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Rapid Responses: Rapid Responses published:
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Belittlement and harassment of medical students
- Jonathan D Belsey (14 October 2006)
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The roots of education are bitter but the fruits are sweet (1)
- Deepak Parasuraman, Deepak Parasuraman (15 October 2006)
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Harassment or Mollycoddling?
- Awais Bokhari (14 November 2006)
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Jonathan D Belsey, Researcher in evidence based medicine JB Medical Ltd, The Old Brickworks, Chapel Lane, Little Cornard, Sudbury CO10 0PB
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I was fascinated by this perspective on the role of belittlement and harassment in medical education. Until recently I would have disagreed with the authors comments but now am inclined to agree. Last summer I was involved in the production of a BBC programme "Thoroughly Modern Medic" in which a group of six third year medical students were subjected to a week of 1950's style ward-based teaching. In essence, we subjected them to a traditional regime of education by humiliation which, although to some extent artificially staged for the TV cameras, the action was unscripted and was treated seriously by all concerned. I was astonished by the changes we saw over such a short timescale. At the outset, the students had a good grasp of the basic skills required to take a history and examine a patient but most of them struggled to place the information gathered into any sort of diagnostic framework. After a week of being put on the spot and being forced to face up to the shortcomings of their thought processes their approach to the task was dramatically transformed, being able to present the information clearly and systematically and arrive at a rational and justifiable differential diagnosis. Having kept in contact with several of the students since filming was completed, they confirmed that the experience had been carried over into their normal practice and had proved beneficial to them in their fourth year of learning. In at least one case, the result was a significant improvement in performance, demonstrated by a rise from consistently being in the bottom quartile of examination results to becoming one of the higher performers. When I was as medical school, I dreaded the ward round as I knew that I would be made to appear a fool, but maybe it was my desire to avoid that fate that ultimately made me a better doctor. Competing interests: None declared |
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Deepak Parasuraman, Senior SHO Paedaitrics Tameside General Hospital. OL6 9RW, Deepak Parasuraman
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I can understand the feeling of current day medical students and sympathise with them. Having gone through similar experiences I would like to air my views on these. I feel obliged to help the medical students I meet on the wards every day. “Do you know what this is? and what do you think?” , are questions I ask them often. Never have I ever dreamt that this could be construed as a form of harassment and bullying by the student. I can say with confidence that these questions were never asked with any intention of malice and I am sure most if not all senior doctors would agree with me. As a student and more so often as a junior doctor I have been told time in and time out, that the first step to learning is to accept ignorance and what better time to accept ignorance than when asked something you do not know. One professor I trained with, always said,” I can tolerate a hundred I don’t knows but not one guess”. If the student feels belittled and bullied would it not be imperative to speak to their mentor and try and address their concerns, after all the students have as much a duty to learn, as a senior has a duty to teach. It is when these two rhyme that makes teaching effective. Mistakes done, as a student should be a stepping-stone to learning as rightly mentioned by Samuel Smiles(2) who said and I quote, “ It is a mistake to suppose that men succeed through success; they much oftener succeed through failures. Precept, study, advice, and example could never have taught them so well as failure has done.” 1 Aristotle 2 Samuel Smiles – Scottish Author 1812-1904 Competing interests: None declared |
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Awais Bokhari, Medical Student King's College London (se1 )
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As one of the six medical students who participated in the TV programme 'Thoroughly Modern Medic', I felt obliged to reply, as there are a few comments I would like to make with regards to the topic of teaching by humiliation. I took part in this exercise, as I wanted to experience the change in medical practice and use it positively so that when I qualify I could gain a better insight into medicine, its history and its evolution throughout the years. With regards to the medical advancement, I would agree that medicine has evolved to become more efficient and undoubtedly a superior practice to what it was in the 1950's. However, I would have to disagree the support Dr Belsy has for ‘teaching by humiliation'. The reason as to why I think Dr Belsy would have felt some of us improved as the programme progressed were largely due to the fact there were two contrasting settings throughout the filming. During filming, we were all performing as we would have on the wards, but off-screen we were one ‘big happy family’. We cannot look at the experience of the participants to determine whether teaching by humiliation is the way forward as the setting was totally different to what one would expect to find on the hospital wards today. I have experienced strict consultants who do teach by humiliation. However, in this day and age we need the consultants to establish a rapport with their students, just as we are taught in medical training to establish rapport with our patients. Awais Bokhari (Final Year Medical Student at: Guy’s King’s and St Thomas’ Hospital) awais.bokhari@kcl.ac.uk Competing interests: None declared |
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