Medical students abused by patients develop negative views on professional identity

A new study finds that medical students' exposure to abuses during their training, such as unfair patient treatment, adversely affects their professional identity as doctors.

A team of researchers from the Peking University Institute of Medical Education analyzed the results of the China Medical Science Student Survey (CMSS) conducted in 135 medical schools from 2019 to 2022. It recently published the results in the Journal of the American Medical Association (JAMA) Network Open.

“Assault and other forms of abuse are common victimization experiences during medical school,” the researchers said, noting that numerous studies have shown that such abuse affects not only the well-being of medical students but also their career satisfaction and quality of care.

Notably, experiences such as assault during clinical training can have a negative impact on medical students' professional identity, the study found.

The researchers analyzed the results of the CMSS conducted from 2019 to 2022 to examine students' perceived experiences of abuse and their professional identity. Chinese medical students complete the CMSS at the end of each academic year. The study included 94,153 responses. The survey categorized experiences of abuse as unfair treatment from patients, performing personal services unrelated to work, public humiliation, unfair treatment, and intentional harassment.

The survey found that 79,554 respondents, or 84.5 percent, experienced at least one incident of abuse. Of these, 40.9 percent (38,482) reported experiencing abuse once, 28.6 percent (26,905) reported moderate frequency, and 15.0 percent (14,167) reported high frequency.

When asked by type of abuse (multiple responses were allowed), students were most likely to report being treated unfairly by a patient, with 67,439 respondents, or 71.6 percent of the total. Also, 57,455 (61.0 percent) reported performing personal services outside of work, 46,082 (48.9 percent) reported being intentionally insulted, 35,926 (38.2 percent) reported being treated unfairly in other ways, and 24,348 (25.9 percent) reported being publicly humiliated.

Students who reported experiencing mistreatment scored lower on occupational identity than those who did not. When medical students' professional identity was assessed using the Macleod-Clark Professional Identity Scale (MCPIS), there was a strong negative association between the level of abuse and medical students' professional identity scores.

“Students learn how to perform the role of a physician through a process of socialization within the community, sharing experiences and ideas with members of the healthcare system, including seniors, peers, and patients,” the researchers said. “During this critical stage of professional identity formation, medical students’ experiences of abuse can negatively impact their professional development as physicians and their relationships with patients.”

The study concluded that institutional efforts are needed to improve medical students' learning experiences and support their identity development.

“For example, Yale School of Medicine in the U.S. holds annual 'Power Day workshops' to support and advise students on identity formation,” it added.