Medical Education: The Impact of Teaching by Humiliation on Patients and Doctors
Imagine the pressure of being questioned about complex technical knowledge in front of your peers, supervisors, and even members of the public. For medical students, this scenario is all too familiar, with up to 90% of them experiencing public humiliation during their training.
Research conducted by Wendy Li and Carolyn Heward delved into the issue of teaching by humiliation in medical education. This practice involves intentionally shaming or humiliating medical trainees in front of their peers, other healthcare staff, and sometimes even patients. Despite the detrimental effects, teaching by humiliation remains a common occurrence in medical training.
A systematic review of 33 studies involving over 40,000 individuals revealed that, on average, 34.9% of people experience public humiliation. However, the prevalence of teaching by humiliation was significantly higher in medical education settings. A follow-up study led by Luisa Wigg focused specifically on teaching by humiliation in medical education, analyzing 28 published studies with nearly 35,000 medical trainees across various countries.
The results were alarming, showing that, on average, 57% of medical students and junior doctors reported experiencing teaching by humiliation. In some cases, such as in the US, the numbers were as high as 90.8% of graduating medical students. Surveys from the Association of American Medical Colleges consistently highlighted public humiliation as the most common form of mistreatment experienced by medical students.
Teaching by humiliation often manifests in aggressive questioning of medical knowledge, mocking wrong answers, and making derogatory comments about a student’s capabilities in front of others. These incidents commonly occur in hospital wards, operating rooms, and medical conferences. While senior doctors are typically the perpetrators, the research revealed that nurses, fellow students, and even junior doctors also engage in this harmful practice, perpetuating a cycle of humiliation in medical culture.
The implications of teaching by humiliation on patient care are concerning. Doctors who have experienced humiliation are more likely to develop mental health issues, such as burnout, anxiety, and depression. This can lead to a reluctance to seek help or ask questions, ultimately affecting the quality of care delivered to patients.
The hierarchical structure of the medical profession contributes to the prevalence of teaching by humiliation, with senior doctors holding significant power over the education and future careers of their trainees. While some argue that rigorous questioning maintains high standards, the evidence suggests that it creates anxious and less confident doctors who may be more prone to errors.
To address this issue, medical schools and hospitals must acknowledge the problem and implement clear policies to prevent teaching by humiliation. Alternative teaching methods, such as structured feedback sessions, simulation-based training, and constructive mentorship programs, can help maintain excellence while supporting the well-being of trainees.
Ultimately, patients deserve to be treated by healthcare professionals who have received their training in supportive, psychologically safe environments. By addressing the harmful practice of teaching by humiliation, we can ensure a healthier and more effective healthcare workforce for the benefit of both medical professionals and the patients they serve.
