Is abuse a part of medicine’s hidden curriculum?

Here at Science Careers we have occasion—a good deal more often than we’d like—to hear of graduate students and postdocs mistreated by those supposedly guiding their educational development. Those on the Ph.D. track, apparently, are not the only science-oriented trainees abused by teachers and superiors. Medical students and residents, too, are often frequently abused, research shows.

A May issue of the journal , in fact, included four research articles and an editorial on this subject. “[T]he literature describes a persistently high prevalence of mistreatment … ,” writes David Sklar, the journal’s editor-in-chief, in the editorial.

Clearly, Sklar writes, the problem is ‘part of the fabric of our institutional environments.’

Exactly how high is a matter of debate, with reported rates depending on definitions and how the questions are asked. Over 12 years of annual surveys of graduating medical students conducted by the Association of American Medical Colleges, “approximately 17% to 20% of medical students across the country each year reported mistreatment,” write Brian Mavis of Michigan State University in East Lansing and co-authors. The definition of mistreatment used in the surveys has changed, including, at various times, “denied opportunities, lower evaluations or grades, and offensive names and remarks predicated on gender, race/ethnicity, and/or sexual orientation”—as well as “public humiliation, requests to perform personal services, threatened or actual physical harm, sexual harassment and unwanted sexual advances, and others taking credit for a student’s work,” they note.

“Mistreatment based on specialty choice was common” for third-year medical students surveyed by Tamara Oser of Penn State Hershey Medical Group, Camp Hill, and co-authors. “The nature of mistreatment differed between students interested in primary care and those interested in a subspecialty. … Students perceived that teaching opportunities and evaluations were negatively affected by their specialty choice,” the authors write. This suggests, Sklar notes, “that faculty and residents are biased against certain specialties that differ from their own and may embarrass or criticize students who express interest in those specialty areas.”

Clearly, Sklar writes, the problem is “part of the fabric of our institutional environments.” In an earlier issue of Academic Medicine, Joyce Fried and co-authors at David Geffen School of Medicine at the University of California, Los Angeles, report on a program aimed at “eradicating medical student mistreatment.” Thirteen years of “multipronged” efforts have thus far had little effect. “Aspects of the hidden curriculum may be undermining these efforts,” the authors note. The Glossary of Education Reform defines “hidden curriculum” as “unwritten, unofficial, and often unintended lessons, values, and perspectives that students learn in school,” including “unspoken academic, social, and cultural messages that are communicated to students.” Are humiliation, disrespect, and discrimination among the lessons medical students are being “unofficially” taught? Similar questions are warranted for those on the Ph.D. track, which no doubt has its own hidden curriculum.

“We need to better understand the way in which learners move through medical education and create routes of safe passage for them, with supportive mentors who know and care about their progress and well-being,” Sklar concludes, in a sentiment that applies to other trainees as well.

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