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Munish Luthra, MD

Blogger: Munish Luthra, MD

About the blogger: Munish Luthra, MD, is an Assistant Professor of Medicine at Emory University School of Medicine. His interest & expertise includes managing patients with lung cancer and immunocompromised host. He has a strong interest in medical education with focus on Graduate Medical Education and Inter-professional education. He also serves as a Coach to the Internal Medicine Residency Program at Emory.

Citation: Whitgob EE, Blankenburg RL, Bogetz AL. The discriminatory patient and family: Strategies to address discrimination towards trainees. Acad Med. 2016;91(11 suppl): S64–S69.

Summary: Mistreatment is any behavior that shows disrespect for the dignity of others including discrimination based on race, gender, and religion. Only one study has examined the prevalence of discrimination and other forms of mistreatment towards trainees by patients. This study found that patients accounted for nearly 40% of this behavior1. Discrimination towards trainees by patients and families does not appear to be uncommon. However, to our knowledge, literature offers no recommendations for how to respond. To address this gap, the authors sought to qualitatively explore the perspectives of experienced faculty educators to:

  1. identify approaches trainees and physicians can use to respond to discrimination from patients and their families, and
  2. describe specific educational strategies trainees and faculty can employ to address this issue.

13 faculty members of the pediatric residency Program Evaluation Committee (PEC) at Stanford University participated in the study. The semi-structured interview guide consisted of three clinical scenarios of trainee discrimination (one each for race, gender, and religion) and a series of open-ended questions to probe reflection and responses to these scenarios. Participants were also asked to describe strategies that could be employed to teach trainees and faculty how to respond effectively in these situations.

Four themes emerged in how participants would respond to discrimination in the scenarios:

  1. assess illness acuity,
  2. cultivate a therapeutic alliance,
  3. depersonalize the event, and
  4. ensure a safe learning environment for trainees.

Participants described several specific responses both trainees and faculty can take immediately following a discriminatory event that fall within these themes. Finally, participants generated several recommendations of educational strategies to teach trainees and faculty how to respond to these scenarios

Why this article: Trainee mistreatment remains an important and serious medical education issue. Mistreatment and discrimination is a widespread phenomenon with between 17% and 95% of trainees reporting its occurrence. 2,3,4 One meta-analysis found that verbal harassment was the most common form, with discrimination based on gender and race most prevalent, ranging from 4% to 19%, respectively.4 This study extends the medical education community’s understanding of mistreatment by describing concrete approaches for addressing acts of discrimination, one form of mistreatment, by patients and families. This study describes a range of acceptable responses that trainees and faculty can take with discriminatory patients and families, and provides strategies for teaching our learners how to best respond in these situations in ways that ensures the safety and well-being of patients and trainees.

  1. Crutcher RA, Szafran O, Woloschuk W, Chatur F, Hansen C. Family medicine graduates’ perceptions of intimidation, harassment, and discrimination during residency training. BMC Med Educ. 2011;11:88. 
  2. Learning about medical student mistreatment from responses to the medical school graduation questionnaire. Acad Med. 2014;89:705–711.
  3. Baldwin DC Jr, Daugherty SR. Do residents also feel “abused”? Perceived mistreatment during internship. Acad Med. 1997;72(10 suppl 1):S51–S53.
  4. Fnais N, Soobiah C, Chen MH, et al. Harassment and discrimination in medical training: A systematic review and meta-analysis. Acad Med. 2014;89:817–827.