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U.S. Medical Students Endure Daily Harrassment

Mental abuse by higher-ups ingrained in doctors' training, study finds

FRIDAY, Sept. 8, 2006 (HealthDay News) -- U.S. medical students typically face harassment, insults and intimidation by attending physicians and resident doctors, a new study finds.

In some cases, the pressure on students becomes so bad it spurs depression and even suicide.

"Most medical students in the United States are graduating from medical school having had experiences that they report as being either belittling or harassing," said lead author Dr. Erica Frank, an associate professor and vice chairwoman of the Emory University School of Medicine in Atlanta.

In fact, 42 percent of seniors said they had been harassed by other students, residents, preclinical professors, clinical professors or attending physicians, or patients. Eighty-four percent said they had been belittled, and 40 percent said they had been harassed and belittled.

The report appears in the Sept. 6 online edition of the British Medical Journal.

This treatment can have serious consequences for students' mental health, Frank said. "Rates of depression and suicide are higher," she said. "They are also less likely glad that they trained to be a physician if they were belittled or harassed."

In the study, Frank and colleagues collected data on nearly 2,900 medical students from 16 U.S. medical schools. The students responded to questionnaires sent to them during their training. Questionnaires were sent three times: during freshman orientation, when the students started seeing patients in hospitals, and during their senior year.

Students were asked if they had been harassed or belittled by other students, residents, preclinical professors, clinical professors or attending physicians, or by patients.

Upon entering clinical rotations in hospitals, 8 percent of the students said they had been harassed by residents, 8 percent by clinical professors or attending physicians, and 10 percent by patients. These numbers grew during senior year to 27 percent, 21 percent and 25 percent respectively, the researchers found.

On starting clinical rotations, 28 percent of students said they had been belittled by residents, 32 percent by clinical professors or attending physicians, and 22 percent by patients. During the senior year, these numbers increased to 71 percent, 63 percent, and 43 percent, respectively.

However, only 13 percent of the students said any of these experiences were severe, the researchers report.

"Physicians don't understand the consequences of their comments," Frank said. "Professors and residents say things that make students feel not worthy," she said. "It is the reigning culture and [always] has been."

For some students, these types of pressures prompted alcohol abuse and binge drinking, depression and even suicide attempts. Some students felt faculty did not care about them, and others said they regretted training to become a doctor.

Frank said she doesn't hold out hope for change anytime soon.

"This kind of culture change is not going to happen with any particular rapidity," she said. "We give a lot of lip-service to teaching professionalism [and] to reducing the prevalence of disruptive physicians, but unless we train physicians not to do this, it still falls into the action-speaks-louder-than-words category."

One expert wasn't surprised by the study results.

"The findings of this study only add to the body of information that we already have in hand," said Jan D. Carline, a professor of medical education and biomedical informatics at the University of Washington in Seattle. "We know that many medical students experience harassment and belittlement during their training," he said.

It is also not surprising that the percentage of students who report these types of behaviors rises as they proceed through medical school, Carline said.

He added, however, that there's no proof medical school atmosphere, in and of itself, triggers breakdowns in students' mental health. "This study does not prove causality in this relationship," Carline cautioned.

"The most important conclusion that the authors draw is the call for faculty to interact with students in an 'ethically appropriate and sensitive way,' " the Seattle expert said. "This issue is a difficulty one to face, but important for all medical schools to deal with."

More information

There's more on the medical school experience at the American Medical Association.

SOURCES: Erica Frank, M.D., associate professor and vice chairwoman, Emory University School of Medicine, Atlanta; Jan D. Carline, Ph.D., professor, medical education and biomedical informatics, University of Washington, Seattle; Sept. 6, 2006, British Medical Journal online
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