How can one create a safe, moral and supportive community in your little classroom of first year medical students? How can a teacher affect the medical classroom community? What about just flying by the seat of your pants? Sure, maybe they said, “Start tomorrow!” “We always need experienced physicians, we need you now.” “You’ll learn as you go, we all did it”. Was the emphasis put on sound presentation of the science? Was the presumption that, “It’s up to them to learn?” Do you really need to do this in medical school?
I agree to an extent. A university professional school student is a unique animal. This person usually has a degree already, and has been declared exceptional. She has won a competition to walk through the door, at great financial cost, and sometimes at the expense of personal relationships. Study habits are usually pretty good. No matter how the material is presented, they will do “adequately”. At least most of them.
Studies have shown bullying and harassment is rampant in medical training (Wood, 2006), most students having experienced it at least once. Suicides are known in almost every medical school. Rates are 40% higher for male physicians, and 130% higher for female physicians, than the general public. Belittlement and bullying leads to work dissatisfaction, binge alcohol use, and depression (Frank et al, 2006). Why? “Words DO hurt,” (Lickona/2000).
Does one need to do anything in the classroom with adult expert learners? Probably not. Just throw it up on the overhead and walk away. Would students learn more effectively, completely, become better physicians if they developed into good team players? Would fostering loyalty to the class, to each other, and to their learning team leave them with anything of use in life, in practice? Learning to treat each other with respect? Honestly facing deficits in knowledge, showing themselves so that learning could be more complete? Having that kind of trust in other professionals, would that be helpful? Learning to reach out to a colleague if their brain was melting? Would that be helpful? No, apart from a handful, they haven’t learned it yet. This kind of training is NOT just for elementary grade levels. A lot of your students don’t know how to do this. You need to teach them!
I’ve often said to beware the physician claiming to know it all. This person is simply dangerous. Usually he’s isolated, arrogant. What is a physician’s most essential character value? Perhaps it’s self knowledge. Or knowledge of lack of knowledge. This can be clearly taught in a class. The feared “Socratic Method” employed on the medical ward is meant to shatter arrogance, and display knowledge / logic deficits (Aref-Adib, 2006). It doesn’t work on the student who honestly asks for help, that displays the deficit. This kind of medical student is a new development, one that I’ve had the pleasure to teach. This person doesn’t have to be shattered. It’s a product of what we have here in our program in Hamilton and Niagara, Ontario. It’s non traditional.
What if that first year medical student could have some seeds of humility planted early? Learn to trust enough to bare his lack of knowledge? Respect himself enough to be honest? So he wouldn’t need to be demolished with a Socrates like method (Aref-Adib, 2006)? So he could reach out his hand to a suffering colleague? Could we make such a being ? They’re starting to sprout here in Hamilton/ Niagara. What about other places? I dare say they’re rare, anywhere. This has to spread.
To engender this kind of growth, teaching virtues will be important. At this level, it would be done indirectly, by modelling, mentoring, with group work, circle meetings, community outreach. A prof certainly can affect the medical classroom community, even if she teaches only one subject.
One way or the other, things have got to change.
Aref-Adib. (2006) Belittlement and harassment of medical students: is a source of medical education. British Medical Journal, Oct 14;333(7572):809. doi:10 1136/bmj.333.7572 309 a
Frank, E, Carrera,Js, Stratton, T, Bickel, J & Nora, LM. (2006) Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey. British Medical Journal, Sep 30;333(7570):682-4
Lickona, T. (1991) Educating for Character: How our Schools Can Teach Respect and Responsibility. New York: Bantam Books
Lickona, T. (2000) Sticks and Stones May Break My Bones AND Names WILL Hurt Me: 13 ways to prevent peer cruelty by Thomas Lickona, Ph.D. Legacy Educational Resources. Retreived Nov 15, 2012 from http:// www.character-education.info/Articles/Preventing_Peer_Cruelty.htm
Wood, D. (2006) Bullying and harassment in medical schools: Still rife and must be tackled. British Medical Journal, Sep 30;333(7570):664-665 doi 10 1136/bmj.38954 568143.BE