The authors offer recommendations for addressing the use of derogatory humor directed at patients that include a more critical, open discussion of these attitudes and behaviors with medical students, residents, and attending physicians, and more vigorous attention to faculty development for residents.

BACKGROUND: Medical educators act on the belief that students benefit from formal and informal educational experiences that foster virtues such as compassion, altruism, and respect for patients. OBJECTIVE:The purpose of this study is to examine fourth year medical students' perspectives on how, where, and by whom they believe the virtues associated with good physicianhood have been taught to them.DESIGN: Fourth year students were assigned a two-to three-page essay that asked them to reflect on how their medical education had "fostered and hindered" their conceptions of compassion, altruism, and respect for patients.PARTICIPANTS: All 112 students completed this assignment, and 52 (46%) gave us permission to use their essays for this study.APPROACH: An inductive, qualitative approach was used to develop themes derived from students' essays.RESULTS: Students' thoughts were organized around the idea of influences in three areas to which they consistently referred. Foundational influences included parents and "formative years," religious faith, and other experiences preceding medical school. Preclinical education influences comprised formal classroom experiences (both positive and negative effects). Clinical education influences included role modeling (both positive and negative) and the clinical environment (notable for emphasis on efficiency and conflicting cues). Students' essays drew most heavily on the effects of role modeling.DISCUSSION: Medical students arrive at our doors as thoughtful, compassionate people. Positive role models and activities to promote critical self-reflection may help nurture these attitudes.