Is there a relationship between medical student mistreatment and specialty choice and career intentions? A systematic review

Background: Negative experiences such as mistreatment during clinical placement can have implications for medical student specialty preferences. The aim of this study was to synthesise research on the relationship between medical student mistreatment and their specialty and career choices. Methods: We systematically searched five electronic databases (MEDLINE, Scopus, CINAHL, Embase, and PsycINFO) to identify studies published from database inception to June 2024 investigating the relationship between the mistreatment of medical students and their specialty choice and career intentions. Two reviewers independently screened articles for inclusion, assessed study quality, and extracted data. We performed a narrative synthesis of the included studies. Results: We identified 11 studies. The majority used a cross-sectional study design (n = 10). Seven were conducted in the USA. Mistreatment in the form of verbal abuse, discrimination, harassment, and bullying was reported by medical students across the studies. Seven of the studies found an association between mistreatment and specialty or career choices. General surgery and surgical specialties were the most hostile environments for clinical placement and deterred students from pursuing these specialties. Mistreatment was frequently experienced by medical students who identified as female or as a sexual minority. In obstetrics and gynaecology, male students reported experiencing more mistreatment than females and were consequently more likely to change their career choices. Conclusions: Our findings suggest that students are less likely to pursue specialties if they experience mistreatment during clinical training. Medical students were especially deterred from general surgery and surgical specialties due to their experiences of discrimination.