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A Pilot Survey of Patient-Initiated Assaults on Medical Students During Clinical Clerkship

Received June 1, 2004; revised September 12, 2004; accepted September 30, 2004. Drs. Waddell, Katz and Lofchy are with the Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada. Dr. Bradley is with the Department of Anesthesia, University Health Network, University of Toronto, Toronto, Ontario, Canada. Address correspondence to Dr. Waddell, Wilson Centre for Research in Education, Toronto General Hospital 1ES-565, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4; a.waddell{at}utoronto.ca (E-mail). Copyright © 2005 Academic Psychiatry.

OBJECTIVES: To assess the incidents of patient-initiated assault (PIA) against clinical clerks during the first six months of clinical clerkship. To characterise the assaults with respect to service, location, clerk gender, patient gender. To examine the students’ perceptions of the reporting process for PIA. METHODS: A brief email survey was sent to all third year medical students after six months of clinical clerkship experience. Students were asked to describe assault experiences including: location, service, patient gender and injuries sustained. RESULTS: Six students reported experiencing physical assault in the first six months of clerkship. Assaults occurred on psychiatry (4) and internal medicine (2) services. Two of the assaults took place during consultations in the emergency department. All students reported having pre-clerkship training in management of violent situations. No students were aware of PIA reporting protocols for their hospital. CONCLUSIONS: Clinical clerks are at risk of PIA during their training. Students experiencing PIA feel that current levels of pre-clerkship training do not adequately inform them of the resources available after such an incident. These findings underline the need for PIA programs in the undergraduate curriculum including preclerkship training and clear, institution-wide reporting guidelines.

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