Respecting MD Students: It’s Not a Choice

Trevor Young MD, PhD, FRCPC, FCAHS
Dean, Faculty of Medicine
Vice Provost, Relations with Health Care Institutions
University of Toronto

When you were in training did your supervisor or attending physician ever ask you to run an errand, maybe pick up dinner when it was busy? Perhaps a senior resident commented on how you looked or put you in your place in front of others? Or maybe you saw a colleague receive an inappropriate gender- or race-related comment.

The optimistic among us may think those days are over but our learners are telling us – in bracing detail – they’re most definitely not. 

My message to you today is singular: it’s 2019, and this is simply unacceptable. Going forward, it is our shared responsibility to move the needle on outdated and damaging behaviour that persists in certain clinical learning environments.

Humiliating trainees – with words, deeds or denial of opportunities – not only causes individual harm and breeds resentment, it’s bad for our profession. We must all take responsibility and accept the need to work harder to change our culture.

Humiliation, personal services, sexist and racist remarks

Firstly, you need to know the scale of the issue. Among 2019 MD graduates nationally, 41% say they have been publicly humiliated during their training; at some of our academies that number was more than 10 percentage points higher.

Our MD students tell us that they are asked to perform inappropriate personal services at rates higher than the national average; they are also subject to offensive sexist, racial and ethnic remarks. Our students should never have these experiences.

Why don’t students speak up?

While many students identified experiencing or witnessing mistreatment, actual reporting rates are low. Some don’t know what constitutes mistreatment; others aren’t aware of reporting mechanisms. Still others fear retaliation, or they don’t think anything will be done.

It’s one thing to speak up when you’re an established physician – confident in your future, having the respect of your peers and greater financial stability. Learners are not there yet, and the power imbalance is very real. They worry that speaking up about bad Page 1 of 2 behaviour will backfire: Will a complaint really remain confidential? Will they be branded a troublemaker and jeopardize future reference letters? The whole process feels “challenging and momentous,” one student noted in a 2019 survey.

How you can help

The MD Program has launched SMART: the Student Misconduct Advocacy and Response Team, which is simplifying, supporting and communicating the process of disclosure and reporting to and for learners.

Having the support of well-informed clinical faculty is a key element. Here’s how you, as valued clinical faculty, can help:

• Know the standards: Faculty of Medicine Standards of Professional Behaviour for Medical Clinical Faculty and CPSO Professional Responsibilities in Undergraduate Medical Education;
• Know how and to whom students can disclose or report incidents of mistreatment; this information is provided in the MD student mistreatment policy;
• Ensure your clinical rotation learners know that disclosing an incident of mistreatment that they have experienced or witnessed does not mean they are committed to a formal reporting process. Rather, it is an important first step in helping students make an informed decision about what can be done and how they would like to proceed;
• Ensure your learners know that they can use our Event Disclosure Form, on which they can choose whether or not they want to identify themselves and which MD Program leader they would like the form to go to;
• Contact your relevant Academy Director if you’re a tutor or instructor and you aren’t clear on how to assist students around mistreatment issues. The Academy Directors are your resource on this issue: they are trained and ready to help.

You can also contact the Vice Dean MD Program or the Associate Dean Health Professions Student Affairs. If a student does not want to disclose and as faculty you feel it important that the event is reviewed, you can submit a disclosure on the student’s behalf.

Clinical demands can be gruelling. Even the best of us, no matter how kind or dedicated to our profession we are, get stressed, overwhelmed, and pushed to their limits. When you take care of yourselves everyone around you, trainees included, will benefit.

We all remember the pain and joy of MD training. Creating the environment for all of our learners to thrive is one of the greatest contributions we can make to our profession.

Thank you for your continued support and commitment to this important issue.