"Teaching by humiliation" and mistreatment of medical students in clinical rotations: a pilot study.

Abstract

To generate a contemporary understanding of "teaching by humiliation" as experienced by medical students in Australia. In this pilot study, we surveyed final-stage medical students from two Australian medical schools about their experiences of teaching by humiliation during their adult and paediatric clinical rotations. The students were invited to complete the anonymous survey at the end of their paediatric rotation in Semester 2 of 2013. We used descriptive statistics to analyse quantitative data, and a grounded theory approach to analyse qualitative data. Student reports of experiencing or witnessing teaching by humiliation during their adult and paediatric clinical rotations. Of 151 students invited to participate, 146 (96.7%) completed the survey. Most students reported experiencing (108; 74.0%) or witnessing (118; 83.1%) teaching by humiliation during adult clinical rotations. Smaller but still sizeable proportions had experienced (42; 28.8%) or witnessed (64; 45.1%) it during their paediatric clinical rotation. The humiliating and intimidating behaviours students experienced were mostly more subtle than overt and included aggressive and abusive questioning techniques. The students' responses to these practices ranged from disgust and regret about entering the medical profession to endorsement of teachers' public exposure of a student's poor knowledge. Practices associated with humiliating medical students persist in contemporary medical education. These practices need to be eradicated, given the evidence that they affect students' learning and mental health and are dissonant with formal professionalism curricula. Interventions are needed to interrupt the transgenerational legacy and culture in which teaching by humiliation is perpetuated.