The Age Old Question: Is this Mistreatment?

I became a famous actor this semester. Well, famous at the University of Vermont College of Medicine, at least. This spring, the College’s Learning Environment and Professionalism (LEAP) Committee worked with faculty in the Psychiatry department to put together a “Medical Student Mistreatment Module” to help raise awareness and educate both students and faculty about this perennial topic of conversation. It is a problematic side effect of the culture of medicine for several reasons: If medical students are not included as contributors to the treatment team, they don’t learn the essentials during their clinical rotations that they will need for residency, and patient care suffers. Students become resentful and less eager to learn; physicians become less excited to teach, and the student-teacher relationship suffers. A culture develops where less training is equivalent to less importance and the problem is perpetuated. I strongly believe that over time this culture has, indeed, greatly transitioned to a more positive one. I have had many phenomenal teachers who pushed me to act as a patient’s primary doctor. However, I have also been ignored, belittled or made to do jobs that have nothing to do with patient care, which has a negative impact on both my enthusiasm and my educational experience.

At the University of Vermont, we decided to tackle this issue head-on. Armed with a senior resident who went to film school and has written and produced several short films, and a fellow student whose previous career was as a Hollywood actor (both have IMDB pages), a small group of students, residents, attendings and administrators came together to attempt to define the age-old question of what exactly qualifies as “Medical Student Abuse.”

The difficulty in this topic is in part the fine line between “tough learning” and out-and-out abuse. For example, there is a difference between being asked a question in front of a group of people and feeling embarrassed because you did not know the answer after not studying the material versus having the chief resident tell you that you are worthless and should never become a doctor because you dropped a glove. And then there are the many subtler versions of abuse in between. For example, is it abuse to ask someone junior to you to go pick up coffee for the team? Is it ethically okay to ignore the medical student who is assigned to work with you throughout the day? These were some of the issues we attempted to address in our module.

The writers came up with four specific scenarios that qualified as abuse, all of which were real examples from previous medical student experiences. I played the role of “Amber” who, instead of working with her attending for the day, was assigned to watch the attending’s two young children as she went to see her patients. Each student enacted his or her individual mistreatment scenario, and then had a monologue at the end, discussing what it was about the scenario that was problematic. I will venture to say, mine was one of the more clear-cut scenarios.

Filming was a blast. We had a professional film and sound crew, and people said things like “Action,” and “Take 4.” After reading the script, but before appearing for filming, I figured I would go in, say my six lines, then be done. But no. This was a real production, and I said each of my lines multiple times from different angles, emphasizing different words and trying out different facial expressions until there was enough material for the editor to make the perfect cut. I was on my way to perfecting my Audrey Hepburn. I expect a call from an agent any day.

When all of the filming was completed and most of the footage pieced together, we had a viewing party, complete with wine and cheese. We watched the video on our attending’s big screen television, all a little bit uncomfortable watching our own enormous faces and mediocre acting (except for mine, of course). There was a lot of giggling. However, when the video ended everyone had a comment to make. Parts of the video weren’t clear. Was that mistreatment? Did things like this really happen? It was a great spark to the conversation between the attendings, residents and students who were all in the same room, all with different experiences to share, and we realized that maybe we didn’t want it to be completely clear. It was out of this obscurity that we were able to foster an open discussion on the topic and truly think about how medical students should be taught.

From the raw footage, an actual module was created for the docs to work through on the computer before working with medical students. The module defines what mistreatment is, then takes the user through each scenario, pausing to pose questions and asking for reflections. Outside of showcasing my brilliant acting, my hope is that this module helps students and doctors alike clarify the difference between reasonable expectations for students and frank abuse. I feel extremely lucky to have been a part of this project and hope that at the very least this video sparks a conversation like the one we had in my attending’s living room. Having team members who understand what it means to educate medical students and create a professional environment will foster a much healthier community, and create stronger physicians who can pass on a culture of mutual respect and professionalism while improving patient care.

The Medical Student Mistreatment film and module will launch in fall 2014.