Date of Award

January 2020

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Mayur Desai



While prior studies have described mistreatment in an undergraduate medical setting by sex, sexual orientation, and race/ethnicity, no studies have examined the degree of mistreatment and symptoms of burnout experienced by students with multiple marginalized identities with national data.


To describe the association between mistreatment, burnout, and having multiple marginalized identities during undergraduate medical education.


This cohort study utilized data from the Graduate Questionnaire administered annually by the Association of American Medical Colleges.


This study utilized student responses from the 140 U.S. medical schools accredited by the Association of American Medical Colleges’ Liaison Committee on Medical Education.


The participants were graduating medical students from 2016 and 2017.

Main Outcomes and Measures

Association between mistreatment and Multiple Marginalized Identity (MMI) index score. Association between burnout and MMI index score.


Responses from 25,517 graduating medical students were analyzed. The sample was comprised of 12,363 (48.5%) female, 1,393 (5.5%) LGB, and 9,777 (38.3%) non-White students. There is a statistically significant difference in the degree of mistreatment experienced by MMI score such that those with an MMI score of zero (i.e. heterosexual, white males) have the highest percentage of respondents reporting never experiencing neither general (60.2%, p<0.0001) nor identity-based (89.6%, p<0.0001) mistreatment during their medical education. Those with an MMI score of three (i.e. LGB, non-White females) had the highest percentage of students reporting sustained experiences of multiple types of general (15.2%, p<0.0001) and identity-based (17.8, p<0.0001) mistreatment. Moreover, the proportion of students scoring in the top quartile for the exhaustion dimension of burnout increased as MMI score increased in a gradient fashion. Those with an MMI score of three had 2.4 times the odds of scoring in the top quartile for exhaustion compared to those with an MMI score of zero. Such a pattern was not observed for those scoring in the top quartile for the disengagement dimension of burnout.

Conclusions and Relevance

Marginalized students are exposed to a more harmful learning environment during undergraduate medical education. Actions must be taken at the institutional level to foster a more inclusive learning environment for students from diverse backgrounds.


This thesis is restricted to Yale network users only. It will be made publicly available on 05/27/2021