Mental health consequences and correlates of reported medical student abuse

Medical students who deviate from the traditional norms of masculine or feminine behavior may be subjected to abusive situations more often than other students, and many may suffer psychological problems as a result. Of 137 medical students surveyed every year from their freshman year up to graduation, 71.8% reported at least one abusive experience with faculty, residents or staff. Being yelled at, being forced to listen to sexually suggestive jokes and being excluded from activities because of gender were the most commonly reported abuses. Women were more likely to report many of the abuses; 61.4% reported being uncomfortable listening to sexual jokes and 36.3% reported unwanted sexual advances from superiors. Men scoring low on masculinity tests and women scoring low on femininity tests were more likely to report abuse. These students were more likely to experience anxiety, depression, hostility and problem drinking.
Objective.-To assess the prevalence, correlates, and mental health consequences of reported medical training-related abuses. Design.-A longitudinal cohort study of 137 students surveyed from medical school entrance (time 1) through the winter of the fourth training year (time 4). Setting.-A state college of medicine. Outcome Measures. - Reported training-related abuses (measured at time 4) and mental health status measured at times 1 and 4 (depressive and anxiety symptoms, hostility, problem drinking, escapist drinking, alcohol consumption levels, and gender role orientations). Results.-Seventy-two percent of students reported at least one abusive experience during medical training. Females were significantly more likely than males to report gender discrimination, exclusion from informal settings, discomfort from sexual humor, and unwanted sexual advances. Abuse was significantly related to most psychopathological outcomes, controlling for pre-existing psychopathology. Males low in masculinity and females low in femininity were most likely to report abuse. Conclusions.-The data provide further support for the assumption that a high proportion of medical students not only experience the training process as abusive in nature but also suffer measurable psychopathological consequences. Efforts should be made to reform medical education, with a prominent focus on gender role related issues. (JAMA. 1992;267:692-694)