AAMC 2014: Dealing With Disrespect: How Medical Students Cope

Announcer: Broadcasting for the Algorithms for Innovation booth at the AAMC in Chicago. The Healthcare Insider is on The Scope, University of Utah Health Sciences Radio.

Interviewer: Yas Sanaiha and Bo Espinosa-Setchko are both fourth year medical students at UCLA where we heard yesterday from Dr. Laura Spetz is actually kind of a leader in disrespectful physician behavior. So the question is, is that true? Have you seen any examples of disrespectful physician behavior to you as a medical student or to anybody else?

Espinosa-Setchko: Right, well, I actually would argue that UCLA is maybe a leader in being proactive in these issues.

Interviewer: Sure.

Espinosa-Setchko: You know, one thing that's been striking to me as a fourth year medical student coming to these meetings are when we go to these discussions being able to offer examples of the ways that our school in particular does a good job of looking out for us ahead of time.

Interviewer: Give me an example of those.

Espinosa-Setchko: Right. I think one of the things to think about is that student mistreatment is a broad term. And of course, at the beginning of our first year, and the beginning of our second year and third year, we received lectures on the subject, so first kind of setting the tone, defining what it means, is really important.

Interviewer: Sure, because that could be such an individual thing.

Espinosa-Setchko: Exactly.

Interviewer: Somebody could be just overly sensitive, perhaps.

Espinosa-Setchko:Sure, they could be overly sensitive or they might not really understand. You're coming in as an outsider a lot of times into these settings as a medical student, so you have to learn from that culture and it's hard to know as an outsider what's appropriate versus what's inappropriate.

Interviewer: Compared to the culture you're used to at home or in other jobs that you may have had.

Espinosa-Setchko: Right. Not to mention the fact that medical culture is, as Dr. Ben spoke about yesterday, is very hierarchical, so there are very few avenues in which medical students feel comfortable advocating for themselves or feel comfortable even asking for anything special.

Interviewer: Sure.

Espinosa-Setchko: Right? And so a lot of times as a medical student it's hard to feel as though it's your place to say no or to put limits on things.

Interviewer: Yes.

Espinosa-Setchko: So, as I mentioned, I think defining things in the first few years is something UCLA does really well for us. That said, it's different when you actually get to the wards. So another way that UCLA, I think, has done a really great job, is that in the third year we have what we call doctoring sessions in which all the students come together bi-monthly and discuss how things are going on the wards. This has been really important, not just for student mistreatment, as you can imagine, for things like preventing burnout, for having a safe space to talk about what's been going on in the wards and get feedback from other students as well as usually licensed professionals such as psychiatrists or psychologists who are present.

I think what's been really neat about those sessions is it's an opportunity for us students to ask, "This happened and it made me feel uncomfortable," or "I'm not really sure what I thought about this." We do know that students at UCLA, as well as across the country, do report some mistreatment on those exit surveys when they leave medical school. Yas and I haven't had individual experiences to reflect that. So I've been lucky enough to not have had student mistreatment.

Interviewer: That's pretty awesome. Yas, you're going into surgery and for better or worse, there is this rumor floating around that maybe surgeons can be the worst when it comes to a little bit of mistreatment, or maybe behaving in a way that it could be perceived as mistreatment. Do you find that to be the case at UCLA?

Sanaiha: I think we are very fortunate at UCLA for most of our surgical attendings and residents that the culture is in a way that it's built on respect. Of course, there are tense moments, tense situations where as a medical student they're maybe not as strongly included in the situation, and maybe if someone is in patient care trying to focus on what needs to be done, that the student may not feel they get the attention that needs to be delivered.

Also within the actual surgery clerkship, our clerkship chairs are very active in terms of having and developing real-time student feedback access to more senior residents and actually the clerkship chair if there is an issue so that they may intervene during that clerkship.

Interviewer: It would seem to me that the stakes are really high in surgery, so it'd be really easy, maybe, to do something that might be over the line. Is that an accurate assessment?

Sanaiha: I think that it's human nature. It's intensity in approaching certain life and death situations that you can't see it, but I think to the most extent I see effort by a lot of our attendings and residents in terms of maintaining respectful interaction. At the same time, these doctoring groups, I think, allow for people to explain situations that there might be some misunderstanding.

Interviewer: Do you feel as though that somebody that might be accused of mistreatment might not realize that they've . . . maybe they're just a little bit more intense and they need to be shown what good behavior looks like?

Espinosa-Setchko: I think that this goes back, regardless of what field. When we talk about student mistreatment, it's about personality changes and personality clashes in a working environment. Pointing that out and highlighting that, a student may have thought that this behavior was a form of mistreatment. It's, I think, inherent that someone might be resistant to what that may be because it's part of their generalized personality, if that's what it is.

Interviewer: Mm-hmm. I'm kind of getting maybe clearly defining it for both the students and the physicians might be the most important thing.

Espinosa-Setchko: Yeah.

Interviewer: Or a very crucial thing.

Espinosa-Setchko: Right. I think so. I think that definitions are important. As Yas mentioned, education along those lines is key. Like Dr. Ben said, "It's not just education. It's a culture shift." So there has to be good leadership behind that education and there has to be a desire to want to change.

Interviewer: Yeah, not like just saying, "This is bad behavior, you know what I mean?"

Espinosa-Setchko: Exactly.

Interviewer: And then it's business as usual. You have to actually take it very seriously.

Espinosa-Setchko: Right. And part of that is accountability. People need to be held accountable for their behavior. They can't just point fingers and tell someone, "Don't do it again." Their advancement and their career have to be tied to this behavior.

Interviewer: There has to be consequences.

Espinosa-Setchko: There has to be consequences, just as any organization makes changes.

Interviewer: Any final thoughts from either one of you on this topic? Anything I forgot or anything you feel compelled to say?

Sanaiha: In the end, what discussions regarding student mistreatment come down to is continuing and practicing the pillars of just being good humans to each other and to our patients, and I think readjusting our whole society in a way, kind of bringing that back.

Interviewer: So it's a bigger problem than [inaudible 00:06:10] in medicine. Wow.

Espinosa-Setchko: I think it's a bigger problem. It's a big problem in medicine but I also feel like it's not just in medicine that we see this issue. And it's something to keep in perspective, I think.

Espinosa-Setchko: That's right, like it's not just our problem.

Sanaiha: It's not just medicine, but it's something that in medicine, because of our nature, is something that comes up and we like to act on it.