Berating, Belittling and Behaving Badly

Excerpted from "The Bullying Culture of Medical School ," New York Times, by Pauline W. Chen, MD August 9, 2012--For 30 years, medical educators have known that becoming a doctor requires more than an endless array of standardized exams, long hours on the wards and years spent in training. For many medical students, verbal and physical harassment and intimidation are part of the exhausting process too. It was a pediatrician, a pioneer in work with abused children, who first noted the problem. And early studies found that abuse of medical students was most pronounced in the third year of medical school, when students began working one on one or in small teams with senior physicians and residents in the hospital.

The first surveys found that as many as 85 percent of students felt they had been abused during their third year. They described mistreatment that ranged from being yelled at and told they were "worthless" or "the stupidest medical student," to being threatened with bad grades or a ruined career and even getting hit, pushed or made the target of a thrown medical tool. Nonetheless, many of these researchers believed that such mistreatment could be eliminated, or at least significantly mitigated, if each medical school acknowledged the behavior, then created institutional anti-harassment policies, grievance committees and educational, training and counseling programs to break the abuse cycle. One medical school became a leader in adopting such changes. Starting in 1995, educators at the David Geffen School of Medicine at the University of California, Los Angeles, began instituting a series of school wide reforms. They adopted policies to reduce abuse and promote prevention; established a Gender and Power Abuse Committee; mandated lectures, workshops and training sessions for students, residents and faculty members; and created an office to accept confidential reports, investigate and then address allegations of mistreatment. To gauge the effectiveness of these initiatives, the school also began asking all students at the end of their third year to complete a five-question survey on whether they felt they had been mistreated over the course of the year. The school has just published the sobering results of the surveys over the last 13 years. While there appears to have been a slight drop in the numbers of students who report experiencing mistreatment, more than half of all medical students still said that they had been intimidated or physically or verbally harassed.

While their findings are disheartening, Joyce M. Fried, lead author of the paper and assistant dean and chairwoman of the Gender and Power Abuse Committee at the medical school and her colleagues continue to believe that medical student mistreatment can be significantly reduced - but only if all medical schools come together to work on the issue. "We're talking about the really hard task of changing a culture, and that has to be done on a national level," Ms. Fried said. Such an effort would include shared training programs, common policies regarding mistreatment and greater transparency about the mistreatment that currently exists in medical schools. Full story can be found here.

CMDA’s National Director of Campus & Community Ministries J. Scott Ries, MD: "They called him 'Mad-Dog Madden' (last name changed to protect the guilty, but the moniker is sadly accurate) and I was fortunate enough to be assigned to his 'A-team' surgery rotation as a brand new, first-month-on-the-wards third year medical student. Mad-Dog was indeed a talented, respected and experienced surgeon. However, he was infamous for chewing up and spitting out students and residents faster than yesterday’s rawhide bone.

"One of my first OR experiences witnessed Mad-Dog berating a PGY-2 resident so badly (including dangerously throwing instruments around the OR) that the resident decided to drop out of his surgical residency altogether, even though he had 'made the cut' from his intern year to a resident. I believe he is a radiologist now.

"Though I escaped Mad-Dog’s rotation without a personal assault myself, many of our students even today are not so fortunate. One of our CMDA students posted last month on Facebook a quote from his attending directed toward him on the first day of his surgery rotation, 'Is that medical student standing in the corner going to actually do something or is he going to continue standing there like a retard?'

"I certainly would agree with Dr. Chen that this mistreatment of learners should be curtailed. But in what ways can we as followers of Christ personally help mitigate the decades-old belittling traditions? Here are three things for us to individually consider, whether we are in an academic center or a community practice.

1. Self-check. Do I have a tendency toward critical comments of my staff, colleagues…and especially students and residents when they fall short of my expectations? Are my responses generally flavored by harsh criticism or by the fruit of the Spirit? (Galatians 5:22-23)
   
   
2. Affirm others. Most all of us learn best when instructed in a gracious manner. Do I provide necessary instruction in what went wrong while not letting my student forget what they have done right? Do I affirm while correcting?
   
   
3. Set the standard. The buck stops here. Will I set the tone by how I treat my students and staff? Do I have the moral courage to confront a colleague about their demeaning treatment of others in effort to be a part of the restoration of the standard?

"A seemingly small change of attitude on our part can have a profound impact on many, multiplying a culture of respect and grace over one of fear and bullying. We have a great opportunity to show a better way, regardless of how things were 'when I was a student.'”

Campus Ministries
Life Skills for Students and Residents