Ending Mistreatment Of Medical Students Requires Culture Change

Each year the Association of American Medical Colleges asks medical school graduates about their college experience. In 2013, 42 percent of graduates from all schools reported that they experienced mistreatment during med school. One of the most prevalent mistreatment behaviors was public embarrassment or humiliation.

University of Washington Medical School students reported in graduate surveys from 2010 that they were made fun of, belittled in front of patients and yelled at.

One student wrote that she was told that “women are ruining medicine.” Another wrote about a mentor, “He was not only sexist at times but also humiliated me in front of patients.”

The issue of med student abuse or mistreatment isn’t new and no medical school is immune to the problems.

The UW’s Dr. Erika Goldstein attended med school in the 1970’s. “I saw things that I think I would report if I lived in this world now,” she said.

But in 2008 and 2009, UW students said they experienced mistreatment at nearly twice the national average. In 2010 the school was cited by the Liaison Committee on Medical Education, the agency that accredits US medical schools.

Goldstein said the school was aware before the LCME citation that the school's numbers were creeping up and they’d already started working on the problem.

Dr. Ellen Cosgrove, UW Medicine’s associate dean of academic affairs, said despite the citation the school's accreditation remained intact. It did however, force UW medicine to reevaluate its approach to the problem.

“When our performance falls short of our expectation for ourselves, and particularly when the national accreditation agency calls that to your attention, it makes sense to take a step back and take a look at the issue,” she said.

Geoffrey Young, of the Association of American Medical Colleges, said part of the problem lies within the culture of the doctors who are mentoring students. "You sort of have to pay your dues. 'If I did it therefore you have to do it' — that’s sort of the mentality that I think folks may have," he said.

Young and others agree that a toxic environment for learners can erode empathy, considered the cornerstone of the doctor-patient relationship.

Goldstein said the UW is trying to do a better job preparing students for what to expect when they transition out of the classroom, where the focus is on them, to residencies, where the focus is patient care.

“When they move into the clinical training is where most of these disquieting situations occur because we’re all focused on what’s best for the patient,” she said. "And [the students'] needs, and their priorities, may not be the highest priority thing all the time. In fact it will not be, it will not be.”

Goldstein tells students they may have to hold off asking a question until a more appropriate time or understand that during an emergency someone may physically move them if they’re in the way.

She also said that in her experience, when a faculty member is counseled for unprofessional behavior with students, they’re usually surprised and embarrassed.

“Most of the time faculty are very responsive. It’s very rare that we get somebody who is just absolutely terrible," she said. "Usually with coaching, with intervention, with discussion, most people come to realize what they need to do to welcome all students into their environment. And we have seen change."

Since the citation UW Medical School has changed. Faculty members are educated about how to give respectful feedback to students. Fourth year med students are interviewed in small groups about the positives and negatives of their clinical experience.

The school is also working to develop an anonymous feedback tool for students to report concerns about unprofessional behavior. The UW decided that the feedback about two clinics was so severe that the UW stopped sending students to those locations until the problems could be addressed.

According to student surveys, mistreatment at UW Medical School remains higher than the national average, but not as high as in previous years.

Cosgrove will be submitting another report to the LCME next year. She believes the school's efforts are paying off. “What I am looking at is where we stand relative to the national average. I feel that we’re moving in the right direction,” she said.

The movement among med schools to eliminate student mistreatment has been ongoing for more than a decade.

Young said the issue of mistreatment is a cultural problem, but one that medical schools need to tackle through leadership. “It is an important issue because I’m convinced that ultimately my care, your care and my children’s care will be better for it,” he said.

For the problem to be addressed it has to be reported. Surveys are a good first step. But in those surveys, 55 percent of UW med students said they chose not to report their incidents officially.

Most believed that the incident didn’t warrant an official report, which may be an indicator of the gray area that exists around the issue for students and professionals. Still, others said they thought reporting mistreatment would negatively impact their career.