Balancing tension and kindness in medical education

I recall a particularly tense interaction on my surgery rotation in medical school. The sub-intern on our team, a dedicated classmate of mine, was instructed to carry the call pager one Friday afternoon, to the undue chagrin of the team’s nurse practitioner. With an irritable toss of her blonde hair, eyes rolling with exasperation, the NP snappily handed off the pager to our sub-intern. “Ugh, this is going to slow us down so much, but I guess this is how we’re doing things now!” she snarked in an exaggerated whisper that was clearly meant to be heard.

And then my intern year rolled around. A co-resident stormed into our workroom, visibly upset. Her patient had suddenly become febrile, and the ED nurse had paged her, asking to administer Tylenol. My co-resident had replied, “Could you wait for just a minute until I come see the patient to assess?” and hurried off to the ED.

My co-resident overheard the nurse cackling away with her colleagues: “What, are we now waiting to see how high the patient is going to burn? Is she stupid?” The nurse paled with horror when she noted my co-resident’s presence right behind her and immediately backtracked.

But the damage was already done. Later, when one of my own patients suddenly spiked a fever, my co-resident acerbically muttered at me, “Careful, Chloe. Don’t be stupid and wait for her to burn too high.”

Her hurt was palpable.

Medicine is an exercise in delayed gratification and sacrifice. My colleagues devote years of their lives and a small fortune to their education, sacrificing sleep, self-care, seminal moments with friends and family, and, in some cases, close relationships for this profession.

Adding insult to injury, medical students and trainees often feel undervalued and unwanted in the clinical environment. “What is the point of medical students doing a 24-hour shift? I’m mostly ignored anyway,” laments one 3rd year student on Twitter.

I recall voicing the same opinion in medical school, only to be told sternly, “It’s a good learning experience for you” – the insufferable “Because I said so!” of the medical profession.

But it was very difficult to appreciate a learning experience that involved exasperation at my mere presence and derision whenever I made an honest mistake as I tentatively navigated the uncharted waters of the clinical environment. I imagine many other trainees feel similarly.

The mental health consequences of workplace bullying – and let’s call this what it is: bullying – are significant. Victimization by workplace bullying is significantly associated with subsequent suicidal ideation; one study found a twofold increase in odds for suicidal ideation over a 5-year period.

Physicians are certainly not immune to these mental health consequences. Although widely regarded as more resilient than the average person, our suicide rate is higher than the national average. Regular calls for action and articles about burnout accompanied by pithy hashtags abound when one of our own sadly takes their life.

Yet, the bullying persists in medicine.

Now a resident myself, I am utterly scornful of medical staff who treat students and other trainees with contempt and mockery. I usually conclude my observations of these cruel episodes with a profanity-laced tirade in the safety of the resident room, a semi-regular phenomenon to which my co-residents can definitely attest. Why in the world would you work in an academic medical center if you’re going to be awful to medical students?

More than that, I am disappointed. I am truly disappointed in the professionals who have chosen to pursue a calling that is rooted equally in empathy and compassion as it is in science, and who, paradoxically and inexplicably, insist on perpetuating a toxic culture.

But there are small moments when I cautiously hope for better. I watched my attending firmly step into a group chat where three nurses inappropriately ganged up on our sub-intern after she articulated her concerns about the care of one of her patients. Thankfully, my attending intervened on behalf of the student, who was clearly distressed by the group’s unprofessionalism and defensiveness and who was decidedly on the unfavorable end of a vicious power differential.

I am grateful to this attending for modeling the compassion, decisiveness, and supportive culture that I want to be able to show my trainees someday.

And for everyone else: a little humility and empathy go a long way. It would be nice if we could all remember that each of us was a student once – vulnerable, uncertain, learning, and internally begging someone to tell us, You belong here. You have value.

Remember how anxious you felt at being a novice, terrified of failure and ridicule?

So do I. Don’t make someone else feel that way.

Chloe N. L. Lee is a psychiatry resident.


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