COMMENTARY

Hostile Culture 'Makes Worse Doctors'

F. Perry Wilson, MD, MSCE

Disclosures

February 26, 2020

Welcome to Impact Factor, your weekly dose of commentary on a new medical study. I'm Dr F. Perry Wilson.

Close your eyes for a second and think about medical school. What are you feeling? For many of us, medical school was an exhilarating if challenging time. We were learning what felt like the deepest secrets of the human body, we were finally applying decades of academic effort to something that might actually make a difference, and of course we were working our asses off.

That's OK— no one ever said med school was supposed to be easy.

But for too many med students, med school is not simply a tough but rewarding 4 years; it is a gauntlet — an environment where around any corner there might be someone who will demean, belittle, or harass you. And according to this study in JAMA Internal Medicine, the individuals running that gauntlet are disproportionately women and racial, ethnic, and sexual minorities.


 

Prior studies have looked at harassment of medical students, but this one really brings the numbers: 27,504 student surveys taken at med school graduation over a 2-year period were included in the analysis. The surveys asked a host of questions about the medical school experience, but importantly included questions like, "How frequently were you publicly humiliated?" and "been subject to sexist remarks or names?" and "been denied opportunities for training based on race/ethnicity?"

I was shocked when I saw the results. Please check out the paper because I can only highlight a few standouts here, but for example:


 

A quarter of male, and 40% of female, graduates reported experiencing mistreatment. Nearly a quarter of female graduates reported that they were subject to sexist remarks or names and 7% to unwanted sexual advances. Roughly 20% of male and female graduates were publicly humiliated.

Underrepresented minorities bore the brunt of mistreatment, with around a quarter having experienced race- or ethnicity-based discrimination, and a fifth subjected to racially offensive remarks or names.


 

Sexual minorities also appeared to be targeted, with 23% reporting discrimination based on sexual orientation and 27% publicly humiliated.


 

And these experiences were synergistic. Underrepresented minority women, for example, were more likely to be harassed and discriminated against than white women or underrepresented minority men.

So I feel like I have to say it: Folks, this is unacceptable.

I am fully aware that med school has a bit of a hostile culture. We all remember being pimped on rounds, put on the spot, and asked to demonstrate our knowledge amidst a group of senior physicians. I have issues with that modality of teaching, but I want to be clear that this is not solely what this study is talking about.

The thing that bothers me most in this space are those physicians who seem to think the hostile culture of medical school is a feature, not a bug — that somehow we need it to make good doctors. I think this is not only wrong but about 180 degrees wrong. I think this culture makes worse doctors. But if we continue to allow that hostility and allow it to be directed to physicians-in-training who actually reflect the diversity of our patient population — if we disrespect those students — the profession will lose the respect from society that we've enjoyed for so long.

F. Perry Wilson, MD, MSCE, is an associate professor of medicine and director of Yale's Program of Applied Translational Research. His science communication work can be found in the Huffington Post, on NPR, and here on Medscape. He tweets @methodsmanmd and hosts a repository of his communication work at www.methodsman.com.

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