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Walking on Eggshells in Medical Schools


“I think that if physicians and trainees are going to make the most out of the learning environment, it has to be a learning environment in which feedback can go in both directions so the trainee can share respectfully with the attending how they’re experiencing the situation,” Dr. Rosenthal said.

One fraught area is personal style.

“I had to share with a resident, ‘that outfit is not suitable for work,’” Dr. Serwint said. “We didn’t have a dress code, but several people had mentioned it — she left in a huff, saying we were so conservative.” A few years later, that same former resident came to her office to tell her that she had had to deliver the same message to one of her own trainees, “and she understood how hard it was.”

And patients may also make comments that doctors in training (or out of training) find hurtful or offensive. “At some level, the physician needs to have the bigger shoulders,” Dr. Rosenthal said. “The patients are stressed.”

But medical practice brings you up against complicated and difficult issues, from sexual practices to poverty, from child abuse to death, and we have to teach — and evaluate — in all of those domains.

“I’m interested in looking at medical education as a moral education,” Dr. Kumagai said. “We talk about medical ethics, but we often don’t talk about the development of a moral orientation to the world.” We have to look at medical education as encompassing more than a training in skills, he said, but also as how students come to understand “what it means to practice medicine with excellence, compassion and justice.”

In a previous position where she was doing adolescent medicine, Dr. Gold said, she had experiences with medical students who said they had religious objections to advising pregnant patients about the possibility of terminating pregnancies.

“We weren’t forcing them,” Dr. Gold said. “We told them that if they were unable to do the kind of options counseling we felt was the standard of care, we wanted them to stay in the room and hear, and they didn’t want to.”


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