Highlights from the RAS-ACS Hangout on Medical Student Mistreatment
Thursday, December 5, 2019
On November 11, the Resident and Associate Society of the American College of Surgeons (RAS-ACS) hosted an incredibly interactive hangout call in collaboration with the American College of Surgeons Medical Student Community and the Association of Women Surgeons (AWS) Medical Student Committee.
This collaboration was developed in order to expand medical student and resident engagement in ACS, as well as to increase awareness of the ACS resources available to trainees. As a result of this collaboration, AWS medical student members are also welcome to join!
The call was moderated by Dr. Tania K. Arora (@TaniaKArora). Dr. Arora is a surgical oncologist and the associate program director for general surgery residency at the Medical College of Georgia. She is a strong advocate for diversity and inclusion in surgery. Also leading the call were Dr. Madeline Torres, current Chair of the RAS-ACS Committee, and Dr. Patricia Martinez, current Chair of the AWS Resident Committee.
The discussion was centered on medical student mistreatment, focusing especially on ways to identify it and how to act upon it early. Higher incidence of mistreatment has been shown to occur in specific phases during medical training, such as during clerkships. Therefore, it is imperative to raise awareness regarding this issue and to, consequently, create a safe space nationwide for students to speak up and have the most advantageous learning experience possible. Abused students can later become abusive residents or faculty, thus early detection and action is crucial.
These were some mistreatment situations and stories (personal or witnessed) that were discussed during the call:
- You are a medical student starting your surgical rotation. Although you are participating in rounds and in the other scheduled activities, showing up early and leaving late, and taking notes, you don't feel like you are part of the team. How can you approach this situation? How can you ask for feedback?
- Medical students in their surgical rotations reported having bad experiences in the OR, which made them not want to go into a surgical field. They reported being ignored or even yelled at, and felt powerless. The idea that no crying or whining is allowed in surgery can bring negative consequences and can relate to early burnout among medical students. How can we detect and act upon this before it affects a student's experience and career track?
- Medical-to-medical student mistreatment: what are ways to mitigate this?
- During residency, junior residents were constantly bullied by a specific attending, and were unsure why. How can you approach and get feedback from faculty that are targeting you specifically? How much retaliation could result from coming forward about it?
- How can attendings and residents help create a safe space for medical students to report when they experience mistreatment?
Here are a few solutions discussed during the call, as well as key take-home messages helpful to students, residents and faculty:
- When students start their rotations, it is a two-way street. Residents and faculty should set expectations and make them feel welcomed on the team. On the other hand, students should ask the team to know what their role should be. They should ask how to be more productive. They should ask the intern how they can help more, how they can study for a specific case, how they can better prepare for rounds. A student should advocate for their education.
- A piece of advice for students: As you undergo your rotation, you should always seek feedback. And when you do receive it, document what you hear back. If you need to report a mistreatment occurrence later, you can show that you met with your faculty and tried getting feedback earlier. If you don't get answers and feel disconnected from the service, you should report that as well.
- Institutions should guarantee that medical students have avenues to report mistreatment during their training without retaliation. Students should not worry about any negative impacts on their grades or letters of recommendation.
- If your school does not have a clear statement on mistreatment or a safe avenue for anonymously reporting mistreatment, find people that can advocate for you.
- If your institution provides an avenue for reporting mistreatment, make sure that you take a look at the annual reports that compile that information, including total number of complaints. Know your data! This information should be used to change what is needed and to improve clerkships and student experiences.
- If someone is taking advantage of their position to mistreat students, they are usually doing it to more than one person. The only way to identify those patterns is to have students report it. In order to identify an individual with negative behavior (student, resident, faculty) and try to improve the situation, it is crucial to have documentation and to make the behavior pattern visible.
- Regarding medical-to-medical student mistreatment, competition can sometimes be the trigger during clerkship rotations. Students may compete among themselves to scrub in a certain case, or to try to show their knowledge and impress the team. It is important that residents and attendings coordinate the development of a culture of respect. They should mitigate some of that smaller competition and disagreements, while creating and nourishing fairness and collegiality. The team should try to keep medical students from all levels engaged. They should tailor rotations to each student's needs.
- Residents as team leaders in a rotation can set expectations from day one (along with clerkship directors), and spread a culture of "if you see something, say something," as well as a culture of respect. Many students may have a bad experience in their surgical rotations by not feeling included as part of the team, or not feeling that they can speak up. Surgical rotations should be a safe environment for students to ask questions, to feel included and empowered. This can contribute greatly to improving the overall learning experience and ultimately patient care.
- An important point to remember is to differentiate mistreatment (which has a very clear pattern) to simply a resident (or attendings) having a bad day, for example. Residents and attendings are humans, and are constantly undergoing an immense amount of pressure and number of responsibilities. If they have a bad day and don't give you as much attention, remember you will be on their shoes in the near future, and show compassion.
Make sure to check the ACS Statement on Harassment, Bullying, and Discrimination. In addition, watch out for our next medical student hangout call in collaboration with RAS-ACS, to be held in February 2020! Hope to talk to you all there!
Camila R. Guetter is a recent MD graduate from Universidade Federal do Paraná in Curitiba, Brazil. In her third year of medical school, she was awarded a one-year scholarship to study Biomedical Sciences at UCLA. During her time in Los Angeles, she worked as a research student at the UCLA Translational Oncology Research Laboratories studying pancreatic cancer cell lines, and since then research has become one of her main passions. She later worked as a research student at Beth Israel Deaconess Medical Center in Boston, studying pancreatic surgery outcomes and patient education. She was also a former student and teaching assistant in the Principles and Practice of Clinical Research program from the Harvard T.H. Chan School of Public Health. Camila is passionate about pursuing a career in academic surgery and is very active in AWS. She has been a member of the AWS National Medical Student Committee since 2017, serving as International Representative, Social Media and Marketing Coordinator, and currently as Vice-Chair. She is also a member of the Publications Committee and currently serves as Medical Student Chair of the AWS Blog Subcommittee. You can find her on Twitter at @camila_guetter.