Specialty disrespect in the medical learning environment: What is known and how can we intervene? A scoping review: BEME review no. 93.

Abstract

Background: Specialty disrespect or badmouthing is an aspect of the hidden curriculum that can inappropriately affect medical student specialty choice. The authors sought to map the breadth and depth of knowledge on this topic and identify existing interventions.

Methods: A scoping review was conducted by systematically searching several databases, grey literature, and hand-searching reference lists. English-language reports were included from any country through September 2024. Two authors screened each record for eligibility, coded and extracted data.

Results: Eighty-three reports were included in further analysis. Many terms were used to describe specialty disrespect, with badmouthing being the most common. Clinical faculty and non-primary care specialties were common sources of badmouthing and medical students were the most frequent recipients. Learners often encountered specialty shaming and perceived specialty hierarchies. Causes of disrespect included bias and stereotyping. Specialty disrespect was one of many factors impacting specialty choice. Few reports included implemented interventions.

Conclusions: Specialty disrespect is a worldwide phenomenon negatively impacting the learning environment and specialty choice. It is experienced by trainees in many fields, though it disproportionately impacts primary care specialties. Given the dearth of published interventions, future work should identify and assess responses to this issue.[Box: see text].