Building a medical culture that is safe and nurturing
BY ALEX FARRELL, PRESIDENT, AUSTRALIAN MEDICAL STUDENTS’ ASSOCIATION
I am often told that when it comes to changing culture, students are the way forward. This year I’ve sat in countless meetings with reassurances that our problems will be solved, because the younger generation will eventually reach the top.
The medical students of Australia are extraordinary. But that is a huge burden to place on our shoulders alone, without the structures to support us. We have the least power, and often the most to lose.
‘Generational change’ is a myth when the problems lie in a system that the upcoming generations are still trained to conform to. They will continue to perpetuate that culture, unless it is actively disrupted. We need support from you, doctors who have power in the system, to help us change it.
To begin, gender inequity is alive and well in medicine today. It starts in medical school. Every female student will recall a time they were told to avoid specialties that aren’t ‘family friendly’. I’ve spoken to students told that “there’s no point teaching them how to suture, because they are just going to become a GP anyway”; to a student whose supervisor was well-known to either bully or flirt with their female students, and told she was lucky to be picked for the latter.
It’s what we call unconscious bias. Women need to work harder to prove themselves, because they don’t fit the leadership image we expect to see, whether in an operating theatre or hospital boardroom. It’s not really about gender or sex, it’s about power and authority, and who we see holding it. Women are underrepresented in nearly every position of medical leadership.
The truth is, most doctors involved in lower levels of sexism and harassment aren’t malicious. They think they are being helpful, or flattering, or telling a harmless joke. The behaviour builds, and the lack of accountability builds, and, for the few with bad intentions, the opportunities to abuse power builds too.
The same goes for all vulnerable groups. Earlier this year, I spoke with the student representatives of the Australian Indigenous Doctors’ Association, and heard their stories of daily stereotyping and racism, of being told they had taken the place of someone who “actually deserved to be in medicine”.
We know most students mistreated during their medical training don’t report it. They don’t know how, and they’re afraid of what might happen.
“We are taught from our first year that whistle-blowing in medicine is career suicide”
“My supervisor could be my examiner”
“I tried. The university told me it was the hospital’s responsibility, the hospital directed me back to the university”
The responsibility to speak up lies with you. To take colleagues aside if they might be crossing lines. To create systems in hospitals where reporting doesn’t put students and staff at risk. To demand consequences.
When it comes to mental health, there is one area where students and senior doctors often don’t see eye to eye – resilience.
Resilience has become a dirty word. It’s a word that has been overused, at the worst times. Resilience takes students at their darkest point, and tells them they should have been stronger. It acknowledges that the medical training environment is flawed, but insists the answer is fixing students, rather than seeking larger change. So instead, let’s talk about what they are being resilient against.
Sixty per cent of students have witnessed mistreatment in medical education. Most of the time, this comes as belittlement, condescension or humiliation.
Doctors spend years learning to practise medicine, but are expected to teach with no training at all. You hold the power to impact the lives of your students everyday. It only takes a moment to say ‘good job’, to answer a question, or explain how to improve next time.
I believe that we can build a medical culture that is safe and nurturing, but it can’t wait 20 years. It has to start now, and it has to come from the top. In the way you teach, in the way you lead, and in the systems you influence, be part of that change. I promise, we will do you proud.
This is an edited version of the AMSA President’s address to the AMA National Conference.
Published: 12 Jun 2018