We know three things about mistreatment of medical students and trainees: (1) it is unethical, (2) medical schools and hospital systems are mandated to address it effectively, and (3) medical student reports of mistreatment have not diminished since the problem was first documented more than 20 years ago. Contributors to the March 2014 issue sort out why reported incidents of mistreatment have not declined despite efforts to curb the practice. Major hurdles to reform include medical education’s traditional rites of passage, difficulty in defining mistreatment precisely and collecting valid data about its occurrence, and inability to discipline offenders on the basis of anonymous reports.