Medical Students Often Abused, Surveys Find : Education: Verbal and psychological mistreatment may turn them into less caring doctors, researchers say.
Medical students, who can best serve their future patients if they become humane and caring physicians, frequently suffer severe verbal, psychological or even physical abuse from their superiors that warps their professional development, according to two pioneering surveys of students being published today in the Journal of the American Medical Assn.
The separate surveys of about 500 students, conducted at the University of Colorado School of Medicine in Denver and the University of South Florida College of Medicine in Tampa, document an “obvious” problem that needs to be solved, according to Dr. DeWitt C. Baldwin Jr., director of the American Medical Assn.’s division of medical education research. Baldwin said the findings are buttressed by similar data collected on another 700 students in yet-to-be-published surveys at 10 other medical schools.
“The physician who has been treated in this manner may well carry over those attitudes and behaviors to their patients and students,” said Baldwin, who was a co-author of the Florida study.
Publication of the studies comes at a critical time for the nation’s 126 medical schools. Over the last decade, the annual number of applicants for approximately 17,000 first-year slots has plummeted from 36,727 in 1981 to 26,915 in 1989, according to the Assn. of American Medical Colleges.
The decline in applicants has been attributed to many factors. These range from the dehumanizing aspects of medical school and residency training to limits on fees, fear of malpractice suits and a widespread perception of public disenchantment with the profession.
“If we want to attract well-adjusted and talented young people to medical school, we can ill afford to have an environment that is perceived by some to be aversive, hostile or abusive,” wrote the University of South Florida research team, which was led by psychiatry professors K. Harnett Sheehan and Dr. David W. Sheehan.
The conventional wisdom about medical education has been that regimentation and discipline are more likely to produce good physicians than a “kinder, gentler” learning environment. Many medical students, however, do not share this perspective, the new studies reveal.
Nearly half of the 431 Colorado students who responded anonymously to a 1985 questionnaire said they had been abused at some time during medical school, with two-thirds describing an experience that was of “major importance and very upsetting.” One-sixth of those reporting abuse said that the most serious episode would “always affect them.”
Florida Survey
At the University of South Florida, one-third of the 75 third-year medical students surveyed in 1988 indicated that they “had considered dropping out of medical school,” and one-fourth claimed they would have “chosen a different profession if they had known in advance about the extent of mistreatment they would experience.” The third year is traditionally considered the most stressful because students are intensively immersed for the first time in the pressure-filled world of hospital practice.
One Florida student reported “he had been kicked in the testicular region by an attending physician and required medical attention for his injury.”
One Colorado student being instructed in eye diagnosis techniques balked at examining a classmate in “obvious pain” from a corneal abrasion accidentally inflicted by another student. “When I explained this to the supervising physician, he said, ‘Oh good, this gives us an opportunity to learn how to force a patient to cooperate even if they are in pain.’ ”
Another Colorado student was hit so hard on the knuckles with a surgical instrument by an attending surgeon while being taught to suture that “after the operation, my knuckles were bleeding, and I now have a scar on the back of my right hand.”
Authors of the studies acknowledged that such instances of physical abuse are extreme, and that the surveys may be biased because they are based on the students’ subjective judgments about past events. But they said medical school faculty and administrators are unlikely to take the problem seriously unless egregious cases are widely publicized. In addition, they said the perception of significant abuse could not be explained away.
When asked about the studies, Dr. August Swanson, a vice-president of the American Assn. of Medical Colleges in Washington, agreed the percentages “reflected a problem” but added that “exactly how pervasive it might be is open to investigation.”
Caroline Reich, a fourth-year medical student at Emory University in Atlanta and president of a group of medical students that advises the medical colleges association, said the articles “ring very true.”
The authors called for medical schools to take remedial steps, some of which the Colorado and Florida schools have already taken, such as educational campaigns and the establishment of grievance committees, disciplinary procedures and confidential counseling programs.
Out in the Open
Baldwin said that in most instances medical students now believe that “it won’t do any good (to report abuse), and ‘I would probably get screwed if I did.’ ”
Dr. Henry K. Silver, the principal author of the Colorado study, said, “Just bringing (abusive behavior) out in the open will make a difference.”
But Dr. Martin Pops, dean of students at UCLA Medical School, cautioned that “what one student would interpret as abuse, other students wouldn’t.” He said it is his impression that medical student abuse is “not a major problem” at UCLA.
The new studies are based on carefully designed surveys, and in this respect differ from anecdotal reports of medical student mistreatment and other information sources, such as Dr. Samuel Shem’s satiric 1978 novel “The House of God,” anthropologist and physician Dr. Melvin Konner’s 1987 book “Becoming a Doctor,” and the television series “St. Elsewhere,” which was aired from 1982 to 1988.
Authors of the medical school studies said no comparable surveys have been conducted at law, dental or veterinary schools, but they speculated that similar problems may exist in other professions. The only other groups that have been “systematically studied as victims of abuse are children and battered wives,” the University of South Florida’s David Sheehan said.
Abuse was defined in the Colorado study as “harmful, injurious or offensive” treatment, in particular “unnecessary or avoidable acts or words of a negative nature.” Both studies differentiated between experiences that might be considered unavoidable parts of the education process, such as long hours and sleep deprivation, and other episodes, such as sexual harassment, verbal humiliation and unjustifiable threats of failing grades or “ruining” careers.
Baldwin, of the American Medical Assn., said he has coordinated similar surveys within the last several years at 10 other “representative” medical schools; he declined to name the institutions and said there are no plans to identify the schools. The results, which are being prepared for publication, “are essentially the same,” he said.
