range of behaviors that medical trainees perceive as being humiliating, hostile, or abusive. To understand the significance of such mistreatment and to explore potential preventive strategies, the authors conducted a systematic review and meta-analysis to examine the prevalence, risk factors, and sources of harassment and discrimination among medical trainees.
Method: In 2011, the authors identified relevant studies by searching MEDLINE and EMBASE, scanning reference lists of relevant studies, and contacting experts. They included studies that reported the prevalence, risk factors, and sources of harassment and discrimination among medical trainees. Two reviewers independently screened all articles and abstracted study and participant characteristics and study results. The authors assessed the methodological quality in individual studies using the Newcastle-Ottawa Scale. They also conducted a meta-analysis.
Results: The authors included 57 cross-sectional and 2 cohort studies in their review. The meta-analysis of 51 studies demonstrated that 59.4% of medical trainees had experienced at least one form of harassment or discrimination during their training (95% confidence interval [CI]: 52.0%-66.7%). Verbal harassment was the most commonly cited form of harassment (prevalence: 63.0%; 95% CI: 54.8%-71.2%). Consultants were the most commonly cited source of harassment and discrimination, followed by patients or patients' families (34.4% and 21.9%, respectively).
Conclusions: This review demonstrates the surprisingly high prevalence of harassment and discrimination among medical trainees that has not declined over time. The authors recommend both drafting policies and promoting cultural change within academic institutions to prevent future abuse.
(C) 2014 by the Association of American Medical Colleges
|
References: | 1. Silver HK. Medical students and medical school. JAMA. 1982;247:309-310
2. Cook DJ, Liutkus JF, Risdon CL, Griffith LE, Guyatt GH, Walter SD. Residents' experiences of abuse, discrimination and sexual harassment during residency training. McMaster University Residency Training Programs. CMAJ. 1996;154:1657-1665
3. Baldwin DC Jr, Daugherty SR, Eckenfels EJ. Student perceptions of mistreatment and harassment during medical school. A survey of ten United States schools. West J Med. 1991;155:140-145
4. Li SF, Grant K, Bhoj T, et al. Resident experience of abuse and harassment in emergency medicine: Ten years later. J Emerg Med. 2010;38:248-252
5. Association of American Medical Colleges. . Medical School Graduation Questionnaire: 2011 All Schools Summary Report. 2011 https://www.aamc.org/download/26...- ouverture dans une nouvelle fenêtre. Accessed January 13, 2014
6. Sheehan KH, Sheehan DV, White K, Leibowitz A, Baldwin DC Jr. A pilot study of medical student "abuse". Student perceptions of mistreatment and misconduct in medical school. JAMA. 1990;263:533-537
7. Lubitz RM, Nguyen DD. Medical student abuse during third-year clerkships. JAMA. 1996;275:414-416
8. Richman JA, Flaherty JA, Rospenda KM, Christensen ML. Mental health consequences and correlates of reported medical student abuse. JAMA. 1992;267:692-694
9. Tennant CC. A student mental health and welfare program in a medical faculty. Med J Aust. 2002;177(suppl):S9-S10
10. Thomas NK. Resident burnout. JAMA. 2004;292:2880-2889
11. Wilkinson TJ, Gill DJ, Fitzjohn J, Palmer CL, Mulder RT. The impact on students of adverse experiences during medical school. Med Teach. 2006;28:129-135
12. Moher D, Liberati A, Tetzlaff J, Altman DGPRISMA Group. . Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. J Clin Epidemiol. 2009;62:1006-1012
13. Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. http://www.ohri.ca/programs/clin...- ouverture dans une nouvelle fenêtre. Accessed January 13, 2014
14. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539-1558
15. Milstein V. Patient assaults on residents. Indiana Med. 1987;80:753-755
16. Baldwin DC Jr, Daugherty SR, Eckenfels EJ, Leksas L. The experience of mistreatment and abuse among medical students. Res Med Educ. 1988;27:80-84
17. Silver HK, Glicken AD. Medical student abuse. Incidence, severity, and significance. JAMA. 1990;263:527-532
18. Chaimowitz GA, Moscovitch A. Patient assaults on psychiatric residents: The Canadian experience. Can J Psychiatry. 1991;36:107-111
19. Wolf TM, Randall HM, von Almen K, Tynes LL. Perceived mistreatment and attitude change by graduating medical students: A retrospective study. Med Educ. 1991;25:182-190
20. Komaromy M, Bindman AB, Haber RJ, Sande MA. Sexual harassment in medical training. N Engl J Med. 1993;328:322-326
21. Nicolson P, Welsh CL. Sexual harassment, male dominated organizations and the role of counselling psychology: The case of medical school. Couns Psychol Q. 1993;6:291-301
22. Baldwin DC Jr, Daugherty SR, Rowley BD. Racial and ethnic discrimination during residency: Results of a national survey. Acad Med. 1994;69(10 suppl):S19-S21
23. Black KJ, Compton WM, Wetzel M, Minchin S, Farber NB, Rastogi-Cruz D. Assaults by patients on psychiatric residents at three training sites. Hosp Community Psychiatry. 1994;45:706-710
24. Moscarello R, Margittai KJ, Rossi M. Differences in abuse reported by female and male Canadian medical students. CMAJ. 1994;150:357-363
25. Schulte HM, Kay J. Medical students' perceptions of patient-initiated sexual behavior. Acad Med. 1994;69:842-846
26. Uhari M, Kokkonen J, Nuutinen M, et al. Medical student abuse: An international phenomenon. JAMA. 1994;271:1049-1051
27. McNamara RM, Whitley TW, Sanders AB, Andrew LB. The extent and effects of abuse and harassment of emergency medicine residents. The SAEM In-service Survey Task Force. Acad Emerg Med. 1995;2:293-301
28. Bergen MR, Guarino CM, Jacobs CD. A climate survey for medical students. A means to assess change. Eval Health Prof. 1996;19:30-47
29. Lebenthal A, Kaiserman I, Lernau O. Student abuse in medical school: A comparison of students' and faculty's perceptions. Isr J Med Sci. 1996;32:229-238
30. Margittai KJ, Moscarello R, Rossi MF. Forensic aspects of medical student abuse: A Canadian perspective. Bull Am Acad Psychiatry Law. 1996;24:377-385
31. Moscarello R, Margittai KJ, Rossi MF. Impact of faculty education on the incidence of sexual harassment experienced by Canadian medical students. J Womens Health. 1996;5:231-237
32. Nora LM, McLaughlin MA, Fosson SE, Jacob SK, Schmidt JL, Witzke D. Does exposure to gender discrimination and sexual harassment impact medical students' specialty choices and residency program selections? Acad Med. 1996;71(10 suppl):S22-S24
33. vanIneveld CH, Cook DJ, Kane SL, King D. Discrimination and abuse in internal medicine residency. The Internal Medicine Program Directors of Canada. J Gen Intern Med. 1996;11:401-405
34. Vukovich MC. The prevalence of sexual harassment among female family practice residents in the United States. Violence Vict. 1996;11:175-180
35. Barlow CB, Rizzo AG. Violence against surgical residents. West J Med. 1997;167:74-78
36. Daugherty SR, Baldwin DC Jr, Rowley BD. Learning, satisfaction, and mistreatment during medical internship: A national survey of working conditions. JAMA. 1998;279:1194-1199
37. Kassebaum DG, Cutler ER. On the culture of student abuse in medical school. Acad Med. 1998;73:1149-1158
38. Mangus RS, Hawkins CE, Miller MJ. Prevalence of harassment and discrimination among 1996 medical school graduates: A survey of eight US schools. JAMA. 1998;280:851-853
39. Elnicki DM, Linger B, Asch E, et al. Patterns of medical student abuse during the internal medicine clerkship: Perspectives of students at 11 medical schools. Acad Med. 1999;74(10 suppl):S99-101
40. Barry D, Cyran E, Anderson RJ. Common issues in medical professionalism: Room to grow. Am J Med. 2000;108:136-142
41. Elnicki DM, Curry RH, Fagan M, et al. Medical students' perspectives on and responses to abuse during the internal medicine clerkship. Teach Learn Med. 2002;14:92-97
42. MMA Committee on Women Physicians. . Gender-based harassment. Minn Med. 2002;85:45-49
43. Nora LM, McLaughlin MA, Fosson SE, et al. Gender discrimination and sexual harassment in medical education: Perspectives gained by a 14-school study. Acad Med. 2002;77(12 pt 1):1226-1234
44. Maida AM, Vasquez A, Herskovic V, et al. A report on student abuse during medical training. Med Teach. 2003;25:497-501
45. Walter G, Rey JM, Giuffrida M. What is it currently like being a trainee psychiatrist in Australia? Australas Psychiatry. 2003;11:429-434
46. Hinze SW. "Am I being over-sensitive?" Women's experience of sexual harassment during medical training. Health (London). 2004;8:101-127
47. Hoosen IA, Callaghan R. A survey of workplace bullying of psychiatric trainees in the West Midlands. Psychiatr Bull. 2004;28:225-227
48. Kovatz S, Notzer N, Bleiberg I, Shenkman L. Cultural perception of harassment in two groups of medical students: American and Israeli. Med Teach. 2004;26:349-352
49. Cohen JS, Patten S. Well-being in residency training: A survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Med Educ. 2005;5:21
50. Finucane P, O'Dowd T. Working and training as an intern: A national survey of Irish interns. Med Teach. 2005;27:107-113
51. Keeley PW, Waterhouse ET, Noble SI. Prevalence and characteristics of bullying of trainees in palliative medicine. Palliat Med. 2005;19:84-85
52. Nagata-Kobayashi S, Sekimoto M, Koyama H, et al. Medical student abuse during clinical clerkships in Japan. J Gen Intern Med. 2006;21:212-218
53. Recupero PR, Cooney MC, Rayner C, Heru AM, Price M. Supervisor-trainee relationship boundaries in medical education. Med Teach. 2005;27:484-488
54. Waddell AE, Katz MR, Lofchy J, Bradley J. A pilot survey of patient-initiated assaults on medical students during clinical clerkship. Acad Psychiatry. 2005;29:350-353
55. Avan BI, Raza SA, Khokhar S, et al. Residents' perceptions of work environment during their postgraduate medical training in Pakistan. J Postgrad Med. 2006;52:11-16
56. Frank E, Carrera JS, Stratton T, Bickel J, Nora LM. Experiences of belittlement and harassment and their correlates among medical students in the United States: Longitudinal survey. BMJ. 2006;333:682
57. Witte FM, Stratton TD, Nora LM. Stories from the field: Students' descriptions of gender discrimination and sexual harassment during medical school. Acad Med. 2006;81:648-654
58. Acik Y, Deveci SE, Gunes G, et al. Experience of workplace violence during medical specialty training in Turkey. Occup Med (Lond). 2008;58:361-366
59. Ahmer S, Yousafzai AW, Bhutto N, Alam S, Sarangzai AK, Iqbal A. Bullying of medical students in Pakistan: A cross-sectional questionnaire survey. PLoS One. 2008;3:e3889
60. Cohen JS, Leung Y, Fahey M, et al. The happy docs study: A Canadian Association of Interns and Residents well-being survey examining resident physician health and satisfaction within and outside of residency training in Canada. BMC Res Notes. 2008;1:105
61. Rademakers JJ, van den Muijsenbergh ME, Slappendel G, Lagro-Janssen AL, Borleffs JC. Sexual harassment during clinical clerkships in Dutch medical schools. Med Educ. 2008;42:452-458
62. Judy K. Workplace violence: A survey of paediatric residents. Med Teach. 2009;31:1038
63. Nagata-Kobayashi S, Maeno T, Yoshizu M, Shimbo T. Universal problems during residency: Abuse and harassment. Med Educ. 2009;43:628-636
64. Mukhtar F, Daud S, Manzoor I, et al. Bullying of medical students. J Coll Physicians Surg Pak. 2010;20:814-818
65. Shoukat S, Anis M, Kella DK, et al. Prevalence of mistreatment or belittlement among medical students-a cross sectional survey at a private medical school in Karachi, Pakistan. PLoS One. 2010;5:e13429
66. Behnam M, Tillotson RD, Davis SM, Hobbs GR. Violence in the emergency department: A national survey of emergency medicine residents and attending physicians. J Emerg Med. 2011;40:565-579
67. Fnais N, al-Nasser M, Zamakhshary M, et al. Prevalence of harassment and discrimination among residents in three training hospitals in Saudi Arabia. Ann Saudi Med. 2013;33:134-139
68. Baldwin DC Jr, Daugherty SR. Do residents also feel "abused"? Perceived mistreatment during internship. Acad Med. 1997;72(10 suppl 1):S51-S53
69. Baldwin DC Jr, Daugherty SR, Rowley BD. Residents' and medical students' reports of sexual harassment and discrimination. Acad Med. 1996;71(10 suppl):S25-S27
70. Stratton TD, McLaughlin MA, Witte FM, Fosson SE, Nora LM. Does students' exposure to gender discrimination and sexual harassment in medical school affect specialty choice and residency program selection? Acad Med. 2005;80:400-408
71. World Bank. . World Bank Classification. 2011
72. McLaughlin H, Uggen C, Blackstone A. Sexual harassment, workplace authority, and the paradox of power. Am Sociol Rev. 2012;77:625-647
73. American Medical Association. . Guidelines for establishing sexual harassment prevention and grievance procedures. JAMA. 1992;268:273
74. Kelly S. Workplace bullying: The silent epidemic. N Z Med J. 2004;117:U1125
75. American Medical Association. Graduate Medical Education Directory, 1993-1994. 1993 Chicago, Ill AMA
|
Language: | English.
|
Document Type: | Reviews.
|
Journal Subset: | Clinical Medicine. Health Professions.
|
ISSN: | 1040-2446
|
NLM Journal Code: | acm, 8904605
|
DOI Number: | https://dx.doi.org/10.1097/ACM.0...- ouverture dans une nouvelle fenêtre
|
Annotation(s) | |
|
|