“Teaching by humiliation” and mistreatment of medical students in clinical rotations: a pilot study

Abstract

Objective: To generate a contemporary understanding of “teaching by humiliation” as experienced by medical students in Australia. Design, setting and participants: In this pilot study, we surveyed final‐stage medical students from two Australian medical schools about their experiences of teaching by humiliation during their adult and paediatric clinical rotations. The students were invited to complete the anonymous survey at the end of their paediatric rotation in Semester 2 of 2013. We used descriptive statistics to analyse quantitative data, and a grounded theory approach to analyse qualitative data. Main outcome measures: Student reports of experiencing or witnessing teaching by humiliation during their adult and paediatric clinical rotations. Results: Of 151 students invited to participate, 146 (96.7%) completed the survey. Most students reported experiencing (108; 74.0%) or witnessing (118; 83.1%) teaching by humiliation during adult clinical rotations. Smaller but still sizeable proportions had experienced (42; 28.8%) or witnessed (64; 45.1%) it during their paediatric clinical rotation. The humiliating and intimidating behaviours students experienced were mostly more subtle than overt and included aggressive and abusive questioning techniques. The students' responses to these practices ranged from disgust and regret about entering the medical profession to endorsement of teachers' public exposure of a student's poor knowledge. Conclusions: Practices associated with humiliating medical students persist in contemporary medical education. These practices need to be eradicated, given the evidence that they affect students' learning and mental health and are dissonant with formal professionalism curricula. Interventions are needed to interrupt the transgenerational legacy and culture in which teaching by humiliation is perpetuated.

Novice students navigating the clinical environment in an early medical clerkship

“…This is consistent with the increasing recognition in medical education of the effects of emotions on learning and the new understanding of emotional intelligence ready for application in our field . Our study emphasises the importance of providing individualised affective support in preference to dismissing struggling students as soft, spoilt and needing to ‘toughen up’ (or assuming they will take up a specialty that does not require patient contact).…”

Grace Under Pressure: a drama-based approach to tackling mistreatment of medical students

“…Although a multipronged approach is needed to generate systemic change,3 this pilot offers a uniquely positive, creative approach. It aims to enable students, the most vulnerable in the medical hierarchy, to begin to develop acting and leadership skills that will help them deal with challenges in the clinical setting, including mistreatment.…”

“…Recent American research found 59.4% of trainees experienced harassment or discrimination during medical school 2. Research at two Australian medical schools found 74.0% of students experienced ‘teaching by humiliation’ and 83.1% witnessed it 3. Some students and teachers believe coping with humiliation is part of professional development 2.…”

Making the night shift the right shift

“…19 Traditionally, handover has been seen as a tool to improve the training experience. 21 This educational combination still leaves its mark on many overnight-to-day handovers, and can be one of the less desirable and sometimes anxiety provoking aspects of night shift. 21 This educational combination still leaves its mark on many overnight-to-day handovers, and can be one of the less desirable and sometimes anxiety provoking aspects of night shift.…”

“…20 Such tradition has also seen the use of intimidation to enhance learning and may involve questioning the decision-making that occurred, the disposition or management plan that has been proposed, or the anatomical or physiological rationale for various management options. 21 This educational combination still leaves its mark on many overnight-to-day handovers, and can be one of the less desirable and sometimes anxiety provoking aspects of night shift. At best, this can give the night registrar a chance to eloquently display their medical expertise.…”