Implementation of an Online Reporting System to Identify Unprofessional Behaviors and Mistreatment Directed at Trainees at an Academic Medical Center

Abstract

ImportanceUnprofessional behaviors and mistreatment directed at trainees continue to challenge the learning environment. Academic medical institutions should encourage reports of inappropriate behavior and address such reports directly to create a safe learning environment.ObjectiveTo determine the feasibility of creating and implementing an online reporting system for receiving and reviewing complaints of unprofessional behavior directed toward or experienced by students, postdoctoral trainees, and residents.Design, Setting, and ParticipantsThis cohort study assessed implementation of an online reporting system (feedback form) with a method for triaging reports, providing both positive and negative feedback, as well as adjudication and transparent public disclosure of aggregate data. The system was launched at a large urban academic medical center with numerous trainees that is fully integrated with a health system of 8 hospitals. Participants included faculty who interact with trainees, medical students, graduate students and postdoctoral fellows, and residents and clinical fellows. Follow-up began in October 2019 (at the time of tool launch) and lasted through December 2021. Data were analyzed from January to March 2022.Main Outcomes and MeasuresThe primary outcomes were the numbers and types of reports according to the reporter and the person reported about.ResultsParticipants included 2900 faculty who interact with trainees, 600 medical students, more than 1000 graduate students and postdoctoral fellows, and 2600 residents and clinical fellows. Trainees submitted 196 reports, 173 (88.3%) of which described unprofessional interactions. Among the reports describing unprofessional behavior, 60 (34.7%) were from medical students, 96 (55.5%) were from residents and fellows, 17 (9.8%) were from graduate students or postdoctoral trainees, and 78 (45.1%) were from men. The majority of negative reports described behaviors by faculty (106 [61.3%]), followed by residents and fellows (24 [13.9%]). Twenty faculty (<1.0%) accounted for 52 (50.0%) of the 104 reports describing unprofessional behaviors. Since implementation, most trainees are aware of this process. An increasing number have reported instances of mistreatment, and those who shared concerns through the online system report satisfaction with the outcome of the response to the report.Conclusions and RelevanceIn this cohort study, the new reporting mechanism facilitated identification of the small number of individuals associated with unprofessional behaviors toward trainees and increased awareness of the school’s commitment to creating a safe learning environment.