Editor’s Note: Below is the third in a four-part series on trainee mistreatment. Check back for additional perspectives on this issue. Be sure to read the collection of articles on the topic in our May issue.
By: Molly Blackley Jackson, MD, assistant professor, University of Washington Department of Medicine; chair, UW Medicine Continuous Professionalism Improvement Committee; and Rainier College Mentor
Mistreatment in medical education has been a concern for over thirty years, and remains a serious challenge in our profession. Despite significant efforts on the part of countless schools of medicine across the globe, there is no clear improvement in the perception of mistreatment by students during their walk through medical education. We are certainly not alone–professional education and practice in law and business are also known for moments of intensity and intimidation. In our field, where humanism is widely accepted as one of our most central and important values, I feel we should know (and do) better. So why don’t we?
My sense is that the problem is complicated and multifactorial, but it starts with the slow erosion of our personal humanity during medical education and training. Without the right practice environment, this continues for practicing physicians. Medical school and residency is a wild ride of growth, stress, exhilaration, and fatigue. The hours are long, the stakes are high…and we doctor types are not terribly great at caring for ourselves. On top of this, electronic medical records, productivity pressures, and technology pull us further from the bedside and from time with each other as clinicians and students. This milieu results in teachers and learners who are experiencing burnout and are occasionally not their best selves. Though the literature is full of reports of students’ perceptions of learning environment, including one in the April issue of Academic Medicine, we need more investigation into how our teachers (trainees and clinicians) are faring out there in the trenches and more thoughtful work into how we can better support them in their walk.
How can we dig ourselves out of this mess? First, we need to remind ourselves of our ultimate professional purpose. Every student, trainee, faculty, and staff member on a medical team has one primary goal–patients are first. When “we are in this together” as a team, community and common purpose breaks down the hierarchical barriers between individual team members.
Second, every member of the team needs to have a role. At our institution, medical students repeatedly share that the best moments of their medical education were when they could participate in patient care in a meaningful way. The degree to which a student or trainee can contribute will vary drastically by team and setting, but individuals learn more effectively and are more invested when they play a specific role. Hierarchy in medical education is not the problem (we DO need to know who is in charge!), but our system would be improved without exhibitions of hubris and bravado at the expense of others.
One unfortunate outcome of the conversation on student mistreatment is that some teaching physicians are now reluctant to ask questions to students on rounds at all. Medical students are an incredibly bright and resilient breed, and most want to be pushed to maximize their learning, but they like to know what to expect. Don’t we all? I encourage teaching faculty at our school to prepare students for clinical rounds by very briefly sharing how they teach, especially if they use the Socratic method. Transparency about the goals can also be helpful, for example, “I’m pushing you because I want you to be the best physician you can be.” Senior students, trainees, staff, and faculty can also role model lifelong learning for students and each other. Teams in which every student is a teacher, and every teacher is a student, likely grow faster and work together more effectively. It takes some bravery for teachers to expose what they don’t know, but the collective curiosity, investigation, and growth is good for patients and for our spirits.
Finally, I feel strongly that we need to get to know each other on teaching and care teams, becoming more like a family. Learning just a few morsels of information about each of your team members (he likes to play harmonica, she served in Iraq, he runs marathons, she has a 3 month old son at home) can remind us of the humanity of the individual before us and can nudge us all to more open hearts and minds. Humanism isn’t just about patients–it’s about pausing to see the humanity in every individual before us (and in ourselves).