“Constantly ignored and told to disappear”: A review of the literature on “teaching by humiliation” in medicine
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.
Al-Hussain, S. M., Al-Haidari, M. S., Kouri, N. A., El-Migdadi, F., Raith, S., & Mohammad, M. A. (2008). Prevalence of mistreatment and justice of grading system in five health related faculties in Jordan University of Science and Technology. Medical Teacher, 30, 82‒96.
Anderson, J. (2013). Can pimping kill? The potential effect of disrespectful behavior on patient safety. Journal of American Association of Physician Assistants, 26(4), 53‒56.
Baldwin, D. C., Daugherty, S. R., & Eckenfels, E. J. (1991). Student perceptions of mistreatment and harassment during medical schools: A survey of ten United States schools. The Western Journal of Medicine, 155(2), 140‒145.
Barrett, J. (2013). Medical teachers in Australian hospitals: Knowledge, pedagogy and identity (Unpublished doctoral thesis). The University of Melbourne, Melbourne.
Bartle, E. (2014). What is professionalism? Three different perspectives. The Clinical Teacher, 11(3), 233‒234.
Birden, H., Glass, N., Wilson, I. G., Harrison, M., Usherwood, R., & Nass, D. (2014). Defining professionalism in medical education: A systematic review. Medical Teacher, 36, 47‒61.
Cook, A., Arora, V., Rasinski, K., Curlin, F., & Yoon, J. (2014). The prevalence of medical student mistreatment and its association with burnout. Academic Medicine, 89, 749‒754.
D’Eon, M., Lear, N., Turner, M., & Jones, C. (2007). Perils of the hidden curriculum revisited. Medical Teacher, 29, 295‒296.
Daugherty, S. R., Baldwin, D. C., & Rowley, B. D. (1998). Learning, satisfaction and mistreatment during medical internship. JAMA, 279(15), 1194‒1199.
Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2005). Medical student distress: Causes, consequences and proposed solutions. Mayo Clinical Proceedings, 80(12), 1613‒1622.
Fnais, N., Soobiah, C., Chen, M., Lillie, E., Perrier, L., Tashkhandi, M., . . . Tricco, A. (2014). Harassment and discrimination in medical training: A systematic review and meta-analysis. Academic Medicine, 89, 817‒827.
Frank, E., Carrera, J. S., Stratton, T., Bickel, J., & Nora, L. M. (2006). Experiences of belittlement and harassment and their correlates among medical students in the United States: Longitudinal survey. BMJ, 333(7570), 682‒684.
Gagyor, I., Hilbert, N., Chenot, J., Marx, G., Ortner, T., Simmenroth-Nayda, A., Himmel, W. (2012). Frequency and perceived severity of negative experiences during medical educaiton in Germany: Results of an online survey of medical students. GMS Zeitschrift fur Medizinische Ausbildung, 29(4), 7–12.
Gan, R., & Snell, L. (2014). When the learning environment is suboptimal: Exploring medical students’ perceptions of mistreatment. Academic Medicine, 89, 608–617.
Gaufberg, E. H., Batalden, J., Sands, R., & Bell, S. (2010). The hidden curriculum: What can we learn from third-year medical student narrative reflections? Academic Medicine, 85(11), 1709‒1716.
Greenberg, L. W. (1990). Abuse of medical students. JAMA, 264(13), 1657.
Hafferty, F. W., & Castellani, B. (2009). The hidden curriculum: A theory of medical education. In C. Brosnan & B. S. Turner (Eds.), Handbook of the Sociology of Medical Education. Abingdon, UK: Routledge.
Imran, N., Jawaid, M., Haider, & Masood, Z. (2010). Bullying of junior doctors in Pakistan: A cross-sectional survey. Singapore Medical Journal, 51(7), 592‒595.
Karnieli-Miller, O., Taylor, A. C., Cottingham, A. H., Inui, T. S., Vu, T. R., & Frankel, R. M. (2009). Exploring the meaning of respect in medical student education: An analysis of student narratives. Journal of General Internal Medicine, 25(12), 1309‒1314.
Kassebaum, D. G., & Cutler, E. R. (1998). On the culture of student abuse in medical school. Academic Medicine, 73(11), 1149‒1158.
Kaufman, D. M., & Mann, K. V. (2007). Teaching and learning in medical education: How theory can inform practice. Edinburgh, Scotland: ASME.
Leape, L., Shore, M., & Dienstag, J. L. (2013). In reply to Alexander, Rajput, and Katz [Letter]. Academic Medicine, 88(6), 741–742.
Lempp, H., & Seale, C. (2004). The hidden curriculum in undergraduate medical education: Qualitative study of medical students’ perceptions of teaching. BMJ, 329, 770‒773.
Mahood, S. C. (2011). Medical education: Beware the hidden curriculum. Canadian Family Physician, 57, 983‒985.
Mavis, B., Sousa, A., Lipscomb, W., & Rappley, M. (2014). Learning about medical student mistreatment from responses to the medical school graduation questionnaire. Academic Medicine, 89, 705‒711.
Mossop, L., Dennick, R., Hammond, R., & Robbe, I. (2013). Analysing the hidden curriculum: Use of a cultural web. Medical Education, 47(2), 134‒143.
Musselman, L. J., MacRae, H. M., Reznick, R. K., & Lingard, L. A. (2005). “You learn better under the gun”: Intimidation and harassment in surgical education. Medical Education, 39, 926‒934.
Nabi, H., Harley, S., & Murphy, E. (2012). The perils and triumphs of night surgical residents across South Australia. Journal of Surgical Education, 70(2), 265‒272.
Neville, A. J. (2008). In the age of professionalism, student harassment is alive and well. Medical Education, 42, 447‒448.
Oser, T., Haidet, P., Lewis, P., Mauger, D., Gingrich, D., & Leong, S. (2014). Frequency and negative impact of medical student mistreatment based on specialty choice: A longitudinal study. Academic Medicine, 89, 755‒761.
Phillips, S. P., & Clarke, M. (2012). More than an education: The hidden curriculum, professional attitudes and career choice. Medical Education, 46, 887‒893.
Rautio, A., Sunnari, V., Nuutinen, M., & Laitala, M. (2005). Mistreatment of university students most common during medical studies. BMC Medical Education, 5(36), 1‒12.
Rees, C. E., & Monrouxe, L. V. (2011). A morning since eight of just pure grill: A multischool qualitative study of student abuse. Academic Medicine, 86(11), 1374‒1382.
Scott, J., Blanshard, C., & Child, S. (2008). Workplace bullying of junior doctors: A cross-sectional questionnaire survey. The New Zealand Medical Journal, 121(1282), 10‒15.
Scott, K. M., Barrett, J., Cheetham, V., McCallum, Z., Barzi, F., & Phelps, M. (2014). Mismatch between medical student expectations and experience: Student over-entitlement or programs needing reform? Focus on health professional education: A multi-disciplinary journal, 15(3), 41‒52.
Sheehan, K. H., Sheehan, D. V., White, K., Leibowitz, A., & Baldwin, D. C. (1990). A pilot study of medical student abuse. JAMA, 263(4), 533‒537.
Silver, H. K. (1982). Medical students and medical school. JAMA, 247, 309‒310. Silver, H. K., & Glicken, A. D. (1990). Medical student abuse: Incidence, severity
and significance. JAMA, 263(4), 525‒532.
Sklar, D. (2014). Mistreatment of students and residents: Why can’t we just be nice? Academic Medicine, 89, 693‒695.
Spencer, J., & Lennard, T. (2005). Time for gun control. Medical Education, 39, 868‒869.
Tibbo, P., deGara, C. J., Blake, T. M., Steinberg, C., & Stonehocker, B. (2002). Perceptions of intimidation in the psychiatric educational environment in Edmonton, Alberta. Canadian Journal of Psychiatry, 47(6), 562‒567.
University of Melbourne. (2014). Discrimination, sexual harassment and bullying procedure. Retrieved from https://policy.unimelb.edu.au/MPF1230
Wynia, M., Papadakis, M., Sullivan, W., & Hafferty, F. (2014). More than a list of values and desired behaviors: A foundational understanding of medical professionalism. Academic Medicine, 89, 712‒714.
Zou, L., King, A., Soman, S., & Lischuk, A. (2011). Medical students’ preferences in radiology education: A comparison between the Socratic and didactic methods utilizing powerpoint features in radiology education. Academic Radiology, 18(2), 253‒256.
- There are currently no refbacks.