Background: Over 50% of Canadian medical students report experiencing mistreatment, yet only a small proportion of students report these concerns to administration. It is unknown how medical students make sense of their experiences of mistreatment and come to decide about formally reporting these experiences. Improved understanding of this phenomenon will facilitate changes at the administrative and institutional levels to better support students.
Methods: This Constructivist Grounded Theory study interviewed 19 current and former medical students from one institution about their experiences with mistreatment and reporting. Anonymized transcripts were reviewed, coded and theory was developed.
Results: Students undergo a journey surrounding experiences of mistreatment in five phases: Situating, Experiencing and Appraising, Reacting, Deciding, and Moving Forward. Students move through these phases as they come to understand their position as medical learners and their ability to trust and be safe within this institution. Each experience of mistreatment causes students to react to what has happened to them, decide if they will share their experiences and reach out for support. They choose if they are going to report the mistreatment, at what cost and for what outcomes. Students continue through their training while incorporating their experiences into their understanding of the culture in which they are learning and continually resituating themselves within the institution.
Discussion: This study revealed institutional mistrust from students especially as it related to reporting mistreatment. Interventions designed to support students and decrease exposure to mistreatment may be best focused on increasing organizational trust and organizational compassion between students and the medical school. Students volunteered mechanisms of support and to improve the reporting process. Medical school administration should consider how they can increase trust with their learners while identifying areas of concern and procedures for intervening and providing more transparent resolutions.
