Broadening conceptions of medical student mistreatment during clinical teaching: message from a study of “toxic” phenomenon during bedside teaching

Abstract

PurposePart of the local hidden curriculum during clinical training of students in the University of Maiduguri medical college in Nigeria, metaphorically referred to as “toxic” practice by students, are situations where a teacher belittles and/or humiliates a student who has fallen short of expected performance, with the belief that such humiliation as part of feedback will lead to improvement in future performance. Through a framework of sociocultural perspective, this study gathered data to define the breadth and magnitude of this practice and identify risk and protective factors with the aim of assessing effectiveness of current intervention strategies.Materials and methodsUsing a mixed method research approach, quantitative data were collected from fourth-year medical students in a Nigerian medical college through a survey questionnaire, and qualitative data were obtained through a face-to-face, individual, semi-structured interview of students attending the same institution.ResultsFindings indicate that many students continue to experience “toxic” practice, with only very few reporting the incidents to relevant authorities, raising important questions about the appropriateness of current intervention efforts.ConclusionCurrent intervention strategies grossly underestimate the influence of institutional forces that can lead to or promote this behavior. Acknowledgment of this has implications for an appropriate intervention strategy.

A study of “toxic” phenomenon during bedside teaching: a medical student’s perspective

“…We disagree with the ideology that mistreatment is “only students” perceptions, not reality. 1 A study by Bursch et al 3 provides evidence that refutes the notion that students who experience mistreatment are merely being oversensitive.…”

“…We read with great interest the study by Olasoji 1 exploring the mistreatment of medical students by the bedside. As senior medical students at Imperial College London (ICL), we have had many teaching sessions and therefore have first-hand experience on this matter of “toxic teaching”.…”

“…As senior medical students at Imperial College London (ICL), we have had many teaching sessions and therefore have first-hand experience on this matter of “toxic teaching”. 1 …”

“…It was found that 85% of medical students “experienced toxic practice during bedside teaching”, yet only one student reported their experience to the faculty. 1 In addition, a study by Chung et al 2 found that over half the medical students at University of California Los Angeles did not report their mistreatment because of barriers such as “fear of reprisal” and “perception that mistreatment is part of medical culture”. This suggests that students are afraid to speak out.…”

“…We agree “it is the responsibility of the institution to take the lead”. 1 At ICL, we are fortunate to have several opportunities to voice our concerns – for example, via our Personal Tutor, Teaching Coordinator, or Student Online Evaluation (SOLE) surveys. SOLE surveys are emailed to us directly at the end of each rotation, where we can anonymously express our thoughts without fear of retribution.…”