COMMENTARY

Doctors Give Millennial Med Students a Bad Rap

Kolin M. Meehan

Disclosures

December 03, 2019

Before you roll your eyes at yet another annoying millennial demanding a "safe space," let me be clear: We get it. Medicine is tough. Despite the "participation trophies" lining our bedrooms, we know that we are committing to a lifetime of hard work and self-discipline. That is not lost on us.

Doctors in practice for decades have witnessed a shift from what they endured during their medical education. One hundred–hour workweeks, errand runs for senior staff, and copious "scut" work have declined in the face of shifting attitudes regarding the treatment of medical trainees. Today's students largely reject the notion that the training culture of the past made doctors "tougher" or "better." In fact, it may well have laid the foundation for the current, well-recognized epidemic of physician burnout.

This rejection of abuse and mistreatment by today's trainees has, sadly, led many current practitioners to feel as though they have to tiptoe around my generation's fragile sensibilities. A recent publication in JAMA Pediatrics suggested that teaching medicine now requires "walking on eggshells." This appears to be a commonly held belief.

Take a scroll through the comment section of virtually any article that addresses concerns about medical trainee well-being and you'll see established doctors who express anger and frustration with criticisms put forth by this generation. I'm frankly concerned at some of the language posted to public forums with commenters' names attached.

As a current student myself, I certainly don't have all of the solutions to closing this increasingly hostile generational divide. I do believe that bridging the gap is crucial and that it starts by finding common ground, beginning with a shared understanding of what mistreatment actually looks like.

'Suck It Up, Buttercup'

Although it dates back nearly 30 years, I like Dr Henry Silver's definition of medical student abuse: "unnecessary or avoidable acts or words of a negative nature inflicted by one person on another person or persons." How does that work in practice? Well, everyone—I hope—recognizes physical threats and abuse as inappropriate and rightfully discouraged. Verbal abuse is far more of a gray area.

Significant disagreement centers on what constitutes verbal abuse in the training setting and just what to do about it. In a culture where "pimping" is an acceptable term, where do we draw the line on appropriate communication? Many doctors without the "millennial" label can recall their experiences being on the receiving end of descriptors like "stupid," "worthless," and others that are normally printed as a series of asterisks... Speaking solely from my own and my friends' experiences, those moments are a rarity today, but exchanges that leave students feeling miserable about themselves still occur.

Some in the old guard brush off these exchanges, thinking, I went through worse and survived. What's the big deal? This attitude can be summed up as "Suck it up, buttercup." However, just because previous generations experienced this treatment, why should we still allow for public humiliation or childish insults? What may seem harmless to a senior doctor now may be a demoralizing experience for a medical student that can be avoided.

Students are wrong. A lot. We are still learning. As we present patients during rounds or answer questions during a procedure, we'll inevitably mess up. At this stage, our education involves exposing mistakes by speaking them out loud, as opposed to clicking the wrong bubble on a test. This real-time correction can be very intimidating for us. My best teachers have mixed clinical pearls with funny anecdotes, witty mnemonics, and passion for the material; that's the kind of positive environment in which education flourishes.

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