Perceptions of intimidation also occur among trainees. When 2,884 students from the class of 2003 at 16 U.S. medical schools completed questionnaires at various times during training, 27% reported having been “harassed” by house staff, 21% by faculty, and 25% by patients.7 Further, 71% reported having been “belittled” by house staff, 63% by faculty, and 43% by patients.
Mistreated students were significantly more likely to have suffered stress, be depressed or suicidal, and less likely to report being glad they trained as a physician.
Studies consistently show that nurses are hesitant to report episodes of verbal abuse whether it is from a family, a patient, a physician, or a fellow nurse.
—David I. Rappaport, MD, pediatric hospitalist, Alfred I. Dupont Hospital for Children, Wilmington, Del.
This may have an underlying effect on the potential to monitor for patient safety.8,9 Because errors and near misses often result from miscommunication, medical students may be adept at preventing certain types of errors. Students’ observation skills may be just as keen, if not more so, than their more clinically proficient healthcare teammates.8 In four cases from two U.S. academic health centers reported by medical students Samuel Seiden, Cynthia Galvan, and Ruth Lamm in 2006, medical students demonstrated keen attention to detail and appropriately characterized problematic situations with patients—adding another layer of defense within systems safeguarding against patient harm.8 Yet of the 76% of medical students who had observed a medical error, only about half of the students reported the errors to a resident or an attending, despite having received patient-safety training; only 7% reported having used an electronic medical error reporting system.10
Some intimidation in medical education may be the result of anger toward students and residents over a lack of medical knowledge, says Jeffery G. Wiese, MD, associate professor of Medicine at Tulane University in New Orleans and member of the SHM Board of Directors. “It is natural to feel [that anger]; people abhor in others what they most detest in themselves,’’ he says. “As physicians, a lack of medical knowledge is what we detest in ourselves. But a student’s ignorance is usually a product of where she is in her training; that’s why she is with you.”
—Jeffery G. Wiese, MD, associate professor of Medicine at Tulane University, New Orleans
Anger alienates students, absolving them of the guilt of not knowing the information, and demotivating them from learning it. “The lesson to be communicated is that it is OK not to know, but it is not OK to continue to not know,” Dr. Wiese says. “Reprimands should be reserved for the student who does not know, and then after being taught or asked to look it up, continues to not know.”
“The average physician who practices for 30 years will take care of roughly 80,000 people,” estimates Dr. Wiese. “That’s an arithmetic contribution and there is nothing wrong with that. But if you really want to change the world, teaching is the rule. The same 30 years invested in teaching will indirectly affect 400 million people,” he says. “Even better, if you can train your students and residents in the value of coaching their students and residents, well, now you’re talking about 10 billion people that you can affect over the course of a career.”
The question to ask yourself, says Dr. Wiese, is: Do you want to change the world? “If you do, this is the way to do it,” he says.