Speaking Up: From Exercise to Habit

By: Katie Rong

K. Rong is a third-year medical student, SUNY Upstate Medical University, Syracuse, New York.

After two years of learning basic sciences and rehearsing clinical scenarios behind classroom doors, I was excited to have proven myself worthy to be working alongside professionals; but I was also worried that I would be more of a hindrance than help on the team. It was this conscious awareness of my position on the totem pole of medical hierarchy mixed with my budding understanding of clinical medicine and team dynamics that ultimately made me a cautious, silent learner at the beginning of my third year of medical school.

Then I got the assignment to speak up. As part of our clinical bioethics course, we are tasked to actively look for problematic situations around us that we are ethically responsible to speak up about despite concerns for our grades and evaluations. This assignment has been a part of our curriculum for a number of years, and the outcomes from a previous year have been reported in a recent Academic Medicine article. The assignment helps us keep in mind the ethical responsibility that we should be learning as we are learning about our clinical responsibility. We are given months to do this assignment, and judging by my experience, all of that time is needed. Slowly, through pattern recognition and the shared experiences of other students, I had more understanding of what problems are real problems, which ones are addressable, what I can do to help, who to speak to when it is beyond me, and more importantly when and how to say it to get the most effect.

For a newly minted third-year student in her first clerkship on the labor and delivery floor, I had many questions about what practices were ethical or not. In one case, I thought a woman in the early stages of labor was neglected by the staff. I asked the midwife on the team, the only person who was not too busy rushing around the floor for me to interrupt. She welcomed my naïve question and explained that the woman needed time to be alone with her family.

By the time I got to my fourth clerkship, I had a little more insight and practice on speaking up. For this clerkship, I was on the psychiatry consult team. The team did not have their own therapist, but we would get consulted by doctors for that very service for their inpatients. Some residents would send us medical students to do supportive therapy, but we were ill-equipped. So, I spoke up. I asked different residents and attendings about how to provide very basic therapy for these hospitalized patients, and I was able to help two patients. Once the clerkship ended, I contacted the clerkship director and told her about the lack of a therapist on the team, the kind of requests we got, and the ways that students could help if we had more education and training. She responded well to my feedback and promised to work with the attending to discuss this idea. Her reception encouraged me to continue to speak up politely but persistently.

I was fortunate enough to have had help along the way in learning to speak up. I met regularly with a faculty advisor and a small group of Nightingale Scholars, students committed to integrating social responsibility and patient care. Each of us tried, during every clerkship, to engage in some small practice aimed at making patient care more just and compassionate. Not every practice had to be about speaking up against a problem; it could simply be returning to give patients pamphlets that answered questions that were skipped over during rounds. However, usually with every clerkship, someone from the group has practiced speaking up; and in this group, we shared experiences, benefited from open discussion, learned from others’ failures, and were empowered by others’ successes. Using the skills I learned from the assignment and honing them with this group, has helped me build up a habit of speaking up and trying to create systematic changes.

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