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Comprehension and Factors Associated with Underreporting
of Mistreatment in Medical Students
Rathanan Rungrojwattana1, Phanuwich Kaewkamjornchai2, Pongtong Puranitee1, Pornthep Tanpowpong1*
1 Faculty of Medicine, Ramathibodi Hospital, Mahidol University
2 Chakri-Naruebodindra Medical Institute, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Background: Methods: *Corresponding Author E-mail: pornthep.tan@mahidol.ac.th
Abstract
To identify mistreatment and factors related to underreporting mistreatment in medical
students at a tertiary care teaching hospital.
This was a census-based survey study. Demographic data on mistreatment and perceived
causes, the response for mistreatment in victims’ aspect and witnesses’ aspect, association
with underreporting with regards to reasons, perception and encouraging factors were
collected. A 5-point Likert scale was used to define the participants’ perception. Beside
the basic statistical analyses, multivariable logistic regression was also performed. An
exploratory factor analysis was performed to investigate the factor model of survey
responses.
Results: We received 344 responses (response rate 36.7%) with 52.3% experienced ≥1 event in
the past 6 months but the events were reported only in 19/180 (10.6%). A concern on
confidential reporting system received the highest score for underreporting (mean of 4.37
[SD 0.96]). The highest proportion of the events being reported were inappropriate physical
contact. Twelve participants (63%) decided to report to the responsible staff. Inappropriate
physical contact (OR 6.9; 95% CI: 2.1, 22.6), unmanageable workload (OR 3.8; 95% CI: 1.3,
11.2), and underlying psychiatric disorder (OR 14.3, 95% CI: 4.0, 51.6) were independent
predictors of underreporting. Factor analysis on intensity and pattern of mistreatment
domain (e.g. the incident was not important, ’I can resolve the problem by myself’) yield
a significant association with underreporting (P=0.007). Moreover, 59% experienced
mistreatment as witnesses and 9.8% witnessed at least once a month. Most agreed that
transparency of the consideration process was the most important encouraging factor
for reporting. Furthermore, 90% believed that underreporting affects the recurrence of
mistreatment.
Conclusion: Among medical students, mistreatment is not uncommon, and the proportion of
underreporting remains very high. Factors related to underreporting may be modifiable or
manageable. Improving the transparency process may enhance the reporting rate which
may prevent mistreatment recurrence.
Harmony in health: Innovation for Sustainable Medicine
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