What is Learner Mistreatment?

Learner mistreatment is disrespectful or unprofessional behaviour directed at a learner or a group of learners that has a negative effect on the learner or the learning environment. Learner mistreatment can be intentional or unintentional, a single incident or pattern of behaviour, it can range from subtle comments to egregious conduct. Mistreatment is any conduct that is contrary to the principles that support a respectful environment and includes making demeaning, offensive, belittling and disrespectful comments, using abusive language, engaging in bullying, harassment, and discrimination.

Categories of Mistreatment

General Mistreatment

Experience	Unacceptable Conduct	Acceptable Conduct
Publicly humiliated	A student is told, in rounds, that he/she is stupid or lazy when he/she doesn’t know the answer to a question.	A student who doesn’t know the answer to a question during rounds is advised by the preceptor to look it up.
Threatened with physical harm	A Preceptor pounds his/her hand on the desk and says loudly “If you do that again I will smack you”.	In a clinical setting a staff person shouts at you to get out of the way because there is an emergency.
Physically harmed	A trainer throws materials at you, saying, “Read it again”.	Student is inadvertently burned during cautery in surgery. The surgeon apologizes.
Required to perform personal services	A student is asked to pick up an attending’s dry cleaning.	A student is asked to get coffee for themselves and for the team prior to rounds. The team gives the student money.

Sexual Mistreatment

Experience	Unacceptable Conduct	Acceptable Conduct
Subjected to unwanted physical touching or sexual advances	A Dean puts a hand on your shoulder, saying “I would like to teach you something… later”	After an upsetting incident the Dean puts their hand on a shoulder, asking “How are you doing?”
Asked to exchange sexual favours for grades or other rewards	A trainer tells you “I’m sure your evaluation will improve if we talk about it over dinner…”	A trainer says “Let’s meet after rounds to talk about your evaluation. I will help you with organizing your case presentations.”
Denied opportunities for training or rewards based on gender	Nurse says to patient, “we only have a male medical student today. You probably don’t want to be seen by a guy?”	Staff person says to student, “I’ll ask the patient if she is okay being examined by a male?””
Subjected to offensive sexist remarks/names	Preceptor says, “Hi Gorgeous” and to patient, “Aren’t we fortunate to have the lovely Margaret with us today? Hard to believe she’s a medical student!”	Preceptor says to patient, “This Margaret. She’s the fourth-year medical student on our team today.”
Received lower evaluation/grades based on gender	Preceptor says: “I don’t expect you to get your hands dirty in the OR. You should really think about psych or family – you girls are so good at those soft skills.”	Preceptor says to all students “All students will do well in this rotation if you are prepared to put in the work.”

Racial/Ethnic Mistreatment

Experience	Unacceptable Conduct	Acceptable Conduct
Denied opportunities for training or rewards based on race or ethnicity	Preceptor says to student from ethnic minority when they meet for the first time: “I really don’t think that you will find this subspecialty is for you. You won’t find many of your people seeking this sort of treatment.”	Preceptor supports all students in their career plans.
Subjected to racially or ethnically offensive remarks/names	A Program Director says: “You people make great pathologists – you guys are always talking.”	No comments are made about race or ethnicity.
Received lower evaluations or grades solely because of race or ethnicity rather than performance	A trainer comments on an evaluation and says in their experience “people like you should specialize so you can treat your community better.”	No statements are made about race or ethnicity.
Subjected to offensive remarks about religion	A preceptor says to a student observing Ramadan, “you better let go of that if you want to survive residency in this specialty.”	A preceptor says to a student observing Ramadan, “you know, I’m not too clear on the purpose of Ramadan, would you mind explaining to me as we walk to rounds?”

Sexual Orientation/Gender Identity Mistreatment

Experience	Unacceptable Conduct	Acceptable Conduct
Denied opportunities for training or rewards based on gender identity	A preceptor says: “I don’t think you will like Ortho. It’s a pretty tough specialty – too much heavy lifting for girls.”	No general or specific comments about sexual orientation.
Subjected to offensive remarks/names related to sexual orientation	A Faculty member says “You seem like a really nice person – strange that such pretty girl would like girls instead of guys”.	No general or specific comments about sexual orientation.
Received lower evaluations or grades solely because of sexual orientation rather than performance	Someone says “My impression is that people like you are super sensitive and not really cut out for this specialty.”	No general or specific comments about sexual orientation.
Subjected to discriminatory remarks regarding gender identity	A staff person says “All these new gender neutral washrooms! Why can’t you people use the one they’re supposed to? People have been doing it all their lives up until now.”	No general or specific comments on gender identity.

Patient Mistreatment

Patient mistreatment negatively affects the learning environment and is particularly difficult for learners to address on their own. It is important for you to report incidents of patient mistreatment to your preceptor or supervisor at the time they occur. Your preceptor can intervene to support you and take appropriate steps to ensure that such mistreatment does not impede your learning experience. Your preceptor can also assist you to process the interaction and develop strategies to address such behaviour in the future.

Peer-to-Peer Mistreatment

Peer-to-Peer mistreatment is disrespectful or abusive conduct, by someone at the same level, i.e. another undergraduate student, another post-graduate student, another faculty member, another resident, another graduate, another researcher, that should be addressed and reported as you would any mistreatment. Mistreatment between peers is as damaging to learners and the learning environment as mistreatment of learners by faculty or staff.

What is Not Mistreatment?

There are actions or situations that, while potentially uncomfortable, do not fall under the definition of mistreatment. Understanding these distinctions helps maintain a respectful learning environment while promoting accountability and growth.

Constructive Feedback

Providing critical or constructive feedback aimed at helping a learner improve their performance or skills is not mistreatment, even if the feedback feels difficult to receive. Constructive feedback is an essential part of learning and professional growth. However, feedback should be delivered respectfully and with the intention of supporting development.

Constructive Feedback	Less Detailed Feedback, Not Mistreatment	Mistreatment
“When you speak to patients in your rotations, you need to work at speaking more slowly so that they can better hear and understand you. For the last patient you worked with, I noticed that she asked you to slow down several times.”	“I just wish you would do better when you talk to students.”	“No one ever understands what you’re saying. My five-year-old could have explained that better than you.”
“Your note was well-written, but it’s missing a key section on patient follow-up. Make sure to include that next time.”	“This note isn’t what I expected. Try harder next time.”	“This is the worst note I’ve ever read. I can’t believe you think this is acceptable.”
“During your presentation, you used medical terminology that may be difficult for patients to understand. Try simplifying the language to ensure clear communication.”	“Your presentation wasn’t great. You need to explain things better.”	“Your presentation was awful. I can’t believe you think patients would understand anything you said—it was a waste of time.”