While mistreatment in medicine is well-described in the literature,1, 2, 3, 4, 5 particularly against women and physicians from underrepresented backgrounds,5, 6, 7, 8 patients and families have become an increasingly recognized source of provider mistreatment.1, 2, 5, 7, 9, 10 Mistreatment varies across genders, races, and ethnicities, with studies demonstrating there is more gender-based harassment directed towards women,9 and higher rates of general mistreatment of medical providers who are from underrepresented backgrounds.5, 9 Such mistreatment is strongly associated with resident burnout and negative attitudes about the learning environment1 with implications extending into concerns about physician retention in medicine,11, 12 along with negative impacts on patient safety and outcomes.13, 14 Given these dangers, there has been a call to explore ways to protect trainees from mistreatment and to develop more effective methods of responding to this source of mistreatment.15

Physician wellbeing and retention have also been linked to professional identity.16, 17, 18, 19, 20 The goal of medical training is to support trainees in achieving core competencies, but also in developing a commitment to humanism and altruism21 through trainee professional identity formation (PIF),21, 22, 23 or how one comes “to think, act, and feel like a physician.”22 While there are multiple models that describe PIF in medicine,16, 24, 25 Cruess’ model specifically focuses on the influence of the social world, including the communities in which physicians train and their interactions with patients.22, 24, 26 This framework therefore suggests that patients and families have the potential to greatly impact resident PIF, and while prior literature has suggested that positive clinical experiences can reinforce physician values, self-confidence, and feelings of competence,18 there is limited research exploring the effects of mistreatment by patients and families on resident PIF.

Therefore, to promote the development of committed, compassionate, and well physicians, we sought to address the literature gap and explore how mistreatment from patients and families (“mistreatment”) impacts pediatric resident PIF, particularly amongst women and underrepresented in medicine (UIM)27 trainees.