Expectations and Power in Third-Year Medical School Clerkships: A Mixed-Method Inquiry to Ameliorate Student Mistreatment

Medical student mistreatment is a nationwide problem. This study explored if conditions within the clinical setting that create an environment in which a mistreatment event can occur or in which an event can be perceived as mistreatment are actually the result of an "expectations gap" between students and preceptors. A multi-step mixed-method qualitative approach was used. Findings were that three types of gaps exist. A first gap exists not only in how clinical expectations are communicated and understood, but how the word "expectations" is defined. A second gap exists between students' own expectations and their actual experiences. A third gap is that of power, between students and preceptors. The importance of this study is threefold. First, the study makes the internal expectations and external experiences of clerkships observable. Second, the study provides evidence that perceived mistreatment may actually be feelings of loss of relevancy, agency, and a sense of belonging. Third, the study reframes mistreatment, respecting the efforts of students and preceptors by noting how organizational defects, culture, and power play a role. Recommendations include recognizing the shared/divergent definitions of expectations, mapping out contrasts between expectations and experiences, and creating a mechanism to balance power when addressing the expectations gap.