# In Which Scenarios Do Preceptors and Students Agree, Disagree, or Remain Neutral About Learner Mistreatment?

## TL;DR

Medical students and preceptors often disagree on what counts as mistreatment, which could affect how mistreatment is reported and addressed in training.

## Contribution

This study compares students’ and preceptors’ perceptions of learner mistreatment using vignettes, revealing discrepancies in their evaluations.

## Key findings

- Students and preceptors agreed on 12 of 17 vignettes regarding learner mistreatment.
- Students more often viewed public embarrassment as mistreatment, while preceptors emphasized terms of endearment and career-based denial of training.
- Preceptors were more likely to select neutral responses compared to students across most vignettes.

## Abstract

In recent years, nearly half of graduating medical students in the USA and Canada reported personal mistreatment experiences during training. Prior scholarship reports heterogeneous opinions of learner mistreatment behaviors among trainees, and resulting unaligned perceptions may influence reporting, feedback, and policy. However, fewer studies compare students’ and preceptors’ views about learner mistreatment using vignettes of student-preceptor interactions.

We surveyed 141 students and 203 preceptors at an MD-granting institution. Participants indicated their agreement on a 5-point scale on whether behaviors in 17 written vignettes constituted learner mistreatment. Descriptive statistics and bivariate tests were executed to identify areas in which students’ and preceptors’ mistreatment views differed.

Student and preceptor responses converged on 12 of 17 vignettes. More students agreed that vignettes describing a student being addressed by another student’s name and an example of public embarrassment constitutes learner mistreatment. More preceptors agreed that addressing students with terms of endearment and denying training opportunities based on career choice constitute learner mistreatment. The proportion of preceptors who selected neutral responses was higher than that of students for nearly all vignettes.

When presented with written vignettes, students’ and preceptors’ perceptions of learner mistreatment were not consistent. This study highlights potential gaps in students’ and preceptors’ mistreatment perceptions, including differences in participants’ decisions to remain “neutral.” To prevent and address learner mistreatment, follow-up research is warranted to support the development and honing of shared definitions and examples of mistreatment, as well as targeted programming for students and preceptors.