The bullying culture of medical school

[AuxButtesChaumont]

"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."

 

http://well.blogs.nytimes.com/2012/08/09/the-bullying-culture-of-medical-school/?_r=0

 

Can those that have gone through clerkship and/or residency share their thoughts on this topic?

[A-Stark]

I've never experienced anything like that. But then there are a lot of questionable schools and malignant residency programs in the US.

[rmorelan]

according to our more recent surveys about 35% of all graduating medical students in Canada report they have experienced at least one instance like that - it is very dependent on the school and department as well. It is why we have a lot of harassment training etc.

 

Slowly improving - high stress environment (both emotionally and physically) that goes on for years and lingering mindset of a hierarchy don't help. Some people believe that if you are good enough then you can get away with other things - maybe a partial side effect of the respect assigned to doctors with many. Again though it is improving.

[Intrepid86]

I've been yelled at a few times. Being placed on services where criticism is dished out frequently isn't uncommon. Over time you get used to it and learn to look at things constructively (rather than take it personally). This is called developing a thick skin.

[future_doc]

This is not my experience.

[sprinkles]

Thats pretty crazy.

 

I would never have assumed that such a thing would exist, let alone be so widespread. In my mind being a doctor = 'professionalism' and therefore yelling and screaming and being abused would not be tolerated!

 

Its interesting to me that doctors who are caught doing this are not reprimanded immediately?!

 

I just hope its not as common in Canada!

[rmorelan]

Thats pretty crazy.

 

I would never have assumed that such a thing would exist, let alone be so widespread. In my mind being a doctor = 'professionalism' and therefore yelling and screaming and being abused would not be tolerated!

 

Its interesting to me that doctors who are caught doing this are not reprimanded immediately?!

 

I just hope its not as common in Canada!

 

Reprimanded by whom? Part of the reinforcement is that doctors don't really report to anyone except for really big things.

[rmorelan]

I've been yelled at a few times. Being placed on services where criticism is dished out frequently isn't uncommon. Over time you get used to it and learn to look at things constructively (rather than take it personally). This is called developing a thick skin.

 

Sure but why should have to endure it at all - I mean you can get constructive criticism with being yelled. The "abuse" - Does it enhance your education? Does it enhance patient care? Hospital culture should be constructed to maximize benefits after all.

 

If it happened rarely when you actually are or just did something very dangerous or shall I say flat out dumb then it could be considered effective - you would remember it that much more. The response you could argue is justified.

 

If it happens so often you develop a thick skin then its purpose is lost and it becomes pointless. You are effectively immune - or worse your developing immunity forces your instructors in a vicious cycle to constantly up the ante. A lot of the literature strongly suggests ultimately shame based learning is not as effective as other approaches - and like all things in medicine I think anything less effective should be discontinued in favour of better approaches.

[Jochi1543]

according to our more recent surveys about 35% of all graduating medical students in Canada report they have experienced at least one instance like that - it is very dependent on the school and department as well. It is why we have a lot of harassment training etc.

 

I think it's more than that. I read surveys where 95%+ experienced something like that once. However, the number of people who had to deal with bullying or abuse recurrently is much lower.

 

I think people also perceive and react to abuse differently. I remember talking to a few friends about surgical nurses, and most of us had experienced the scrub nurse doing something along the lines of grabbing our hands without saying anything and putting them wherever she felt was more appropriate. I personally found it a bit weird and kind of rude, but wasn't too bothered. But some other people were incredibly insulted. Or one time in the OR, I was there with a friend who was on the same rotation, and the surgeon pointed the bladder neck on me and drained the patient's bladder on my scrub gown. I was pretty shocked by the fact that a grown man would consider that HILARIOUS, but that's about it. But my friend was flabbergasted and said she was going to complain about that behaviour to the faculty.

 

Generally, if you talk to others about various incidents, you'll find that most people have experienced the same thing, which helps not to take it personally. I got a "stupidest med student ever" comment from some surgeon after busting my ass preparing for the rotation. After talking to others, I realized the two students before me were also told the same thing, therefore defying the entire statement, as there was no way THREE people could all be the "stupidest med students ever."

 

You'll get so much conflicting feedback, the only way to deal with it is to laugh and be confident in your own abilities. The "stupidest med student ever" came right after another surgical rotation where I was told I should consider applying to a surgical specialty. And don't tolerate what you perceive to be abusive behaviour.

[ER scrub]

I was told on one rotation that I wasn't to eat or drink until all the work was complete. I think what angered the preceptor was that I was drinking coffee (while writing notes) on a 26 hr call shift. She later explained her expectations and apparently drinking coffee while work was ongoing was a no-no. I would say that is the worst that has happened to me. The bad part is I didn't handle it well and pretty much was miserable on the rotation, only to get flagged later for being hard to get along with and not looking happy on the rotation (all I did was keep my mouth shut and remained stoic). I now have multiple meetings to attend regarding my behaviour. Looking back, had I complained, not sure it would have helped. I see other students complain and they don't really get anywhere. Of course I could have been chipper as ever the following day, but when your nearing the end of clerkship and are massively sleep deprived and on a demanding rotation, not easy to do. Hopefully the majority of schools are more understanding about this.

[nauru]

Multiple meetings regarding your behaviour? Please elaborate?

 

Are these anecdotes some of the reasons many physicians don't want to work in hospitals?

[NLengr]

I was told on one rotation that I wasn't to eat or drink until all the work was complete. I think what angered the preceptor was that I was drinking coffee (while writing notes) on a 26 hr call shift. She later explained her expectations and apparently drinking coffee while work was ongoing was a no-no. I would say that is the worst that has happened to me. The bad part is I didn't handle it well and pretty much was miserable on the rotation, only to get flagged later for being hard to get along with and not looking happy on the rotation (all I did was keep my mouth shut and remained stoic). I now have multiple meetings to attend regarding my behaviour. Looking back, had I complained, not sure it would have helped. I see other students complain and they don't really get anywhere. Of course I could have been chipper as ever the following day, but when your nearing the end of clerkship and are massively sleep deprived and on a demanding rotation, not easy to do. Hopefully the majority of schools are more understanding about this.

 

That's just stupid.

 

The only thing I are about with my med students is that you work hard. I don't even really mind if you are dumb as a post, along as you put the effort in.

 

But you're right, complaining wont help

[ER scrub]

That's just stupid.

 

The only thing I are about with my med students is that you work hard. I don't even really mind if you are dumb as a post, along as you put the effort in.

 

But you're right, complaining wont help

 

Yeah it was ridiculous - frankly I was shocked. And I'm still paying for not being smiley faced after (sadly I have no proof). I will say it's easily the worst thing that's happened to me in clerkship, and there's not much else I can complain about in terms of "abuse". There are pricks everywhere, and you just can't take it personally. So everything else was definitely manageable.

[Satsuma]

I guess partly some behaviours are passed down from generations. Teach through humiliation - should be a thing of the past. But since there are people who learned that way doing the teaching, then it still exists. And let's face it, nobody teaches you how to teach in medicine.

 

I remember one incident as a med student that occurred in front of a patient. The patient's jaw dropped to the ground and you could tell he felt really uncomfortable. My preceptor noticed his look and she said to him - I have to treat her this way for her to learn.

 

Well, she was wrong. Despite her world class efforts at daily humiliation, I didn't learn much on that rotation, lol!

 

But I think if more "outsiders" had a glimpse at some of the mistreatment that goes on, then it would bring some perspective. It's like kids growing up in abusive homes that don't know there's a different way until someone points out that it isn't what happens to everybody! Another doc or a nurse might not have even noticed the mistreatment in my case. But this was blatantly obvious to the patient!

[Renin]

I think it depends on the medical school. Where I did my undergrad, this happened I'd say more often than is acceptable.

 

Now that I'm a resident, I am very careful about what I say to the clerks coming through, and to a certain extent, take the brunt for them if there are unreasonable staff (very rare where I am a resident).

[Intrepid86]

Now that I'm a resident, I am very careful about what I say to the clerks coming through, and to a certain extent, take the brunt for them if there are unreasonable staff (very rare where I am a resident).

 

The best staff are the ones who remember what it was like to be a student. Unfortunately, after 20 or 30 years in their career many of them don't.

[rmorelan]

The best staff are the ones who remember what it was like to be a student. Unfortunately, after 20 or 30 years in their career many of them don't.

 

Hopefully by that point even if they forget they have still forged behaviours that stick Well at least I hope - I don't ever want to be that sort of doctor no matter how long I have been in practise.

[supafield]

Not that I don't hear stories.... but I've had I've been pretty lucky through 3rd year.

 

The odd surgeon that wouldn't talk to me in the OR... but nothing terrible. I've heard worse from my classmates.

 

Actually, it seems uOttawa is making a half decent effort to get on top of this stuff and have The Ottawa Hospital on board. They've assured us there are ways we can report these things while protecting our grades/evals.

 

http://www.med.uottawa.ca/students/beintheknow/eng/

[rmorelan]

Anytime a prick attending decided to take out his or her marital frustrations on me, I zoned out completely and perseverated on one phrase:

 

They can't stop the clock.

 

They can take your time, they can take your sleep, your peace, your dignity, and they can try to reduce you to the lowest form of slime, but they cannot do it forever, and certainly not for a minute past the post-call deadline.

 

I think that its just as important to learn what NOT to become and what NOT to do in medical education as it is to learn what to do.

 

If you ever want to see something fun - watch the moment then that clock runs out. I got to see in an internal medicine subdiscipline in clerkship the week prior to gradation for all the R5/R6s and how they interacted with the staff two years ago in clerkship. Evals are done, fellowships are booked, exams are completed.....there is no real power differential basically. Now that was interesting.

[rmorelan]

Not that I don't hear stories.... but I've had I've been pretty lucky through 3rd year.

 

The odd surgeon that wouldn't talk to me in the OR... but nothing terrible. I've heard worse from my classmates.

 

Actually, it seems uOttawa is making a half decent effort to get on top of this stuff and have The Ottawa Hospital on board. They've assured us there are ways we can report these things while protecting our grades/evals.

 

http://www.med.uottawa.ca/students/beintheknow/eng/

 

there unfortunately was a good reason for that - past surveys put Ottawa at the higher end of reported harassment during training relatively to other schools (we just got a 1/2 day lecture on this). The good news is that they are taking it quite seriously and take a lot of steps to correct that - and already I think are seeing considerable progress.

[hexonu]

I've seen a resident berate and throw a pens at a student. I probably should have said something now that I look back but I assumed it was some sort of rite of passage.

 

It reminds me of child abuse that goes on for generations. The father abuses the son, the son grow up and goes onto abuse his son, etc.

[aaronjw]

So a profession that is self regulated, wants to remain self regulated, and also wants the the public's trust seems to condone work place abuse and harassment.

 

Nah, no ethical or moral issues there.

[future_doc]

Might is right.