How is Mistreatment Defined?
Mistreatment arises when a behavior shows disrespect for the dignity of others and unreasonably interferes with the learning process. It can take the form of physical punishment, sexual harassment, psychological cruelty, or discrimination based on race, religion, ethnicity, gender, age, or sexual orientation. Examples of mistreatment include:
- Threatening or abusive language, profanity, or language that can be perceived as rude, threatening, demeaning, sarcastic, loud, or offensive
- Belittling or humiliating behavior
- Intentional neglect or exclusion from communications
- Offensive sexist remarks or names
- Racist or ethnically offensive remarks or names
- Requirements that personal services – such as babysitting, shopping, or personal errands – be performed
- Threats of physical harm, such as hitting, slapping, and kicking
The Virginia Tech Carilion School of Medicine Learning Environment Advocacy Committee has adopted the following rubric from the Pritzker School of Medicine to help students and faculty better communicate about inappropriate behaviors:
M | Malicious Intent
Not Mistreatment: On the first day of third year, the ward clerk says to the student, “I can tell you guys are newbies,” then offers to help the students find a computer station.
Mistreatment: Resident purposely gives student misinformation before rounds. Student overhears resident laughing about misleading him.
Intimidation on Purpose
I | Intimidation on Purpose
Not Mistreatment: Student working with the chairman of surgery says he feels nervous about operating with him since the chairman can "make or break" his career.
Mistreatment: Resident tells a student that they intend to make them cry before the rotation is over.
S | Sexual harassment
Not Mistreatment: Male student asked not to go into a room because a female patient only wants a female to examine her.
Mistreatment: Student subjected to offensive sexist remarks or names.
Threatening verbal or physical behavior
T | Threatening verbal or physical behavior
Not Mistreatment: A student is yelled at to "get out of the way" by a nurse as a patient is about to be shocked during resuscitation.
Mistreatment: An attending grabs the student's finger with a clamp OR tells them they are an "idiot" after they could not answer a question.
Racism or excessive discrimination
R | Racism or excessive discrimination
Not Mistreatment: Attending gives student feedback on how to improve performance.
Mistreatment: Student subjected to racist or ethnically offensive remarks or names.
Excessive or unrealistic expectations
E | Excessive or unrealistic expectations
Not Mistreatment: Student is asked by an attending to review an article and present it on rounds to the team.
Mistreatment: 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
Not Mistreatment: A student is asked to make or get coffee for themselves and for the team prior to rounds since the resident did it yesterday. The supplies are in the team meeting room.
Mistreatment: A student is asked to pick up an attending’s dry cleaning.
Trading for grades
T | Trading for grades
Not Mistreatment: A resident tells a student that they can review and present a topic to the team as a way to enhance their grade.
Mistreatment: A student is told that if they help a resident move that they will get honors.
Is It Mistreatment?
Here is a useful one page summary of practices for productive interactions between teachers and learners (published in Academic Medicine, 2020)