The New York Times recently posted an article about medical student mistreatment (“The Bullying Culture of Medical School”) on its Well blog. The only thing that surprises me is that anyone in clinical medical education would be surprised by this article.
One of the key challenges in addressing mistreatment, from an organizational perspective, is in separating the wolves from the sheep. In this paper, the authors categorized mistreatment complaints in a non-standardized and potentially non-uniform way, and provided no clear criteria for “severe” vs. “moderate” vs. “mild” mistreatment. Certainly, I would hope that every student has a pleasant and fulfilling experience, but I would be much more concerned about “Attending grabbed and attempted to kiss [me]” than “Chief resident accused me … of not coming to the rotation … leaving me in tears.” Both, however, are labelled as severe incidents.
Another key challenge is creating effective consequences when mistreatment occurs. At present, I cannot fathom a resident (much less an attending) facing meaningful sanctions for anything short of a criminal offense (assault, sexual assault). For some staff, their sanctions are so toothless so as to become a perverse badge of honor. Since these staff have been cited so often, with such miniscule consequences, some even brag about how many times they have been written up. Meaningful sanctions would include an involuntary leave of absence, non-promotion or outright termination. Potentially remedial measures such as education and counseling could be meaningful, depending on their intensity and effectiveness, although usually they are not.
At present, mistreatment is swept under the rug, reducing students’ incentive to report it. Unless students directly observe an event or have an extremely close friend experience mistreatment, they will likely never know that a given staff member has been treating every student they encounter in the same way. Students often have to work with staff in the future (and are evaluated by staff), they often avoid “rocking the boat”. Students never hear about the results of their reporting, and often assume this means their complaints have fallen on deaf ears. In this area, we are quite far from Brandeis’ ideal of publicity, which Brandeis “justly commended as a remedy for social and industrial diseases. Sunlight is said to be the best of disinfectants; electric light the most efficient policeman.”
I hope that administrators will be encouraged to publicly assert responsibility for their educational environments and will address concerns vigorously. A few public floggings of the worst offenders would go a long way towards keeping the peace. Additionally, attaching meaningful consequences (rewards as well as sanctions) to student evaluations of staff would go a long way towards civilizing the environment and reducing the power imbalance.