Taking Students as They Should Be: Restoring Trust in Undergraduate Medical Education.

Abstract

A recently published editorial focused on trust in the relationship between teacher and learner; in this Invited Commentary, the authors examine trust between administrators, course directors, curriculum committees, and medical students, exploring the ways that a lack of trust may be manifest, how this impacts students, and how trust can be built in undergraduate medical education (UME).The hierarchical and paternalistic culture in medical education can skew curricular and policy decisions in the direction of distrust of students, leading to overscheduling and overprogramming of students through much of UME and to inflexible policies and procedures. Students may feel unheard or disrespected by some administrators and course directors when asking for changes, particularly when advocating for reductions in workload or increased flexibility. The collective impact of this lack of trust appears substantial, leaving many students with feelings of frustration, resentment, and cynicism.Trust can be built, and efforts to do so have little associated cost. Administrators and course directors need to demonstrate respect, compassion, flexibility, and trust in students. Trust is built on relationships, and administrators should avoid isolation and engage meaningfully with students. Efforts should be made to reduce overscheduling of students so that they have more opportunity to pursue activities in which they can find meaning. Flexibility in scheduling of mandatory sessions and exams should be introduced wherever possible. If we take these collective steps, students will be more likely to find a path to becoming the doctors they are capable of becoming.