October 2, 2019

Has medical education become too... nice?

Daily Briefing

    Editor's note: This popular story from the Daily Briefing's archives was republished on Oct. 9, 2020.

    While medical education was once rife with harassment and humiliation from attending physicians, to an extent, educators have grown aware of the harm this can inflict—but some attending physicians rebuke that students have become overly sensitive and unreceptive to criticism, Perri Klass, a pediatrician and columnist, writes for the New York Times' "The Checkup."

    Tools to communicate across the physician enterprise

    The 'bad old days'

    Klass trained to be a doctor during the "bad old days" when "[h]umiliation was part of the deal, sometimes deliberately inflicted by certain grandstanding, sadistic attending physicians," she writes.

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    While harassment and discrimination in medical education continues to be a problem, many physicians today understand the negative consequences of this type of harassment, and are working to provide medical students with a safer environment to learn, Klass writes.

    Why constructive criticism is valuable—and how to deliver it

    Yet among some faculty members have begun to avoid delivering "negative feedback of any kind, for fear of upsetting students," Klass writes.

    In August, Melanie Gold, a professor of pediatrics and population and family health at Columbia University, and colleagues published a commentary commentary, titled, "Walking on Eggshells With Trainees in the Clinical Learning Environment."

    While Gold and her colleagues acknowledge that medical school faculty members have raised concerns about the potential for retaliation after they deliver constructive feedback, they write that being too careful of students' feelings in a clinical learning environment is "not the answer."

    Susan Rosenthal, a co-author of the commentary and professor of medical psychology at Columbia, said that providing constructive criticism is part of faculty members' jobs. "Discomfort is a part of learning new skills, of learning new ways of interacting with people," Rosenthal said.

    However, Rosenthal said the feedback must be able to flow "in both directions so the trainee can share respectfully … how they're experiencing the situation."

    But often, Klass writes, faculty members haven't received a lot of education on how to handle conversations on the more uncomfortable aspects of medical care.

    In the commentary, Gold and colleagues outline the steps they've taken to "create an environment that fosters the ability for trainees and faculty to walk across eggshells without fear."

    Those steps include implementing trainings on ways to identify and confront unconscious bias, which could negatively impact evaluations for faculty members and students. The commentary also recommends that faculty ask students have they prefer to receive constructive feedback, giving the students a chance to voice their previous experiences and preferences.

    Lastly, the authors said faculty members should pay attention to how they're feeling physically and emotionally before giving feedback. If you're tired, hungry, or upset, you may be more likely to give harsh feedback, especially in a medical setting where most people are stressed (Klass, "The Checkup," New York Times, 9/9).

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