I was a few weeks into my surgery clerkship and was on the tail end of a student call shift. I had been at the hospital for almost 24 hours, and the last thing left to do before I embraced the comfort of my own bed was to round with the faculty surgeon on call that weekend. The night had been busy, but I was prepared to update my attending on every vital, every new lab, and change in medications. I knew my patients well; everything from the character of their pain to when they last had a bowel movement.
After seeing the first two patients on our list, the attending turns to me and asks me an obscure question about the criteria for abdominal compartment syndrome. I replied that I didn’t know, and his response was “shame.”
He proceeded to ask, “You’re about a year away from being an intern correct?” I nodded my head and said yes. Again he remarked, “shame” while looking down and shaking his head in disbelief.
Commencing the clinical years means entering an institution in which our role as students is muddled. We enter a hierarchy in which our worth depends on our level of experience and wisdom. As such, medical students are usually at the bottom of the pecking order. We enter the hospital eager to immerse ourselves into the world of medicine but to do so we must follow several unwritten rules.
In this system we are bred not to show weakness; as students we do not tire, appear unhappy, or underperform. In this apprenticeship model, we become sort of like “yes men” going with the flow. The ability to challenge those higher up on the chain is very limited, perhaps due to the limited amount of authority we hold or perhaps due to the ever-present clinical evaluations that can “make or break” us as we climb the ladder. As the most naïve member of the team, students sometimes feel like they don’t have a “proper” place in the hospital. There is a lack of belonging and because of our peculiar positions most of the time we are left on the outside looking in. Our very existence on a team is transient, with hundreds of us constantly moving through the system, it’s easy to regard medical students as “just another student.”
While patients seldom note the distinctions between student, resident, and attending, these divisions are very tangible to those of us within the system. Conceivably, this structure is still in existence for good reason. There is a chain of command with each level of personnel having their own sets of duties and responsibilities. The system allows for organization, accountability, and efficiency. All of those before us have gone through the same process so why fix what’s been working for years?
While my experience with the surgeon who responded with “shame” has not been uniform throughout my clinical training, it was definitely not an isolated event. It is not unusual to hear about the occasional “malignant” attending or resident from my classmates.
I believe that we perform at our finest when working with mentors who teach with kindness and sympathy. Teachers who inspire us to perform at our best for the sake of our patients rather than shame us for not knowing. Over decades, the tangible lines of the medical hierarchy have introduced unnecessary stress and pressure into our system of learning. This trial by fire may have worked for past generations but for the health and well-being of our current and future physicians, the culture has to change.
Hundreds of physicians die annually from suicide and as many as 21 percent of medical students suffer from depression. What if we could change the fraternity of medicine into something healthier for the well-being of those within the institution? Instead of relying on the familiar what if we could change the scheme to one that supports innovation, encouragement, and reinforcement of the principles that brought us to the profession in the beginning.
Jorge Roman is a medical student.
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