Strategies to End the Abuse of Medical Students

Marcia Frellick

Disclosures

May 28, 2019

Restorative-Justice Circles

Among the more recent, novel approaches at other schools, Acosta said, is one borrowed from the legal system that is being piloted in about 10 medical schools: restorative-justice circles. In such circles, the perpetrator of the mistreatment, the person or persons reporting the issue, a mediator, and supporters for the parties sit down to talk about what happened and develop a plan to rebuild trust. The number-one requirement for such an interaction to be successful is that the perpetrator has to be remorseful, Acosta said, noting that this is not always the case.

Jay Behel, PhD, at Rush University Medical Center in Chicago, Illinois, explained that some such circles at his institution have been more effective than others. Specifically, they appear to work better when the perceived abuses are systemic, such as unrealistic academic demands, as opposed to cases that involve mistreatment by an individual. "We're trying to get there," he said, acknowledging that there have been some "spectacular failures." He added, "We're now offering it as an option any time a student reports mistreatment."

What has been more successful at Rush is using a group of trusted medical student leaders called SCORE, or the Special Committee on the Rush Medical College Environment. This group serves as proxy for the student reporting the mistreatment and discusses the actions with the perpetrator. Three students from each of the four class years serve on the committee.

Outside of restorative justice, Behel said, what has been most effective is giving students a strong sense of ownership and empowering them to "call out things that are going wrong, call out things that are going well, and know that faculty and administration have their back." He states that Rush was one of the first medical schools to institute an online reporting portal, which has an option for anonymous reporting. Instead of reporting to a human relations department or a dean or faculty member, students can report mistreatment electronically. The report is then reviewed by the student chair of SCORE and the faculty sponsor. Students can choose whether to identify themselves.

"SCORE was just wildly successful in making it safe for people to report things," Behel said. "This year, for the first time, we had more positive reports than negative reports." He said that residents saw the success of the SCORE and restorative-justice practices among students and said, "'Hey, we want that, too.' So we now have a SCORE process for residents as well. It's a bottom-up approach, and junior faculty have expressed interest as well."

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