Caught in the Middle: A Resident Perspective on Influences From the Learning Environment That Perpetuate Mistreatment.

Understanding and addressing the issue of learner mistreatment is among the most pressing challenges facing academic medicine today. Despite the fact that residents have a significant influence on the clinical learning environment and may be both recipients and perpetrators of mistreatment, the resident perspective on the issue of learner mistreatment is notably sparse in the medical education literature. In this Commentary, the authors provide a resident response to recent data showing that mistreatment is subjective and may occur on a spectrum from incident-based mistreatment to environmental-based mistreatment. They focus on specific factors from the learning environment that may increase a learner's tendency to feel mistreated or have a suboptimal learning experience, including team cohesion, marginalization, peer-on-peer mistreatment, witnessing mistreatment, hierarchies, interdepartmental mistreatment, acculturation of uncivil behaviors, and residents themselves. This is followed by a discussion of proposed solutions to mitigate the negative impact of these influences and build safe learning environments, collaborative teams, empathic teachers, and resilient learners.