“Constantly ignored and told to disappear”: A review of the literature on “teaching by humiliation” in medicine
Keywords:clinical teachers, hidden curriculum, medical students, professionalism, student abuse, student mistreatment
Introduction: The aim of this narrative review of the literature was to use systematic search and review procedures to describe a contemporary understanding of the expression “teaching by humiliation.”
Method: A search was conducted of MEDLINE, 1990‒2013, using search terms humiliat*, intimidat*, harass* and abus*. Three hundred and forty-one papers were located; however, only papers related to medical students and medical trainees were considered. Papers dealing with substance abuse, patient abuse and sexual harassment were excluded. Of the 341 papers located, only 30 met the criteria for inclusion. One reviewer/author read all 30 papers; both reviewers/authors annotated 15 papers each, and subsequently agreed on the following categories for the systematic review: clarifying terminology, identifying specific behaviours, the extent of the problem, explanations posited, and finally, the effects of humiliation and abuse.
Results: The review confirmed that the expression “teaching by humiliation” appears in the literature but that “abuse” and “mistreatment” are more common terms for medical teachers’ behaviours towards students. These behaviours range from yelling, shouting and physical abuse to subtle undermining and demeaning language and practices. The behaviours are widespread and persistent across many countries, and victims suffer personal and professional effects.
Conclusion: There is ongoing concern in the literature about the culture of medical education that perpetuates these practices and the failure to interrupt that culture despite decades of research and commentary.
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